Disorders of Fluid, Electrolyte, and Acid-Base Balance

Disorders of Fluid, Electrolyte, and Acid-Base Balance

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Case Study 1: Disorders of Fluid, Electrolyte, and Acid-Base Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced that she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that a protein in her blood was low. The nurse further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away.

What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?
What is the difference between the physiology of pitting and nonpitting edema?
Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues?
Disorders of Fluid, Electrolyte, and Acid-Base Balance

Disorders of Fluid, Electrolyte, and Acid-Base Balance

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Disorders of Fluid, Electrolyte, and Acid-Base Balance
Question One
The medical attendant or nurse could have distinguished the presence of egg whites protein in Amanda’s blood. Typically, the egg whites protein contains 61% protein content, with the colloid oncotic strain of plasma somewhere between 76% and 81% (Kamel & Halperin, 2021). Essential capability of egg whites is moving different chemicals, calcium, medications, and nutrients throughout the whole body. Furthermore, it additionally assists with sustaining body tissues and keeps spillage of liquids from the veins. In the blood compartment, egg whites help keep up with its osmotic tension. The liver is answerable for creating egg whites protein contained in the blood (Kamel & Halperin, 2021). In this situation, Amanda is suffering from anorexia nervosa, which is a condition that influences physiological framework of Amanda because of the mental results of the problem. The condition causes her to feel as though she is obese or overweight. Accordingly, Amanda could want to restrict her admission of food. She could likewise participate in the extreme activity, abuse of purgatives, or self-actuated retching, which are all weight-administrative ways of behaving.
Edema is a condition brought about by maintaining liquids in the body which causes the expansion of the lower legs, legs, hands or face. Aside from different ailments, edema can be brought about by the lack of different minerals in the human body. For the body to work well, particularly in keeping strong vessels from spilling, it requires the egg whites protein of the liver of between 3.6 to 5.7 grams per deciliter in the blood’s plasma, contingent upon the singular’s age. Furthermore, if the body has low levels of the protein, the patient will probably experience the ill effects of hypoalbuminemia. Thus, this condition might prompt edema of the legs, hands, or face (Seifter, 2019). In such situation, Amanda might not have been devouring the suitable food sources that assist her body with creating the necessary measure of egg whites in her blood, which makes her be impacted by anorexia nervosa.
Question Two
There exist two ordinarily known and the most well-known characterizations and types of edema. They incorporate non-pitting edema and pitting edema. Pitting edema is made through gathering liquid that drives a recognizable enlarging of tissues of the body. When the enlarged region is applied or discouraged tension using a finger, a space is framed, that perseveres for some time when the strain is delivered. Even a little pressure can actuate pitting with the kind of edema, even from the flexible piece of socks (Kilic et al., 2020). Likewise, a precise issue with the human liver capability, kidney capability, heart, or the confined issue in an impacted region’s veins, prompts the pitting edema. A heart mumble might accompany a pitting edema, diminished endurance, windedness, pregnancy, low blood protein, lung sicknesses, and weight. Side effects and signs of both non-pitting edema and pitting edema are practically comparative yet have a distinction concerning the immovability of the enlarged region and the reasons for the enlarged areas.
Non-pitting edema is enlarging the delicate body tissues of the upper or lower portions of the appendages because of the gathering of the overabundance of liquid. In any case, it might likewise influence some other piece of the body with delicate tissues. Various ailments can cause nonpitting edema, uncovering that the infection controls the lymphatic framework or the thyroid. The lymphatic framework keeps sufficient liquid levels, eliminates specific side effects, shields the body from particular microorganisms, and retains supplements. The non-pitting edema might create some issues which cause myxedema, lipedema, angioedema, or lymphedema (Scoglio et al., 2021). Enlarging in the non-pitting edema or legs because of the development of lymphatic liquids causes lymphedema. It very well may be delegated essential lymphedema coming about because of lymphatic improvement in various phases of life and is an uncommon and acquired condition. Optional lymphedema is the complete advancement of the lymphatic framework from explicit wounds. A growth might pack the malignant cells remotely, making the cells to block the progression of lymphatic liquids.
Non-pitting edema may also results to lipedema, the gathering of fats or lipids into the layer beneath the subcutaneous tissue or the skin. Youthful female or woman grown-ups who are soon after pubescence are probably going to be impacted by this condition, overwhelmingly on their bum and legs. The way non-pitting edema and pitting edema conditions answer pressure is the most eminent and well-known contrast between the two (Scoglio et al., 2021). For the case of pitting edema, a space is left, assuming that one applies tension on the expanded region; conversely, for the non-pitting edema, the raised region frames or answers no space. Non-pitting edemas, as a rule, feel firm to contact. In any case, pitting and non-pitting edema are not viewed as hazardous, yet the great concern lies in their hidden causes.
Question Three
For the most part, patients having the propensity to keep their lower appendages or limbs depended through different ways, like wheelchairs or movable chairs, and have a high gamble of getting lower leg muscle to suffer dysfunctions. Dormant activation, for this situation, can be exceptionally hazardous for Amanda because her edematous tissues might grow more as she sits more in the wheelchair and have less time to stand or walk. Studies uncover hydrostatic strain increments after significant stretches of sitting, which might work with the advancement of the edema appendages. The level of the liquid filtration in the edema appendages through the hairlike walls relies upon the drawn-out head-up shifting period of sitting on the wheelchair (Scoglio et al., 2021). Most of the wheelchairs have static pads on the seat. During the wheelchair sitting, the leg volume is essentially diminished. Thus, venous siphoning probably won’t be as expected, which doesn’t permit adequate siphoning into the rump region. Blood won’t be compelled to the shallow veins, thus not arriving at the lower appendages as is required. The visually impaired finished lymph channel or the external valve bearing vein will be seriously packed after some time, permitting more liquid to be depleted towards the heart.
For this situation, if Amanda should have been moved to start with one area and then onto the next utilizing a wheelchair, then, at that point, the wheelchair seat ought to be made of a powerful pad. The powerful place gives some kneading components on her posterior, advancing venous returns that successfully decrease expanding. Furthermore, substituting flattening and developing the dynamic residence on the wheelchair will permit some massive and indistinct development on Amanda’s legs that prompt siphoning an adequate number of liquids into her leg muscles (Boag, 2018). She could likewise calm and back rub her legs on the off chance that she has the solidarity to do so or be helped by a medical caretaker. The message on Amanda’s muscles or other muscle activities would expand her muscle tissue pressure, increment lymph stream, and decrease venous tension, subsequently forestalling leg edema. Hence, during wheelchair sitting, for example, Amanda should be furnished with wheelchairs with energetic and dynamic pads, particularly assuming the patients are tall. Tall people, particularly females, are bound to be impacted by hemodynamic and hydrostatic strain changes. During wheelchair sitting, such changes are bound to prompt edema in the lower appendages of tall females.

