Effective Multidimensional Nursing Care for Clients with Acid-base imbalances. Scenario Tony is a 56-year-old Hispanic male admitted to the emergency room due to shortness of breath. He reports that he has experienced shortness of breath for the past two days
. However, he clarified that he has been experiencing fatigue, cough, and fever for the past week. He still reported to work despite feeling unwell. Tony’s medical history includes chronic obstructive pulmonary disease, asthma, and diabetes. His physical examination revealed that he was struggling to breathe. Tony’s vital signs showed a respiratory rate of 36 breaths per minute, blood pressure of 90/40 mmHg, heart rate of 115 beats per minute, and SPO2 of 84%. An arterial blood gas test showed a pH of 7.28, PaO2 of 70 mmHg, PaCO2 of 55 mmHg, and HCO3 of 30 mEq/L.
Acid-Base Disorder
Tony’s acid-base imbalance is acute respiratory acidosis. Normal arterial blood pH in an adult is between 7.35 and 7.45; therefore, Tony has a lower-than-normal arterial blood pH of 7.28. normal arterial blood partial pressure of carbon dioxide (PaCO2) in an adult range between 35 mmHg and 45 mmHg. Tony has a PaCO2 of 55 mmHg, which is higher than normal. Normal serum bicarbonate levels in an adult range between 21 mEq/L and 28 mEq/L; therefore, Tony has a higher-than-normal serum bicarbonate of 30 mEq/L. the normal partial pressure of oxygen (PaO2) ranges from 75 mmHg to 100 mmHg. Tony has a PaO2 of 70 mmHg, which is lower than the normal value (Hopkins et al., 2022).
Respiratory acidosis is characterized by decreased pH and increased PaCO2, which are seen in Tony’s arterial blood gas results. Respiratory acidosis can be either acute or chronic, depending on a patient’s arterial blood gas results. Patients diagnosed with chronic respiratory acidosis have a high PaCO2, a bicarbonate level higher than 30 mEq/L. A normal or near normal blood Ph. Chronic respiratory acidosis is ruled out since Tony has a bicarbonate reading of 30 mEq/L, which is not more than 30 mEq/L, and a pH of 7.28 which is neither normal nor near normal. Acute respiratory acidosis is characterized by an increased PaCO2 and Ph less than 7.35. Tony has an increased PaCO2 and a pH of 7.28, which is less than 7.35 (Patel & Sharma, 2022). the diagnosis is, therefore, acute respiratory acidosis.
Compensation in acute respiratory acidosis begins with cellular buffering, followed by renal compensation. Renal compensation occurs for three to five days, while cellular buffering occurs within minutes or hours. Cellular buffering aims to slightly increase bicarbonate levels by about one mEq/L for a PaCO2 increase of 10 mmHg. Renal compensation aims to increase carbonic acid’s excretion and reabsorption of bicarbonate.
Causes of the Acid-Base Disorder
Causes of respiratory acidosis include chronic obstructive pulmonary disease, obesity, hypermetabolic states, airway and lung diseases, depression of the central nervous system, chest wall disorders, obstructive sleep apnea, and neuromuscular diseases (Patel & Sharma, 2022).
Signs and Symptoms of the Disorder
The clinical presentation of a patient experiencing acute respiratory acidosis depends on the underlying disease. Tony’s underlying disorder is chronic obstructive pulmonary disease and asthma. Symptoms include shortness of breath, cough, anxiety, and progressive confusion. A physical examination in a patient with chronic obstructive pulmonary disease experiencing acute respiratory acidosis might reveal prolonged expiration, rhonchi, decreased breath sounds, wheezing, barrel chest, and hyperresn resonance. Patients diagnosed with acute respiratory acidosis may present with dilated conjunctival blood vessels and papilledema. Depressed mental status occurs when acute respiratory acidosis progresses to severe respiratory acidosis. Possible treatment interventions include ventilator support, oxygen therapy, bicarbonate administration, respiratory stimulants such as medroxyprogesterone, and the administration of bronchodilators (Patel & Sharma, 2022).
Multidimensional Nursing Care
Tony’s illness is managed using multidimensional nursing interventions. Tony is admitted to the emergency unit with shortness of breath and requires mechanical ventilation. The nurse ensures that Tony is adequately hydrated. The nurse must be alert to note changes in Tony’s central nervous system and respiratory and cardiovascular functions. Tony’s arterial blood gases and electrolyte status are frequently monitored. The nurse ensures Tony is positioned in Fowler’s to increase comfort, safety, and ease of breathing (Armstrong & Moore., 2022).
References
Armstrong M, Moore RA. (2022). Anatomy, Patient Positioning. StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK513320/figure/article-26759.image.f2/.