Question

In: Nursing

A 66 yr old patient comes in with shortness of breath and coughing up yellow sputum....

A 66 yr old patient comes in with shortness of breath and coughing up yellow sputum.

medical history of:

-smoking 1 pack/day for 40 yrs. Dx with COPD 2 years ago

-community acquired pneumonia 10 yrs ago

-mild kidney disease first dx 10 years ago --> progressed to chronic now with a decreased GFR of 30.

on exam:

- fever, hypotensive, tachycardic on exam.

has a MIXED METABOLIC-RESPIRATORY ACIDOSIS

DIAGNOSED WITH Right Lower Lobe PNEUMONIA, SPESIS, SEVERE ACIDOSIS.

1. Explain the chronological sequence of events (both chronic and acute) that have contributed to his acidosis.

2. Explain why his current sepsis further complicates his acid/base status.

3. How does his body attempt to compensate chronically and acutely for his acidosis? Be specific! (Remember that there is an interaction between the kidney and the lungs in this case.)

4. Explain how his current renal, pulmonary, and other comorbidities have affected his ability to compensate for the acidosis?

Solutions

Expert Solution

1,

The chronological order of this disease process is right lower lobe pneumonia, And this pneumonia leads to sepsis. Due to severe pnemonia and sepsis respiratory status changes and gas exchange not well occur. This will leads to acidosis.

2,

Sepsis causes changes in the blood chemistry, and it is leads to abnormalities in the hematological functions such as acid and base level. Those difference leads to abnormalities in the electrolyte balance.

3,

The kidneys compensate for a respiratory acidosis by tubular cells reabsorbing more HCO3 from the tubular fluid, collecting duct cells secreting more H+ and generating more HCO3, and ammoniagenesis leading to increased formation of the NH3 buffer. The respiratory rate will be increases thus it eads toremove excess CO2 in the body.

4,

As above says kidney or renal system had a specific role in reversing respiratory acidosis. Pulmonart system help in the compansatory action of body by increasing the respiration,

Nightingale answered 2 years ago
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