Acid-Base Imbalance
Nurses should adopt multidimensional care in their practice. Multidimensional care advocates for comprehensive, evidence-based care plans. Furthermore, it advocates for patient-centeredness and holistic care. This paper discusses a patient, Tony, with an acid-base imbalance disorder and develops a multidimensional care approach for the patient. Do you need urgent assignment help ? Get in touch with us at eminencepapers.com.
Tony’s Acid-Base Disorder
The patient has respiratory acidosis. Patel and Sharma (2022) report that respiratory acidosis is diagnosed based on a patient’s arterial blood gas (ABG). Notably, it is evidenced by elevated HCO3 and PaCO2 levels and a decrease in pH (Patel & Sharma, 2022). The normal reference values for HCO3, PaCO2, and pH are 22 to 26 mEq/L, 35 to 45 mmHg, and 7.35 to 7.45, respectively (Patel & Sharma, 2022). In this context, the patient’s pH (7.28) is below the normal range. Secondly, the patient’s PaCO2 (55mmHG) is elevated beyond the normal range. Thirdly, the patient’s HCO3 (30mEq/L) is elevated beyond the normal range. These ABG values are confirmatory of respiratory acidosis. Elevated HCO3 is a compensatory response aimed at stabilizing the pH that has been decreased by elevated PaCO2 (Tinawi, 2021).
Causes of the Acid-Base Disorder
Past medical history revealed that the patient suffers from chronic obstructive pulmonary disease (COPD) and asthma. These comorbidities are obstructive airway diseases that increase the risk of respiratory acidosis. To begin with, asthmatic patients have airway hyperactivity, edema and remodeling, bronchoconstriction, and mucous plugs that impede airflow (Cevhertas et al., 2020). This causes alveolar hypoventilation and hypercapnia characterized by elevated PaCO2. Elevated PaCO2 is accompanied by a decrease in pH, which causes respiratory acidosis. This is compensated for by an increase in HCO3 levels. Secondly, patients with COPD have limited airflow due to emphysema and underlying chronic bronchitis (Joves, 2022). Limited airflow and gaseous exchange in the alveoli elevate PaCO2 and decrease pH. As such, the patients are predisposed to respiratory acidosis (Joves, 2022).
Signs and Symptoms of the Disorder
The patient presents with various signs and symptoms attributed to respiratory acidosis. Firstly, the patient struggles to breathe and has a respiratory rate of thirty-six breaths per minute. This is a manifestation of hyperinflation. In this context, hyperinflation is a response that attempts to address hypercapnia (elevated PaCO2) and increase oxygenation (Tinawi, 2021). Secondly, the patient’s pulse oximetry is 84 percent. The normal oxygen saturation levels should be at least 95 percent (Tinawi, 2021). As such, 84 percent indicates a decrease in oxygen saturation caused by elevated PaCO2 in respiratory acidosis. Thirdly, the patient’s ABG results are suggestive of respiratory acidosis. In this context, Tony presents with elevated PaCO2, HCO3, and decreased pH and PaO2.
Multidimensional Nursing Care
Multidimensional care focuses on comprehensive, evidence-based practices that fulfill holistic care. The patient’s ABG should be monitored continuously. To begin with, oxygen therapy should be administered to prevent the worsening of the patient’s hypoxemia (evidenced by a PaO2 of 70 mmHg). An exacerbation of hypercapnia is common in COPD patients receiving oxygen therapy (Joves, 2022). As such, oxygen therapy should be administered, followed by close patient monitoring. Also, the patient should be educated on the relevance of diaphragmatic breathing in muscle relaxation and optimizing oxygenation levels. A clear airway should be maintained, and ventilatory support should be embraced if the patient’s hypercapnia worsens (Joves, 2022). Ventilatory support increases PaO2, lowers PaCO2, and averts respiratory failure (Joves, 2022).
Furthermore, medication should be administered to control the impact of the patient’s COPD and asthma. Bronchodilators medication such as anticholinergics, theophylline, and beta-agonists should be administered (Patel & Sharma, 2022). If the patient progresses to cardiopulmonary arrest, sodium bicarbonate should be administered.
References
Cevhertas, L., Ogulur, I., Maurer, D. J., Burla, D., Ding, M., Jansen, K., Koch, J., Liu, C., Ma, S., Mitamura, Y., Peng, Y., Radzikowska, U., Rinaldi, A. O., Satitsuksanoa, P., Globinska, A., van de Veen, W., Sokolowska, M., Baerenfaller, K., Gao, Y. dong, … Akdis, C. A. (2020). Advances and recent developments in asthma in 2020. Allergy: European Journal of Allergy and Clinical Immunology, 75(12), 3124–3146. https://doi.org/10.1111/all.14607
Joves, B. (2022). Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: Ventilating the Patient with Severe Respiratory Acidosis. In: Esquinas, A.M. (eds). Teaching Pearls in Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-030-71298-3_44
Patel, S., & Sharma. S. (2022). Respiratory Acidosis. https://www.ncbi.nlm.nih.gov/books/NBK482430/
Tinawi, M. (2021). Respiratory acid-base disorders: respiratory acidosis and respiratory alkalosis. Archives of Clinical and Biomedical Research, 5(2), 158-168. https://doi.org/10.26502/acbr. 50170157
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Question 
Acid-Base Imbalance
Competency
Describe strategies for safe, effective, multidimensional nursing care for clients with acid-base imbalances.
Scenario
Tony is a 56-year-old, Hispanic male who 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, his heart rate is 115 beats per minute, his blood pressure is 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 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
InstructionsIn 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
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