Running Head: GROUP 6 CASE STUDY #1

Group Six Case Study One

Tabetha Elie, Maria Marquez, Rose Nyarko, Victoria Stock

University of Florida College of Nursing

 GROUP 6 CASE STUDY #1

An obese 36-year-old woman is seen in her primary care physician’s office after suffering from a

weekend of nausea, vomiting, and diarrhea. She is slightly febrile, complains of feeling dizzy

when going from a sitting to a standing position (orthostatic hypotension), and remains

nauseated. She has not vomited or had any loose stools since the previous evening. According to

the history provided, she did not keep any food or liquids down for more than 48 hours. ​Explain

All Answers in Paragraph Form

1. Based on initial clinical observations and reported history, the clinician assumes that the

woman is suffering from dehydration and hypovolemia (decrease in plasma level). As

expected, laboratory results demonstrate

1. Hypokalemia as a result of renal compensation for volume depletion

2. Metabolic acidosis as a result of decreased levels of HCO3-

3. Hypernatremia (sodium increase) as a result of renal tubular reabsorption

4. Respiratory alkalosis as a result of increased water loss from fever

Explanation​: Laboratory results should show that the patient also has hypernatremia due to the

renal tubular reabsorption. Laboratory results should have shown that the patient’s serum sodium

levels increased to over 147 milliequivalents per liter (mEq/L) (​McCance & Huether, 2014).

Since the patient has been excreting bodily fluids for an extended period of time, the patient’s

serum sodium has increased. Since the patient has experienced a great extent of water loss from

vomiting and diarrhea, she is experiencing both extracellular dehydration (ECF) and intracellular

dehydration (ICF). More specifically, the patient’s hypovolemia was caused by free water loss

that attracted water from the ICF (McCance & Huether, 2014). Hypernatremia can also be

caused by an increase in hypertonic sodium as well, due to the hyperosmolality (Kim, 2006). The
 GROUP 6 CASE STUDY #1

hypertonic osmolality affects this patient due to the sodium inundation in the ECF. The patient’s

symptoms are also consistent with what would be expected from hypernatremia. When the body

is deprived of water due to an increase in sodium, it is common to have fevers and hypotension

(McCance & Huether, 2014). The patients other symptoms were most likely caused by the

hypovolemia. Hypovolemia is known to cause both vomiting and diarrhea (​Kreimeier, 2000)​.

The patient’s orthostatic hypotension was most likely caused by the dehydration.

2. In addition, the patient’s obesity is an issue that is due to:

1. Less TBW (p. 104)

2. More TBW

3. Capillary hydrostatic pressure

4. Interstitial oncotic pressure

Explanation​: ​In addition, the patient’s obesity is an issue due to loss of total body water (TBW).

The human body’s cells thrive in an environment with specific ranges of water, acids, bases, and

electrolytes (McCance & Huether, 2014). The combination of all those fluids equals to the TBW,

and the standard of TBW is measured in kilograms (kg) of body weight (McCance & Huether,

2014). Adipose tissue, more commonly known as fat, repels water. Adipose cells carry very

small amounts of water due to their hydrophobic nature. Since our patient has more adipose

tissue, their TBW is usually lower. This increases the patient’s risk for dehydration and fluid

imbalances, like what the patient is currently suffering from (McCance & Huether, 2014).
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3. For fluid resuscitation, the clinician should order an IV fluid that is a(an):

1. Isotonic solution

2. Water and a hypertonic saline solution

3. Calcium gluconate

4. Sodium bicarbonate

Explanation: ​To treat this patient, she should be administered an Isotonic IV to help regain and

balance her fluids properly and safely (McCance & Huether, 2014). The patient should slowly be

given a salt free isotonic solution and her serum sodium should be consistently monitored to

ensure they are returning to normal levels (McCance & Huether, 2014). It’s important to monitor

the flow of an IV to protect the patient from other injuries. The patient can eventually develop

cerebral edema if they are not monitored and the fluids are administered too quickly (McCance

& Huether, 2014).

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References

Kim, S. W. (2006). Hypernatremia : Successful Treatment. ​Electrolytes & Blood Pressure : E &

BP,​ ​4(​ 2), 66–71, doi: 10.5049/EBP.2006.4.2.66

Kreimeier, U. (2000). Pathophysiology of fluid imbalance. ​Critical Care​, ​4​(Suppl 2), S3, doi:

10.1186/cc968

McCance, K. L., & Huether, S. E. (2014). ​Pathophysiology: The biologic basis for disease in

adults and children.​ St. Louis, MO: Mosby.