Expand/ add onto the case study below

Expand/ add onto the case study below developing a scenario in which: – the patient develops respiratory acidosis/alkalosis or metabolic acidosis/alkalosis over the course of two weeks following discharge at home. – use 2 nursing reference sources – at the end, create two-open ended questions regarding the expanded on case study 50 year old female presented to the clinic for a routine appointment. S- 50 year old women presents to the clinic for a routine appointment. Patients complains of nausea, vomiting, polyuria (excessive urination), abdominal pain, fatigue/lethargy, muscle weakness, and bone pain. Patient also notes that her memory has not been great lately. Patient states she has been taking Tums (calcium-carbonate 500mg) for her nausea 8-10 tabs daily for the last several days. B- Patient history: NKDA, hyperparathyroidism, (watching-waiting method at this time), hypertension treated with 50mg of hydrochlorothiazide daily. A- Patient is alert and orientated x4. Generalized weakness. BP is elevated from last visit and HR is bradycardic at 55. Patient rubbed her knees several times and stated they her bones were “just so achy.” Airway is patent, patient able to maintain her own airway. Respirations are in normal range and are easy, unlabored, quiet. Skin turgor is poor. No edema noted. Vitals Today: BP: 160/89 HR: 55 RR:16 02: 98% T: 97.5 F Electrolyte Range Result Sodium 135-145 Potassium 3.5-5.5 Chloride 96-106 Magnesium 1.5-2.5 Calcium 8.6-10.2 12 (H) Phosphorus 2.4-4.4 PTH 10-55 75 (H) R- Stop/switch from your thiazide diuretic to a loop diuretic (furosemide, bumetanide). Increase your fluid intake to 3-4L per day, this will help flush out the excess calcium in your system. Restrict dietary intake of calcium by not taking calcium-rich antacids, stop taking or lower your dose of calcium supplements and/or multivitamins. Low calcium foods would be olive oil, rice, apples, tomatoes, eggplant, strawberries, and asparagus. Drink cranberry or prune juice to help prevent the formation of kidney stones. Increase your weight bearing activity (high-impact aerobics, tennis, stair climbing, and/or walking/jogging/running. Activities in which you are on your feet with your bones supporting your weight). Recommend starting on calcimimetic (cinacalcet, 30mg BID).

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