Patient Japan is a 72-year-old male found collapsed at home

on floor of his bedroom, incontinent of urine and feces. He

complained of significant pain in his right hip with
shortening and rotation. Patient Japan’s family last had
contact with him 3 days prior to his collapse.
Assessment:

 On arrival at Emergency Department he is confused and

combative with a GCS 0f 13
 IVF of D.5 W at 25 gtts/min
 II gram of Calcium chloride given
 Initial observations reveal BP 78/60; Pulse 74, RR 32, SPO2
91% (NRB 15L)
 ABG which shows a Potassium of 9.0, pH of 7.23 and a Blood
Glucose Level of 32mmol

Medical History:

 CCF- Congested Heart Failure

 Hypertension
 Type 2 DM
 Osteoarthritis

Medication History:

 Patient Japan is taking enalapril for hypertension;

spironolactone, prandin & metoprolol for his CCF and Celebrex
for his osteoarthritis
 His diabetes is diet controlled.

An ECG is performed on his arrival to the resuscitation area…
 You briefly review the ECG and confidently state (already knowing
the ABG result) that this patient has sever hyperkalemia.

Guided Questions to answer by the group

The 5 C’s of Metabolic Disturbances

Used the 5 C’s approach to recognise, understand and manage

metabolic disturbances in the ED.

 Causes – Understanding normal metabolic homeostatic

mechanisms helps define potential causative events that lead to
disruption of the sensitive pathophysiological milieu. Increased
production; increased intake and decreased excretion are often
the commonest causal factors in metabolic disruption. (What are
the causes of the Disease?)
 Clinical manifestations – evaluate, recognise and diagnose
the problem (Clinical and pathognomic signs of the disease)
 Complications – what can go wrong in the short, medium and
long term can define clinical manifestation, duration of illness
and potentially affect management decisions (Identify such
complication that led to the condition of the patient)
 Calculations – Calculate to Obviate (Determining results of
the laboratory)
 Corrective measures – Call to action…how do you actually fix
the problem (Nursing Interventions to formulate)
 DIAGNOSIS HYPERKALEMNIA; SEVERE
ELECTROLYES IMBALANC, ISCHEMIC HEART
DISEASE

Pls. answer the following

1. What are the signs and symptoms of the diseases that if being
affected?
2. Why ECG monitoring is an important responsibility for us
Nurses and student nurses?
3. Why the Bowel movement is principal assessment?
4. Why Calcium Chloride is being given to the patient?
5. NCP (3 TOP PRIORITY)