Case Study
K.B. is a 32-year-old woman being admitted to themedical floor for complaints of fatigue and dehydration. Whiletaking her history, you discover that she has diabetes mellitus(DM) and has been insulin-dependent since the age of 8. She hasundergone hemodialysis (HD) for the past 3 years. Your initialassessment of K.B. reveals a pale, thin, slightly drowsy woman. Herskin is warm and dry to the touch with poor skin turgor, and hermucous membranes are dry. Her vital signs (VS) are 140/88, 116, 18,99.9° F (37.7° C). She tells you she has been nauseated for 2 daysso she has not been eating or drinking. She reports severediarrhea. Serum calcium, phosphate, magnesium, and a complete bloodcount (CBC) have been drawn but the results are not yet available.The following blood chemistry results are back:
Laboratory Results
Chemistry
Sodium 145 mEq/L (145 mmol/L)
Potassium 6.0 mEq/L (6.0 mmol/L)
Chloride 93 mEq/L (93 mmol/L)
Bicarbonate 27 mEq/L (27 mmol/L)
BUN 48 mg/dL (17.7 mmol/L)
Creatinine 5.0 mg/dL (442 mcmol/L)
Glucose 238 mg/dL (13.2 mmol/L)
Questions
1. What aspects of your assessment support her admittingdiagnosis of dehydration?
2. Review the lab results above and explain any that might be ofconcern to you as the nurse.
3. Identify two (2) possible causes for K.B.’s low-gradefever.
The rest of K.B.’s physical assessment is within normallimits. You note that she has an arteriovenous (AV)
fistula in her left arm.
4. What is an AV fistula? Why does the patient have one?
5. What steps do you take to assess K.B.’s AV fistula, and whatphysical findings are expected? Explain.
6.As you continue the assessment, you notice that a TrainedClinical Nurse (TCN) comes in to take K.B.’s blood pressure. TheTCN places the blood pressure cuff on K.B.’s left arm. What, ifanything, do you do?
K.B.’s admission CBC results yield the followingfindings:
Laboratory Results
Complete Blood Count
WBC 7600/mm3 (7.6 x 109 /L)
RBC 3.2 million/mm3 (3.2 x 1012 /L)
Hgb 8.1 g/dL (81 g/L)
Hct 24.3%
Platelets 333,000 / mm3 (330 x 109 /L
7. Are these values normal? If not, what are theabnormalities?
