Question

Describe strategies for safe, effective multidimensional nursing care for clients with acid-base imbalances.

Scenario

Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states “I haven’t felt good for about a week, but couldn’t afford to miss work.” He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 4 L via NC and an arterial blood gas.

Tony’s ABG results:

pH 7.28
PaCO2 – 55 mm Hg
PaO2 – 70 mm Hg
HCO3 – 30 mEq/L

Instructions

In a 1-2 page Word document:

1. Determine Tony’s acid-base imbalance
2. Describe possible causes of the imbalance
3. Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance
4. List the multidimensional care strategies that are appropriate for the care of Tony

Answer 1

Tony is a 56 year old ,Hispanic male,that presented to the emergency room with complaints of shortness of breath since past two days.

His chief complaints are  

• Cough
• Fever
• Feeling exhausted

​​​​​​Past medical history includes

• Asthma
• Cheronuc obstructive pulmonary disease
• Diabetes.

On Physical examination :

• Patient s struggling to breath
• Respiratory rate 36breaths/min
• Heart rate :115beats/min
• Blood pressure:90/40 mm of Hg
• SpO2: 84% on Room air

Patient is put on Oxygen at 4 L / min via nasal cannula.

Arterial Blood Gas Result are as following:

pH :7.28

PaCO2 :55 mm Hg

PaO2 : 70 mm Hg

HCO3 :30 mEq /L

The ABG analysis of Mr.Tony is clearly Indicating Componsated Respiratory Acidosis.

​​​​​​ Normal Range Pt Value Inference

pH 7.35 -7.45 7.28 Low(Acidosis)

pCO2 35-45 mm Hg    55 mm of Hg Increased(Resp.Acidosis)

HCO3 22- 26 mEq/ L 30 mEq /L Increased(as a

componsatory mechanism to respiratory acidosis)

Possible causes of ABG imbalance:

Mr.Tony is a known case of Asthma and Chronic obstructive pulmonary disease,hence there is a impaired ability of the lungs to remove CO2 which results increased level of carbonic acid in blood.Due higher level of carbonic acid ,blood pH will fall below the normal,resulting in Acidosis.

As a compensatory mechanism kidney starts reabsorbing more HCO3,which later resuts in near normal pH,even though PCO2 is high.

Signs and symptoms of Mr.Tony as a result of Acid base imbalance:

Signs:

Patient is complaining of

• shortness of breath
• Feeling exhausted

Symptoms includes

• Struggling to breath,Laboured breathing
• Respiratory Rate :36 breaths /min
• Pulse :115 beats /min
• SpO2 : 84% on Room Air
• Low blood pressure,BP :90/40 mm of Hg(Acidosis can affect cardiovascular function resulting in decreased cardiac output)

Multidimensional care strategies which is appropriate for the care of Mr.Tony are as following:

• Oxygen Administration:

Mr.Tony need to be administered with Oxygen at prescribed flow rate.If required Non invasive positive -pressure ventilation can be used.

• Treating underlying causes:

Mr.Tony is a known case Asthma and COPD,hence he need to be treated with corticosteroids and brochodilators inorder m to improve the gas exchange at alveoli.

• Administer prescribed IV fluids inorder to improve blood pressure.

• Treat Fever episode:

Increased bofy Temaparature will later both respirations and heart rate,hence it fever should be treated with antypyretics.

• Rule out any Respiratory tract infection and treat effectively.

• Proper positioning of patients:

Keeping Fowler's/Semi Fowler's position will improve breathing.

• Reassuring the patients:

Reassuring helps in relieving stress and anxiety.