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A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursing facility

Nursing

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:

  1. 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.
  2. What specific electrolyte disturbance does the patient have?
  3. What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
  4. If the patient had an increase in her potassium level, for what clinical manifestations would the nurse monitor?
  5. What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
  6. 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.

 

Rubric: 

Rubric Criteria

Collapse All Rubric CriteriaCollapse All

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 correct.

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 incorrect.

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, supported by thorough and detailed insight.

4. 4: Good 89-92%

23.05 points

Identification of electrolyte abnormality clinical manifestations is accurate.

3. 3: Satisfactory 81-88%

22.04 points

Identification of electrolyte abnormality clinical manifestations is mostly correct but is missing key symptoms.

2. 2: Less Than Satisfactory 76-80%

20.04 points

Identification of electrolyte abnormality clinical manifestations is incorrect and/or incomplete.

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 accurate.

3. 3: Satisfactory 81-88%

22.04 points

Assessment of blood gas abnormality is mostly correct but is missing key specifics.

2. 2: Less Than Satisfactory 76-80%

20.04 points

Assessment of blood gas abnormality is incorrect and/or incomplete.

1. 1: Unsatisfactory 0-75%

0 points

Assessment of blood gas abnormality is not included.

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

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.

3. 3: Satisfactory 81-88%

7.35 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.

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.

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