Case Study Chapter 8: Disorders Of Fluid, Electrolyte, And A

Case Study Chapter 8 Disorders Of Fluid Electrolyte And Acidbase

Case Study, Chapter 8, Disorders of Fluid, Electrolyte, and Acid–Base Balance Norris, T. (2019). Porth’s Pathophysiology: Concepts of Altered Health States. 10th Ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. ISBN: 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.

1. What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?

2. What is the difference between the physiology of pitting and nonpitting edema?

3. 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?

Sample Paper For Above instruction

The case of Amanda, an 18-year-old woman suffering from anorexia nervosa, highlights critical aspects of fluid and electrolyte imbalances and their physiological consequences. Anorexia nervosa, characterized by severe weight loss and nutritional deficiencies, often leads to significant alterations in body fluid compartments and protein levels, which have profound effects on fluid balance and tissue integrity.

Suspected Protein and Its Role in Edema

The protein most likely referred to by the nurse is albumin, a vital plasma protein synthesized by the liver. Albumin plays a crucial role in maintaining oncotic pressure, which is the form of osmotic pressure exerted by plasma proteins that draws water into the circulatory system from the interstitial spaces. In cases of anorexia nervosa, malnutrition often leads to hypoalbuminemia—a reduced level of albumin in blood plasma. This deficiency diminishes the plasma’s oncotic pressure, impairing its ability to retain water within blood vessels. Consequently, water tends to shift into the interstitial spaces, resulting in edema, particularly noticeable in extremities such as the hands and feet, as Amanda reports.

Physiology of Edema: Pitting vs. Nonpitting

Understanding the mechanisms underlying different types of edema is essential for accurate diagnosis and management. Pitting edema is characterized by the presence of a visible indentation or "pit" when pressure is applied to the swollen area, typically caused by increased hydrostatic pressure, decreased plasma oncotic pressure, or lymphatic obstruction. When the pressure is released, the indent remains temporarily until the excess fluid redistributes or is absorbed.

In contrast, nonpitting edema does not produce an indentation under applied pressure. It often results from conditions like hypothyroidism or localized infections where edema involves the interstitial tissues with increased protein content or fibrosis, leading to a less compressible tissue state. The difference fundamentally lies in the interstitial fluid composition and tissue characteristics, with pitting edema generally involving fluid-rich interstitial spaces and nonpitting involving more fibrous or proteinaceous tissue components.

Impact of Mobility on Edematous Tissues

Amanda’s limited mobility, due to her weak condition, further influences her edematous tissues. Movement promotes lymphatic drainage and venous return, helping to reduce edema. When a patient is immobile or restricted to a wheelchair, the natural muscle pump mechanisms that facilitate fluid reabsorption and circulation are diminished. This stagnation of fluids exacerbates the edema, increasing tissue swelling and discomfort. In Amanda’s case, her immobility likely leads to a worsening of her edema, especially in the extremities, and underscores the importance of physical activity and positioning strategies in managing edema.

Conclusion

In conclusion, Amanda’s case illustrates the complex interplay between nutritional deficiencies, protein levels, and fluid regulation. Hypoalbuminemia due to anorexia nervosa diminishes oncotic pressure, promoting edema formation. Recognizing the distinction between pitting and nonpitting edema guides clinical assessment, and promoting mobility is vital in managing edema. Addressing these factors through nutritional therapy and mobilization strategies is essential for improving patient outcomes and reducing tissue swelling in similar cases.

References

• Norris, T. (2019). Porth’s Pathophysiology: Concepts of Altered Health States (10th ed.). Wolters Kluwer/Lippincott Williams & Wilkins.
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