Abnormal Laboratory Findings
Assessment Description
A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursing facility. In the report, the nurse is told the patient has not been breathing well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report:
Blood Chemistries
Na: 147
Cl: 110
K: 4.0
Arterial Blood Gases
pH: 7.33
PCO2: 48
HCO3: 27
PO2: 96
Urinalysis
Urine Specific Gravity: 1.040
Address the following:
Identify each of the abnormal laboratory findings in the above results. Specify how they differ from a normal range and identify what condition each abnormality indicates.
What specific electrolyte disturbance does the patient have?
What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
If the patient had an increase in her potassium level, for what clinical manifestations would the nurse monitor?
What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
What are the three major mechanisms of pH regulation?
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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RUBRIC
Acid-Base and Electrolyte Case Study - Rubric
Identification of Abnormalities
25.05 points
Criteria Description
Identification of Abnormalities
5. 5: Excellent 93-100%
25.05 points
Identification of the abnormal laboratory findings is accurate, supplemented by a detailed and thorough identification of the conditions each abnormality indicates.
4. 4: Good 89-92%
23.05 points
Identification of the abnormal laboratory findings and their respective conditions is accurate.
3. 3: Satisfactory 81-88%
22.04 points
Identification of the abnormal laboratory findings and their respective conditions is mostly correct but is missing key specifics.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of the abnormal laboratory findings and their respective conditions is incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
Identification of the abnormal laboratory findings and their respective conditions is not included.
Identification of Electrolyte Disturbance
25.05 points
Criteria Description
Identification of Electrolyte Disturbance
5. 5: Excellent 93-100%
25.05 points
Identification of the electrolyte disturbance is incorrect.
4. 4: Good 89-92%
23.05 points
N/A
3. 3: Satisfactory 81-88%
22.04 points
N/A
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of the electrolyte disturbance is correct.
1. 1: Unsatisfactory 0-75%
0 points
Identification of the electrolyte disturbance is not included.
Electrolyte Abnormality Clinical Manifestations
25.05 points
Criteria Description
Electrolyte Abnormality Clinical Manifestations
5. 5: Excellent 93-100%
25.05 points
Identification of electrolyte abnormality clinical manifestations is accurate.
4. 4: Good 89-92%
23.05 points
Identification of electrolyte abnormality clinical manifestations is accurate, supported by thorough and detailed insight.
3. 3: Satisfactory 81-88%
22.04 points
Identification of electrolyte abnormality clinical manifestations is incorrect and/or incomplete.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of electrolyte abnormality clinical manifestations is mostly correct but is missing key symptoms.
1. 1: Unsatisfactory 0-75%
0 points
Identification of electrolyte abnormality clinical manifestations is not included.
Increased Potassium Clinical Manifestations
25.05 points
Criteria Description
Increased Potassium Clinical Manifestations
5. 5: Excellent 93-100%
25.05 points
Identification of increased potassium level clinical manifestations is accurate, supported by detailed and thorough insight.
4. 4: Good 89-92%
23.05 points
Identification of increased potassium level clinical manifestations is accurate.
3. 3: Satisfactory 81-88%
22.04 points
Identification of increased potassium level clinical manifestations is mostly correct but is missing key symptoms.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of increased potassium level clinical manifestations is incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
Identification of increased potassium level clinical manifestations is not included.
Blood Gas Abnormality
25.05 points
Criteria Description
Blood Gas Abnormality
5. 5: Excellent 93-100%
25.05 points
Assessment of blood gas abnormality is accurate, supported by a detailed and thorough discussion of the patient’s condition.
4. 4: Good 89-92%
23.05 points
Assessment of blood gas abnormality is mostly correct but is missing key specifics.
3. 3: Satisfactory 81-88%
22.04 points
Assessment of blood gas abnormality is accurate.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Assessment of blood gas abnormality is not included.
1. 1: Unsatisfactory 0-75%
0 points
Assessment of blood gas abnormality is incorrect and/or incomplete.
Mechanisms of pH Regulation
25.05 points
Criteria Description
Mechanisms of pH Regulation
5. 5: Excellent 93-100%
25.05 points
The three major mechanisms of pH regulation are accurately identified, and the properties of each mechanism are briefly described.
4. 4: Good 89-92%
23.05 points
The three major mechanisms of pH regulation are accurately identified.
3. 3: Satisfactory 81-88%
22.04 points
The three major mechanisms of pH regulation are mostly correct.
