Medical-surgical unit for further evaluation and treatment

Jimmy Lewis is brought to the hospital emergency department by some friends. He had been vomiting for several days and was complaining of heart palpitations. Mr. Lewis is a 58-year-old white man who is homeless. He has not had any health care for at least 10 years. He is an alcoholic and drinks 1 quart of gin or vodka every day.

He does not have a job, and his family is all out of state. The emergency physician does an initial assessment and transfers him to a hospitalist, who admits him to a medical-surgical unit for further evaluation and treatment.

Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium, 138 mEq/L; potassium, 3.1 mEq/L (low); chloride, 104 mEq/L; and magnesium, 1.5 mEq/L (low). His arterial blood gas measurements are as follows: pH, 7.48 (high); PaCO2, 40 mm Hg; and HCO3, 29 (high). Jamie Taylor, a 22-year-old nursing student, is assigned to Mr. Lewis. She reviews Mr. Lewis’ medical record before going in to assess him.

Question 1 After reviewing his chart and lab work, what fluid and electrolyte imbalances would Jamie determine?   Question 2 What type of acid-base imbalance is Mr. Lewis experiencing?

Question 3 The hospitalist orders an IV of D5NS to run at 125 mL/hr. What type of fluid is this? Question 4 Two hours after the IV is started, Mr. Lewis complains of pain at the insertion site. Jamie assesses the site and notes that it is cool to the touch around the site and is edematous. She tries to obtain a blood return and does not get any return.

This indicates what type of problem, and what action should she take?