Question

N.A. is brought to the ED for management of intentional drug overdose. He ingested 56 tables of Amoxicillin (prescribed 875 mg po BID for 28 days for a sinus infection) and 30 tablets of Seconal (prescribed 100 mg capsules po QHS prn for sleep). His respirations are slow and shallow, and he is non-responsive. He is admitted to the critical care unit to be closely monitored for the development of ventilatory failure and renal failure, which often accompany drug overdose of Amoxicillin (renal failure) and secondary (ventilatory failure). His urine output is decreased at about 20 mL/hr. His laboratory values and serum K+ = 6.7 mEq/L; arterial blood gas: pH = 7.13, PaCO2 = 65 mm Hg; PaO2 = 88 mm Hg, and HCO3- = 16 mEq/L.

5. Can N.A. compensate for his acid-base disorder? Why or why not? (2 points)

6. How should his acid-base imbalance be medically managed? What is your rationale for each interventions? (2 points)

7. List two nursing diagnoses and one spiritual nursing diagnoses for N.A. (3)

Answer 1

5. N.A has increased PaCo2, pH less than 7.35, and low bicarbonate level shows that he had an acid-base disturbance of metabolic acidosis. The cause of metabolic acidosis is drug intoxication and renal failure. Hyperventilation can compensate for the metabolic acidosis. The patient should regain normal respiration if he managed well and responded to the treatment. Increased PaCo2 shows that he is in the compensatory mechanism.

6.Management of Acid-base disorder

Management	Rationale
Detoxification	To remove the excess drug present in the body.
Administer IV fluids and sodium bicarbonate	To improve the bicarbonate levels.
Assess the potassium levels.	Hyperkalemia leads to increased ECF.
assess respiratory status.	To minimize ventilatory failure.

7. Nursing Diagnosis:

• Decreased cardiac output related to acid-base imbalance as evidenced by hypotension.
• Impaired breathing related to hypoventilation as evidenced by Kussmaul's respiration.
• Spiritual distress related to drug intoxication as evidenced by the loss of hope.