2. 2: Less Than Satisfactory 76-80%
20.04 points
The three major mechanisms of pH regulation are incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
The three major mechanisms of pH regulation are not addressed.
Mechanics of Writing (includes spelling, punctuation, grammar, and language use)
8.35 points
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, and language use)
5. 5: Excellent 93-100%
8.35 points
The writer is clearly in command of standard, written, academic English.
4. 4: Good 89-92%
7.68 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
3. 3: Satisfactory 81-88%
7.35 points
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
2. 2: Less Than Satisfactory 76-80%
6.68 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.
1. 1: Unsatisfactory 0-75%
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed.
Documentation of Sources
8.35 points
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. 5: Excellent 93-100%
8.35 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. 4: Good 89-92%
7.68 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. 3: Satisfactory 81-88%
7.35 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. 2: Less Than Satisfactory 76-80%
6.68 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. 1: Unsatisfactory 0-75%
0 points
Sources are not documented.
Acid-Base and Electrolyte Case Study - Rubric
Identification of Abnormalities
25.05 points
Criteria Description
Identification of Abnormalities
5. 5: Excellent 93-100%
25.05 points
Identification of the abnormal laboratory findings is accurate, supplemented by a detailed and thorough identification of the conditions each abnormality indicates.
4. 4: Good 89-92%
23.05 points
Identification of the abnormal laboratory findings and their respective conditions is accurate.
3. 3: Satisfactory 81-88%
22.04 points
Identification of the abnormal laboratory findings and their respective conditions is mostly correct but is missing key specifics.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of the abnormal laboratory findings and their respective conditions is incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
Identification of the abnormal laboratory findings and their respective conditions is not included.
Identification of Electrolyte Disturbance
25.05 points
Criteria Description
Identification of Electrolyte Disturbance
5. 5: Excellent 93-100%
25.05 points
Identification of the electrolyte disturbance is incorrect.
4. 4: Good 89-92%
23.05 points
N/A
3. 3: Satisfactory 81-88%
22.04 points
N/A
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of the electrolyte disturbance is correct.
1. 1: Unsatisfactory 0-75%
0 points
Identification of the electrolyte disturbance is not included.
Electrolyte Abnormality Clinical Manifestations
25.05 points
Criteria Description
Electrolyte Abnormality Clinical Manifestations
5. 5: Excellent 93-100%
25.05 points
Identification of electrolyte abnormality clinical manifestations is accurate.
4. 4: Good 89-92%
23.05 points
Identification of electrolyte abnormality clinical manifestations is accurate, supported by thorough and detailed insight.
3. 3: Satisfactory 81-88%
22.04 points
Identification of electrolyte abnormality clinical manifestations is incorrect and/or incomplete.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of electrolyte abnormality clinical manifestations is mostly correct but is missing key symptoms.
1. 1: Unsatisfactory 0-75%
0 points
Identification of electrolyte abnormality clinical manifestations is not included.
Increased Potassium Clinical Manifestations
25.05 points
Criteria Description
Increased Potassium Clinical Manifestations
5. 5: Excellent 93-100%
25.05 points
Identification of increased potassium level clinical manifestations is accurate, supported by detailed and thorough insight.
4. 4: Good 89-92%
23.05 points
Identification of increased potassium level clinical manifestations is accurate.
3. 3: Satisfactory 81-88%
22.04 points
Identification of increased potassium level clinical manifestations is mostly correct but is missing key symptoms.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Identification of increased potassium level clinical manifestations is incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
Identification of increased potassium level clinical manifestations is not included.
Blood Gas Abnormality
25.05 points
Criteria Description
Blood Gas Abnormality
5. 5: Excellent 93-100%
25.05 points
Assessment of blood gas abnormality is accurate, supported by a detailed and thorough discussion of the patient’s condition.
4. 4: Good 89-92%
23.05 points
Assessment of blood gas abnormality is mostly correct but is missing key specifics.
3. 3: Satisfactory 81-88%
22.04 points
Assessment of blood gas abnormality is accurate.
2. 2: Less Than Satisfactory 76-80%
20.04 points
Assessment of blood gas abnormality is not included.
1. 1: Unsatisfactory 0-75%
0 points
Assessment of blood gas abnormality is incorrect and/or incomplete.
Mechanisms of pH Regulation
25.05 points
Criteria Description
Mechanisms of pH Regulation
5. 5: Excellent 93-100%
25.05 points
The three major mechanisms of pH regulation are accurately identified, and the properties of each mechanism are briefly described.
