Case Study – Acid-Base Imbalance

Case Study – Acid-Base Imbalance

Tony’s acid-base imbalance is Respiratory acidosis. The primary change in respiratory acidosis is an elevation of arterial PaCO2 above the normal range of 35 mmHg to 45 mmHg. Tony’s arterial PaCO2 of 55 mmHg is above the normal range. His arterial pH of 7.28 is lower than the normal arterial pH range of 7.35 to 7.45, confirming the presence of acidosis (Bruno & Valenti, 2018). A physiological compensatory increase in arterial bicarbonate levels usually accompanies respiratory acidosis. His arterial bicarbonate level of 30 mEq/L exceeds the normal range of 22 to 26 mEq/L, an indication of the compensatory change. Therefore, the acid-base imbalance that Tony has is respiratory acidosis.

Tony’s Respiratory acidosis is caused by his comorbidities: asthma and Chronic Obstructive Pulmonary Disease (COPD). In COPD, there is airflow limitation due to loss of the elastic recoil and decreased airway tethering (Hikichi et al., 2018). Furthermore, there is a narrowing of airway pathways and increased airway resistance. Fatigue and hyperinflation increase the respiratory system’s elastic load, leading to decreased respiratory muscle performance. This causes hypoventilation accompanied by hypercapnia. Hypercapnia causes a decrease in arterial pH and a compensatory increase in bicarbonate levels leading to respiratory acidosis.

In asthma, airway obstruction is caused by airway edema, acute bronchoconstriction, airway remodelling, and chronic mucous plug formation. Airway obstruction leads to increased resistance to airflow and decreased expiratory flow rates (Hikichi et al., 2018). The ability to expel air is reduced, leading to an increase in arterial PaCO2. Elevation of PaCO2 decreases arterial blood pH and causes a compensatory increase in bicarbonate levels. This causes respiratory acidosis.

Tony exhibits different signs and symptoms as a result of his respiratory acidosis. They include the increased respiratory rate that is laboured, feeling exhausted and pulse oximetry of 84%. His Arterial blood gas results are also a reflection of respiratory acidosis. The increase in arterial PaCO2 is the cause of the exhaustion and increased and laboured respiratory rate. This causes a ventilation-perfusion imbalance. Pulse oximetry of 84% is below the normal range of 95% to 100% suggesting a decrease in oxygen supply. The decrease is caused by the rapid, labored respiratory rate that results in the delivery of low oxygen levels and accumulation of carbon dioxide leading to hypercapnia. PaCO2 of 55mmHg is a manifestation of hypercapnia, while the pH of 7.28 reflects the presence of acidosis. An elevation of bicarbonate levels and a reading of 30 mEq/L reflects the physiological compensatory mechanism of the body.

Various multi-dimensional nursing interventions are appropriate for Tony’s care. The first intervention is monitoring the depth and effort of his respiratory rate. This is important because alveolar hypoventilation can cause hypoxemia leading to respiratory failure. The other intervention is to auscultate breath sounds. This identifies areas of decreased ventilation and provides the guidelines for his therapeutic needs. The next intervention is continuous monitoring of heart rate and rhythm. This helps identify tachycardia resulting from stimulation of the sympathetic nervous system and dysrhythmias caused by hypoxia and electrolyte imbalance (Young Hee Choi, 2019). The next intervention is to monitor his skin colour and temperature. This helps to identify pallor, clammy skin, and diaphoresis that indicate severe hypoxemia. Arterial blood gases should be continuously monitored to evaluate the need and the effectiveness of therapy. Oxygen therapy prevents the sequelae of hypoxia and raises oxygen saturation levels within the normal range. Ventilatory support by endotracheal intubation, nasal bi-level ventilation, and nasal continuous positive pressure ventilation increases lung expansion, improves ventilation, and prevents respiratory failure.

The first pharmacological intervention is the administration of bronchodilators such as albuterol and ipratropium bromide to manage bronchospasms caused by COPD and asthma. Small doses of Sodium bicarbonate can be given to help correct the acidosis and bring pH to the normal range (Young Hee Choi, 2019). Potassium chloride helps to restore the potassium that shifts out of the cells during the acidotic state. Ringer’s lactate and sodium lactate helps to control acidosis before the underlying respiratory problem is corrected. Sedatives and tranquillizers should be restricted in hypoventilation because they can cause respiratory depression.

References

Bruno, C. M., & Valenti, M. (2018). Acid-base disorders in patients with chronic obstructive pulmonary disease: A pathophysiological review. Journal of Biomedicine and Biotechnology, 2018. https://doi.org/10.1155/2018/915150

Hikichi, M., Hashimoto, S., & Gon, Y. (2018). Asthma and COPD overlap the pathophysiology of ACO. Allergology International, 67(2), 179–186. https://doi.org/10.1016/j.alit.2018.01.001

Young Hee Choi,  and A.-M. Y. (2019). Beyond Low Tidal Volume Ventilation: Treatment Adjuncts for Severe Respiratory Failure in Acute Respiratory Distress Syndrome. Physiology & Behavior, 176(3), 139–148. https://doi.org/10.1097/CCM.0000000000003406.Beyond

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Case Study – Acid-Base Imbalance

Hi, this assignment is on my multidimensional care course. Please follow ALL instructions. if you scroll down you will find the information you are to work on and the RUBRIC.
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Module 05 Written Assignment – Acid-Base Imbalance

Competency

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

Scenario

Module 05 Written Assignment – Acid-Base Imbalance

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 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

Instructions

Module 05 Written Assignment – Acid-Base Imbalance

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

Resources

• For assistance with citations, refer to the APA Guide.
• For assistance with research, refer to the Nursing Research Guide.

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RUBRIC

Module 05 Written Assignment – Acid-Base Imbalance

Acid-Base Disorder (5 Pts)Thoroughly identified the acid-base disorder for the patient in the scenario to include details of compensation.