Kamel, K. S., & Halperin, M. L. (2021). Use of urine electrolytes and urine osmolality in the clinical diagnosis of fluid, electrolytes, and acid-base disorders. Kidney International Reports, 6(5), 1211-1224. https://www.sciencedirect.com/science/article/pii/S2468024921000747
Boag, A. (2018). Electrolyte and acid-base balance. BSAVA Manual of Canine and Feline Emergency and Critical Care, 44-54. https://www.sciencedirect.com/science/article/pii/S1357303919301318
Kilic, O., Gultekin, Y., & Yazici, S. (2020). The impact of intravenous fluid therapy on acid-base status of critically ill adults: a Stewart approach-based perspective. International Journal of Nephrology and Renovascular Disease, 13, 219. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534048/
Scoglio, M., Bronz, G., Rinoldi, P. O., Faré, P. B., Betti, C., Bianchetti, M. G., … & Milani, G. P. (2021). Electrolyte and acid-base disorders triggered by aminoglycoside or colistin therapy: A systematic review. Antibiotics, 10(2), 140. https://www.mdpi.com/981434
Seifter, J. L. (2019, July). Body fluid compartments, cell membrane ion transport, electrolyte concentrations, and acid-base balance. In Seminars in Nephrology (Vol. 39, No. 4, pp. 368-379). WB Saunders. https://www.sciencedirect.com/science/article/pii/S0270929519300397

Disorders of Fluid, Electrolyte, and Acid-Base Balance

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