Question

Case Study A Mr. Alfonzo Smith Mr. Frank is a 60-year-old with pneumonia. He is admitted with dyspnea, fever, and chills. His blood gas is below: Ph 7.28 Co2 56 PO2 70 hco3 25 Sao2 89% Interpretation Interventions/Goals Case Study B Ms. Strauss is a 24-year-old college student. She has a history of Crohn's disease and is complaining of a four-day history of bloody-watery diarrhea. A blood gas is obtained to assess her acid-base balance: Ph 7.28 Co2 43 PO2 88 Hco3 20 Sao2 96% Interpretation Interventions/Goals

Answer 1

Case study A :

Interpretation - Respiratory acidosis

Interventions :- Medical Management include :-

-improve respiratory ventilation via:

-mechanical ventilation

-bronchodilators, antibiotics, anticoagulants

-pulmonary hygiene; coughing, turning, deep breathing INCENTATIVE SPIROMETER postural drainage

-adequate hydration

-supplemental oxygen (beware if chronic hypercapnia) *COPD pt's are accustomed to increased CO2 levels; a lack of O2 called hypoxic drive stimulates these pt's to breathe

-monitor I&O, VS (always include O2 sat), ABGs

# Case study B :

Interpretation - Metabolic acidosis

Interventions - Medical Management of Metabolic Acidosis

-IV HCO3- may be administered in severe acidosis; a rapid transition from acidosis to alkalosis can be detrimental

-Frequently monitor ABG's

-Correct the precipitating cause of acidosis

# Nursing Management of Metabolic Acidosis

-Identify and treat the cause

-Determine the history of the precipitating cause- diabetes, alcohol intake, renal disease, excessive GI fluid loss, and lactic acidosis.

-Assess serum laboratory results: BUN and Creatinine for renal function, Serum Electrolytes, Serum Glucose levels, monitor ABG's

-Monitor vital signs including weight

-Determine whether compensation is occurring. If the value (CO2 or HCO3-) that does not match the direction of the pH is moving/pH is moving in the opposite direction, then compensation is occurring.

(Kidneys will compensate acidosis by increasing HCO3-, lungs will compensate acidosis by decreasing the CO2)