Question

Name Duby ACID/BASE EXERCISES 1. pH 7.35 PCO2-42 HCO3 26 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care? 2, pH=7.31 PCO2 51 HC03 27 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care? 3. pH-7.47 PCO2- 30 HCO3-24 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care? 4. pH 7.33 PCO2- 40 HCO3-20 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care? 5. pH-7.50 PCO2 38 HCO3-30 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care? 6. pH-7.43 PCO2-30 HC03 20 What is the imbalance and what is the cause? What are the clinical manifestations? What is the nursing care?

Answer 1

1.Now the patient ABG levels are normal at present and progressing towards to the stage of respiratory acidosis

$\rightarrow$ Causes : Asthma,COPD,severe obesity

$\rightarrow$ Clinical Manifestations :Dyspnea,Anxiety,wheezing,Sleep disturbances

$\rightarrow$ Nursing care:

*Assess and monitor the ABG frequently

*Assess the breathing patter nad chest recoiling

*Assess the oxygen status frequently

*Repositioning the patient to promote diffusion

*Maintain semi-fowlers position

*Encourage to use spirometer for improving the alveolar surface area

2.Respiratory acidosis

$\rightarrow$ Causes: Asthma,COPD,Acute Pulmonary edema,Neuro muscular disorders,sedative overdose,Pneumonia,cardiac arrest

$\rightarrow$ Clinical Manifestations :Cyanosis,Altered Mental,Status,Myoclonus or even seizure.Persistence of apnea during sleep can lead to daytime somnolence and head aches.

Here we can see the case is in severe respiratory acidosis accomplished by prolonged hypo ventilation,and shows hyper capnia that leads to cerebral vasodilation,Increased ICP and papilledema,memory loss,impaired co-ordination,polycythemia,pulmonary hypertension and if proper management is not initiated goes to a stage of respiratory failure.

$\rightarrow$ Nursing care:

*Early assessment of patient tissue oxygenation status frequently

*Monitor and evaluate the patient ABG results frequently

*Check for the symptoms such as elevated temperature,anemia,impaired cardiac output,acidosis and sepsis are the indicators for inadequate coronary artery perfusion.

*Assess for the ventilation perfusion mismatch (V/Q matching) to improve respiratory efficiency

*Effective use of incentive spirometrer to maximize diffusion and alveolar surface area

*Suctioning helps to mobilize sputum and other lung secretions

*Repositioning enhances diffusion

3.Respiratory Alkalosis

Causes :Pulmonary Embolism,Pneumonia, Asthma,Pulmonary Edema,Excessive controlled ventilation,Head injury,Stroke,Anxiety hyperventilation

$\rightarrow$ Clinical Manifestations :Hyperventilation,Tacypnea,dizziness,paresthesias,ischemia/ pleuritic chest pain,Severe anxiety,hypocalcemia and hypokalemia

$\rightarrow$ Nursing care :

*Encourage the patient to re-breath in to a paper bag or re-breather mask

*Watch pottasium and calcium levels

*Assess for the symptoms of hypocalcemia and hypokalemia

*Reduce the concentration of mechanical ventilation

*Watch patient on mechanical ventilation to ensures breaths are not hyperventilating the bag

4.Metabolic Acidosis

$\rightarrow$ Causes : High anion gap and Normal anion gap problems

$\rightarrow$ Clinical Manifestations: Kussmaul's Breathing,hyperpnea fatigue,tiredness,confusion,Shortness of breath,sleepliness,head ache

$\rightarrow$ Nursing care:

*Monitor and evaluate ABG closely

*Assess the electrolytes values mainly potassium levels

*Watch the neurological status of the patient

*Take seizure precaution

5.Metabolic Alkalosis

$\rightarrow$ Causes:Acid loss,alkali administration,Hypokalemia,renal bicarbonate retention,excessive aldosterone production,loop diuretics,Anti-coagulant "citrate",Loss of fluid

$\rightarrow$ Clinical manifestations : Hypoventilation,Bradypnea,Nausea and vomiting,light headedness,Hand tremor,Muscle twitching,confusion,prolonged muscle spasm,Numbness and tingling in the face ,hands or feet,confusion can progressive to stupor or coma.

$\rightarrow$ Nursing care:

**Watch and monitor ABG frequently to assess the sign of respiratory distress

*Treat the patient according to the cause

*Administer medications according to the symptoms as per doctor's order

*Monitor pottasium and chloride levels there may chance of loosing in this condition

6.Compensated Respiratory Alkalosis

$\rightarrow$ Causes:Direct or reflex hypoxemic situation of the respiratory center,pulmonary disease,excessive mechanical ventilation

$\rightarrow$ Clinical Manifestations:*Decline in ECF bicarbonate concentration,hyperchloremia,decreased PCO_2,agitation,dyspnea,Kussmaul's breathing,weaknes,tachypnea

$\rightarrow$ Nursing care:

*Be alert for the signs of changes in neurologic,neuromuscular or cardiovascular functions

*Assess for the the signs of Altered level of consciousness,head ache and lack of energy

*Encourage the patient to take deep,slow breaths

*Monitor vital signs

*Monitor ABG

*Restrict sodium and chloride intake