Clinical Decision Case Assignment

You have been assigned two (2) cases to provide analysis.  All cases should include the following:

a. Pathophysiology and pharmacology of the disease

b. Expected signs and symptoms of the disease.

c. Nursing Diagnosis with a plan of care.

d. All questions pertaining to the case are listed under each case.

Clinical Decision Cases

C1.   Mr. Appel has a severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with a respiratory infection and increased dyspnea; yellow, purulent sputum; anxiety; and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained:

Arterial blood gases:

pH 7.25                                         Serum sodium (Na+) 140 mEq/L

PaO2 60 mmHg                             Serum potassium (K+) 2.0 mEq/L

PaCO2 78 mmHg                           Serum chloride (Cl–) 105 mEq/L

HCO3– 34 mEq/l

a. What type of electrolyte imbalance does Mr. Appel have?

b. Interpret his ABGs.

C2.   Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities.

a. What are the possible causes of his peripheral edema?