Case-3: Patient History

T.J. is a 46-year-old science professor brought to urgent carethis afternoon by his wife. T.J. has been at home for 3 days withsevere diarrhea and vomiting. His youngest daughter washospitalized earlier in the week with similar symptoms. T.J. has nosignificant medical history and takes no medications. Examinationreveals an ill-appearing, pale, diaphoretic man who is havingdifficulty concentrating and answering questions. He has diffuseabdominal pain. Vital signs are as follows: Lying—HR 100, BP100/80, resp 26, temp 100. Sitting—HR 136, BP 90/60. He has noturinated since yesterday morning.

Analyze this case study and answer the next three questions thatfollow.

Case-3: Question-1

What other laboratory or clinical data would be helpful inassessing T.J.’s fluid-electrolyte and acid-base status? (selectall that apply)

Assessment of body temperature.

Further assessment could include inspection of mucous membranesfor dryness, skin turgor, status of neck veins, and presence ofdizziness with position change.

Blood test to assess the level of glucose.

A chemistry panel would be helpful in assessing for imbalancesof serum sodium, potassium, and bicarbonate.

Case-3: Question-2

Which assessment data should be monitored during fluidreplacement therapy to determine when adequate volume has beenrestored? (select all that apply)

Electrolytes should be monitored for resolution of anyelectrolyte imbalance.

Mental status should be assessed and expected to improve withadequate fluid replacement.

Vital signs should be monitored for resolution of tachycardiaand postural symptoms, as well as intake and output.

Skin turgor and mucous membranes should be monitored forimprovement of dehydration.

Case-3: Question-3

How might persistent vomiting and diarrhea alter acid-basebalance? (select all that apply)

Vomiting may contribute to metabolic acidosis.

Vomiting may contribute to metabolic alkalosis.

Metabolic alkalosis may occur as a result of persistentdiarrhea.

Metabolic acidosis may occur as a result of persistentdiarrhea.