4. 4: Good 89-92%
23.05 points
The three major mechanisms of pH regulation are accurately identified.
3. 3: Satisfactory 81-88%
22.04 points
The three major mechanisms of pH regulation are mostly correct.
2. 2: Less Than Satisfactory 76-80%
20.04 points
The three major mechanisms of pH regulation are incorrect and/or incomplete.
1. 1: Unsatisfactory 0-75%
0 points
The three major mechanisms of pH regulation are not addressed.
Mechanics of Writing (includes spelling, punctuation, grammar, and language use)
8.35 points
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, and language use)
5. 5: Excellent 93-100%
8.35 points
The writer is clearly in command of standard, written, academic English.
4. 4: Good 89-92%
7.68 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
3. 3: Satisfactory 81-88%
7.35 points
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
2. 2: Less Than Satisfactory 76-80%
6.68 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.
1. 1: Unsatisfactory 0-75%
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed.
Documentation of Sources
8.35 points
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. 5: Excellent 93-100%
8.35 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. 4: Good 89-92%
7.68 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. 3: Satisfactory 81-88%
7.35 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. 2: Less Than Satisfactory 76-80%
6.68 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. 1: Unsatisfactory 0-75%
0 points
Sources are not documented.
I WILL BE AVAIBLE FOR ANY QUESTIONS OR CONCERNS
Name
Institutional Affiliarion
Nursing Pathophysiology
Abnormal Laboratory Findings
The 85-year-old woman in a hospital-based nursing facility presents with a breathing difficulty that has lasted 2 days. The patient has been lethargic and her skin is warm and dry. Besides, she has a decreased urine output and her blood chemistry indicates sodium (Na) levels of 147, chlorine (Cl) of 110, and potassium (K) levels of 4.0. Her arterial blood gasses have a pH of 7.33, PCO2 of 48, PO2 of 96 with a urine specific gravity of 1.040. Normal sodium (Na) levels in blood range between 136 and 145 millimoles per liter (mmol/L). however, Na levels that are below 136 mmol/L are an indication of hyponatremia or low blood Na levels. Besides, Na levels of more than 145 mmol/L indicate hypernatremia or high levels of Na levels in the blood. The patient has 147 mmo/L meaning that she has high levels of Na in her blood (University of Rochester Medical Center, 2021). In extracellular space, chloride (Cl) is the most predominant anion that maintains cellular integrity through its effects on water balance and osmotic pressure. Cl also maintains the blood acidic-base balance and adults need at least 80 to 120 mgeq/d as NaCl. Normal blood levels of Cl are between 98-106 mEq/L or 98-106 mmol/L in SI units. The patient has high levels of Cl of 110 mmol/L in blood and this could be an indication of Bartter syndrome or Gitelman syndrome that points to severely low levels of potassium (K). High levels of Cl could be caused by the recent use of medications used to treat diuresis. High Cl levels or hyperchloremia could be caused by severe dehydration, diarrhea, and excessive union, kidney disease, metabolic acidosis, or chemotherapy (Medical News Today, 2021). The patient’s blood potassium levels of 4.0 are within the normal range of 3.6 to 5.2 mmol/L (Mayo Clinic Staff, 2021). However, high levels of more than 6.0 could indicate hyperkalemia and require immediate attention. Finally, the patient also has a normal urine specific gravity of 1.004, which is within the normal range of 1.002 and 1.030. Given the results obtained from clinical investigations, the patient requires further medical attention.
Specific Electrolyte Disturbance and Clinical Manifestations
Electrolyte disturbances are often caused by a loss of body fluids due to prolonged diarrhea, vomiting, or sweating. Besides, burns could also result in electrolyte disorders and some medications could also cause the same problem as well as chronic kidney diseases. From the results presented, the patient suffers from both hyperkalemia and hypernatremia that cause electrolyte disturbance. Hyperkalemia can be fatal if untreated and is often caused by severe dehydration, kidney failure, diabetic ketoacidosis, and adrenal insufficiency. High levels of Na occur due to inadequate consumption of water, severe dehydration, excessive loss of body fluids, and certain medications such as corticosteroids (Healthline.com, 2021). These two anions in the patient’s blood indicate abnormal levels and could require medical attention. While mild forms of electrolyte disturbance might not cause any symptoms and the disorders may go unnoticed until discovered through routine blood tests, the symptoms only appear when a particular disorder has become severe. However, common symptoms patients might present include fatigue, irregular heartbeat, fast heart rate, irritability, confusion, and headaches.
Clinical Manifestations...