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.
the condition of patient B is an example of hypokalemia ( below 3.5 mEq/L) due to diarrhoea . the main
causes of hypokalemia includes inadequate dietary potassium intake ,excessive potassium loss in urine
due to prescription medications that increase urination. Also known as water pills or diuretics, these types
of medications are often prescribed for people who have high blood pressure or heart disease

2. What will be the emergency medication that should be readily available in

managing the disorder apparent for Patient D? IV administration of calcium
gluconate
3. Explain the relationship of thyroid surgery and the development of
hypocalcemia in Patient C.
Hypoparathyroidism — low calcium levels due to decreased secretion of parathyroid
hormone (PTH) from the parathyroid glands next to the thyroid. This can occur as a
result of damage to the glands during thyroid surgery and usually resolves.
4. Explain the relationship of Patient A’s prior activity and the development of
hyponatremia.
Hyponatremia occurs resulting in decrease plasma osmolality, that causes cerebral edema

5. Explain the mechanism behind the development of prolonged QT –interval for

Patient C.

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 QT prolongation entails action potential prolongation, that results from an increase in
inward current (e.g., through sodium or calcium channels) or a decrease in outward
current (e.g., through potassium channels). Myocardial repolarization is primarily
mediated by efflux of potassium ions.
6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.
PT A- hyponatremia
PT B- hypokalemia
PT C- hypocalcemia
PT D- Hypermagnesemia

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.
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.
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:
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

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 1. Patient A: __
2. Patient B: __
3. Patient C: __
4. Patient D: __
5. Explain why Patient B presented with shallow respiration in relation to the
patient’s condition.
6. Explain why Patient D experiences lightheadedness and why the patient
appears reddish in relation to the patient’s condition.
Emphysema is a lung condition that is part of chronic obstructive pulmonary disease. Patient D
appears reddish because her capillaries are congested and she experience
lightheadedness because her lungs don’t work properly, she don’t get enough oxygen
and carbon dioxide builds up in your blood
7. Explain the purpose of offering brown bag to Patient C as an emergency
management for the patient’s condition.

Breathing into a paper bag is a technique that can help you regulate
hyperventilation. It works by putting some of the lost carbon dioxide back into
your lungs and body. This helps to balance oxygen flow in your body.
8. Create a drug study for the medication: METOCLOPROMIDE specifying the
following:
● Drug classification- Prokinetics agent

● Mechanism of action- Metoclopramide causes antiemetic effects by inhibiting

dopamine D2 and serotonin 5-HT3 receptors in the chemoreceptor trigger
zone (CTZ) located in the area postrema of the brain. Administration of this
drug leads to prokinetic effects via inhibitory actions on presynaptic and
postsynaptic D2 receptors, agonism of serotonin 5-HT4 receptors, and
antagonism of muscarinic receptor inhibition. This action enhances the
release of acetylcholine, causing increased lower esophageal sphincter (LES)
and gastric tone, accelerating gastric emptying and transit through the gut.
Metoclopramide antagonizes the dopamine D2 receptors. Dopamine exerts
relaxant effect on the gastrointestinal tract through binding to muscular D2
receptors.

● Indication (*for the case of the patient mentioned above)- Nausea and
vomiting and gastroparesis
● Contraindication- GI hemorrhage, perforation, or mechanical obstruction
● Side effects- restlessness, drowsiness,depression, insomnia,headache
anxiety,dizziness, and confusion

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 ●
● Nursing Considerations:

- Assess for extrapyramidal symptoms and tardive dyskinesia (more likely in older
patients).
- Assess for gastrointestinal complaints, such as nausea, vomiting and constipation.
- In oral administration, for better absorption allow 30 minutes to one hour before
eating.

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