and is tightly by specific ion-exchange
ELECTROLYTE IMBALANCES:
Several patients were admitted in the
medical ward. Answer the following
questions pertinent to the patients’
conditions.
PATIENT A–Presented in the
emergency department with severe
headache, irritability, and tremors after
finishing a full marathon. Laboratory
values reveal Serum sodium level of
130 mEq/L.
PATIENT B–Presented in the
emergency department with severe
body malaise, diminished bowel sounds,
and ECG reveals an extra U-wave in the
tracing after 8 bouts of watery diarrhea.
Laboratory values further reveal a
Serum potassium level of 3.0 mEq/L.
PATIENT C–A post thyroidectomy
patient presented with severe muscle
cramps and prolongation of QT-interval
in the ECG and was referred to the
medical consultant for co-management.
Serum calcium level is 4.0 mEq/L.
PATIENT D–A patient receiving
magnesium for the management of
seizure disorder suddenly presented
with depressed deep tendon reflex and
becomes stuporous. Laboratory values
reveal a Serum Magnesium level of 2.6
mg/dL.
1. Given the Patient B’s
presentation, trace the
pathophysiological cause of the
decrease in serum potassium
level.
Potassium is the most abundant
intracellular cation is essential for the life
of an organism. Potassium homeostasis
is integral to normal cellular function,
pumps, primarily by cellular, membrane-
bound, sodium-potassium adenosine
triphosphates (ATPase) pumps. Most
important site of regulation is the renal
collecting duct, where aldosterone
receptors are present.
2. What will be the emergency
medication that should be readily
available in managing the
disorder apparent for Patient D?
Buccal (oromucosal) midazolam-
is given into the buccal cavity.
3. Explain the relationship of thyroid
surgery and the development of
hypocalcemia in Patient C.
Hypocalcaemia is a serious post-
operative complication following
complete thyroidectomy that causes
severe symptoms and prolong
hospitalization. The major cause is
secondary hypothyroidism caused by
surgical injury or devascularization of
one or more parathyroid glands.
4. Explain the relationship of Patient
A’s prior activity and the
development of hyponatremia.
Although exceedingly rare, this
illness has resulted in death during
or after lengthy runs or marathons.
Many runners are unduly worried
with hyponatremia and fail to drink
enough fluids, during and after a
lengthy run. After running a
marathon, a significant number of
runners have unusually low blood
sodium concentrations. The single
most important component related
with hyponatremia is excessive fluid
consumption, as shown by
 significant weight gain during
running.
5. Explain the mechanism behind
the development of prolonged QT
–interval for Patient C.
The mechanism of drug-induced
prolonged QT interval involves inhibition
of the rapid component of the delayed
rectifier potassium current (lKr).
Blocking lKr leads to prolongation of the
ventricular action potential duration,
leading to an excess sodium influx or a
decreased potassium efflux.
6.Enumerate at least one (1) nursing
diagnosis for Patient A, B, C, and D.
Patient A - Hyponatremia
Patient B - Hypokalemia
Patient C – Long QT Syndrome
Patient D – Seizure Disorder
ACID-BASE
IMBALANCES:
Multitude of patient’s conditions can
predispose them to different acid-base
imbalances. Several patients were
admitted in the medical-surgical ward
and are put under your care. Answer the
following questions pertinent to the
patients’ conditions.
PATIENT A–admitted in the medical
ward 30 minutes ago with chief
complaint of severe dizziness and
vertigo accompanied by frequent
vomiting. As the patient moves, vomiting
follows which is now recorded to be 7-8
times from the time of admission.
Diphenhydramine 1 ampule TIV and
metoclopramide 1 ampule TIV as stat
doses were given to the patient.
PATIENT B–a dialysis patient who have
stopped attending his dialysis session
was admitted in the ward due to
changes in sensorium. Serum creatinine
level is elevated as well as the Blood
Urea Nitrogen (BUN). Shallow
respiration is noted upon the
assessment of the patient
Answer:
PATIENT C–a patient was rushed to the
emergency department and later was
admitted to the ward with chief
complaint of shortness of breath,
numbness and tingling around mouth
and fingers, and lightheadedness after
taking a major examination in school.
The patient was offered a brown bag by
the admitting nurse.
Answer:
 A.pH 7.50 PaC02 31 HCO3 17
B.pH 7.30 PaC02 30 HCO3 18
C.pH 7.48 PaC02 49HCO3 30
D.pH 7.32 PaC02 50 HCO3 28

1. Patient A: __
2. Patient B: __
3. Patient C: __
4. Patient D: __

5. Explain why Patient B presented

PATIENT D–A patient with emphysema
as admitted in the ward due to difficulty
of breathing. The patient appears
reddish and is complaining of
lightheadedness. The patient was
immediately hooked to oxygen therapy
at 2 Lpm. Choose from the following
ABG results which will be consistent
with the patient’s condition:
Answer:
with shallow respiration in
relation to the patient’s condition.
Answer:
• Shallow breathing is a feature
of or a symptom of a numver of
illnesses. Among the most
frequent are anxiety disorders,
asthma, hyperventilation,
pneumonia, pulmonary edema,
and shock. Shallow breathing is
frequently accompanied with
anxiety, stress, and panic
attacks.

6. Explain why Patient D

experiences lightheadedness and
why the patientappears reddish in
relation to the patient’s condition.
 • That might be an indication of COPD
when your lungs do not function
correctly, you do not obtain enough
oxygen when sleeping, and carbon
dioxide accumulates in your blood. A
sense of lightheadedness or dizziness
upon awakening might potentially be an
indication of COPD.
7. Explain the purpose of offering
brown bag to Patient C as an
emergency management for the
patient’s condition.
• When you lose a substantial
amount of CO2 as a result of
hyperventilation, your body’s tissues
might begin to fail. The bag is that
rebreathing exhaled air assits your body
in reintroducing CO2 into your
bloodstream.
8. Create a drug study for the
medication: METOCLOPROMIDE
specifying the following:
Name : METOCLOPROMIDE
Brand Name: Maxolon
Dosage: 5mg/ml
Frequency : 1-2 hours
Route : Intravenous
 Drug classification
- GI stimulant , Mis
ellaneous antiemetics
 Mechanism of action
- Blocks dopamine receptors by
disrupting CNS chemorec eptor
trigger zone, increasing
peristalsis and promoting gastric
emptying.
 Indication (*for the case of the
patient mentioned above)
- To prevent chemotherapy –
induced vomiting
 Contraindication
- To hypersensitivity to drug , GI
obstruction ad history of seizure
disorder
 Side effects
- Restlessness
- Fatigue
- Nausea
- Constipation
- Diarrhea
 Nursing Considerations –
- Tell pt to take 30 mins before
meals
- Instruct the pt to report
involuntary movement of face ,
eyes, or limbs , muscle rigidity
altered consciousness ,
excessive sweating.