Competency

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 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

 

1. Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance
2. List the multidimensional care strategies that are appropriate for the care of Tony

Answer:

Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance

After the physical test Tony has been found difficult to breath, his breathing rate is 36 respiration's per minute and operated, his heart rates are 115 beats per minute and his blood pressure is 115.
The pulse oximetry of the 90/40 mm Hg in a room air is 84 percent. He complains that he feels drained as well. "For approximately a week I haven't been feeling good, but couldn't let it miss my work," Tony says.

The following are the signs and symptoms displayed by Tony:

• Fight for respiration
• A higher rate of respiration
• Higher cardiac rates
• Blood pressure decreased ( due to acidic blood)
• Higher saturation of oxygen (spo2- 84 percent in room air)
• Feeling tired
• Anxieties

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

    Respiratory acidosis treatment is principally aimed at treating the underlying condition, which disrupts gas exchange and the normal respiratory process. It should be protected against asthma or COPD smoking irritants ( He should be asked to stop smoking). Hypoxemia relief (non-invasive positive -pressure ventilation) is supplied with supply oxygen. Drugs will be made available to improve breathing, including drugs which open the airways to the airway blockage.

Oxygen Administration:

Mr.Tony should be directed with Oxygen at recommended stream rate.If required Non intrusive positive - pressure ventilation can be utilized.

Treating fundamental causes:

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

Control recommended IV liquids inorder to improve circulatory strain.

Treat Fever scene:

Expanded bofy Temaparature will later the two breaths and heart rate,hence it fever ought to be treated with antypyretics.

Preclude any Respiratory parcel contamination and treat viably.

Legitimate situating of patients:

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

Consoling the patients:

Consoling aides in diminishing pressure and tension.

Step-by-step explanation

Tony's ABG results are as per the following NOTE: The typical reach are as per the following-

pH : 7.28 pH: 7.35-7.45 (DECREASE in pH show an ACIDOSIS and INCREASE in pH demonstrates an ALKALOSIS)

PaCO2: 55mm Hg PaCO2: 35-45 mm Hg (INCREASED PaCO2 shows a respiratory condition)

PaO2: 70mm Hg PaO2: 80-100 mm Hg (DECREASED PaO2 shows HYPOXEMIA)

HCO3: 30 mEq/L HCO3: 22-26 mEq/L

Here, Tony's blood pH is 7.28 which is not exactly as far as possible and in this manner demonstrates an acidosis

Acidosis (acidic blood) happens when there is expanded measure of carbon dioxide in the blood which joins with water through carbomic anhydrase to shape carbonic corrosive and later separates into H+ particle and bicarbonate (HCO3)

So,increased CO2 in blood shows expanded H+ particle in the blood which turns the blood to be acidic.

Tony has a previous clinical history of Asthma and COPD which discloses to us that he was experiencing a respiratory condition. COPD and Asthma causes aviation route check consequently restricting wind stream all through the lungs. Subsequently there will be develop of CO2 prompting acidosis. The body repay it by expanding the degree of HCO3 (bicarbonate)

References

Moon, K. M., Min, K. W., Kim, M. H., Kim, D. H., Son, B. K., Oh, Y., ... & Kwon, O. Y. (2019). Higher acid-base imbalance associated with respiratory failure could decrease the survival of patients with scrub typhus during intensive care unit stay: a gene set enrichment analysis. Journal of clinical medicine, 8(10), 1580.

Brezina, T., Fehr, M., Neumüller, M., & Thöle, M. (2020). Acid-base-balance status and blood gas analysis in rabbits with gastric stasis and gastric dilation. Journal of Exotic Pet Medicine, 32, 18-26.