Case scenerio: L.L. is a 83-year-old woman whose son brings her to see the healt


Case scenerio:
L.L. is a 83-year-old woman whose son brings her to see the health care provider because she has had a case of the “stomach flu,” with vomiting and diarrhea for the past two to three days and is now experiencing occasional light-headedness and dizziness. Her past medical history includes hypertension, hypercholesterolemia, and mild heart failure. She is taking:
Digoxin (Lanoxin) 0.125 mg po daily.
Captopril (Capoten) 25 mg po BID.
Furosemide (Lasix) 40 mg po daily.
Potassium chloride (K-tab) 20 mEq po daily.
Simvastatin (Zocor) 20 mg po at bedtime.
Subjective Data
Has been following a low sodium diet
States her abdomen feels bloated and she has been constipated since the onset of the “flu”
Has been taking her medications except for the potassium chloride pill because it upsets her stomach.
Occasionally takes an extra “water pill” when her ankles are swollen
Objective Data
Physical Examination
Temperature 98.2° F, pulse 88, respirations 20, BP 138/86
Lungs clear to auscultation, breathing regular and unlabored
+1 edema bilaterally in ankles
Muscle strength in upper extremities normal and equal and in lower extremities weak
Sensation to all extremities normal
Abdomen distended with hypoactive bowel sounds
Diagnostic Studies
Lab values
Sodium 139.0 mEq/L
Potassium 3.0 mEq/L
HCO3- 25.4 mEq/L
Chloride 99.5 mEq/L
Discussion Questions: Address each question in full, complete sentences in your own words in the format of a paper. Provide the references as the last page.
What are the potential etiologies for alterations in fluid, electrolyte, and acid-base balance?
How does fluid, electrolyte, and acid-base balances develop?
What are the goals of care for patients who have alterations in fluid, electrolyte, and acid-base balance?
Explain the differences that place the elderly compared with infants at greater risk for fluid balance alterations.
Which interdisciplinary team member(s) should be involved in this case and provide a rationale?


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