Question

Isaac is 63 yrs old,

13. Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes. On his admi ission, the nurse observed rapid respirations, confusion, and signs of dehydration. a. Isaac's arterial blood gas values are pH, 7,27: HCOs, 20mEqL Pa0 33mmig The nurse understands that the patient is compensating at this time. What do the blood gas results indicate for this patient? What does the nurse recognize are the manifestations associated with an alteration in acid-base balance? b. In terms of cellular buffering response, what should the nurse expect the major electrolvte disturbance to be? c. What prescribed intravenous medication does the nurse anticipate administering to correct the acid-base imbalance? d.

Answer 1

A, Issac blood gas results indicate on metabolic acidosis

Normal PH - 7.35-7.45

His PH value -7.27(low)

Normal HCo3- 22- 66mmol/L

His HCO3 - 20mmol/L(low)

Normal paco2 35-45mmhg

His paco2 33mmhg (low)

Acidosis is an abnormal process that increase the serum hydrogen ion concentration, it lowers the pH and cause acidemia..

In metabolic acidosis PH range will be less and HCo3 decreased and respiratory compensation occur paco3 either low or high..

B, manifestation associated with an alteration acid- base balance is rapid respiration, confusion and dehydration and having a history of diabetes..when people having diabetes our body will not get enough insulin, we get dehydrated..our body burn fat instead of carbs that make ketones..more ketones in our body blood turn into acidic..

C, There is intracellular and extracellular buffers in case of respiratory and metabolic acid base disturbance..in metabolic acid base disorder, body responds by intracellular and plasma buffers..That time kidney acts to correct the metabolic disturbances..In metabolic acidosis respiratory compensation will not return PH normal..Renal acid excretion serves to correct the acidosis..in metabolic acidosis the acid load H+ will be high and non- carbonate buffers intracellularly that is protein and phosphorus in soft tissues,hemoglobin in red blood cells binds the excess hydrogen and there is decreased calcium level.....

Low pH causing hyperventilation,it reduces the paco2.. hyperventilation due to increased tidal volume it make deep breath..The kidney corrects the metabolic acidosis by excreting excess acid as ammonium chloride by the process of ammoniagenesis in the kidney..it takes several days to correct acidosis, kidney also excrete hydrogen actively in tubules there by H- ATPase..once NH4 formed it stuck in the fluid and excreted with chloride.. Ammoniagenesis affect the ability of nephron to excrete hydrogen, decrease the PH and pump the hydrogen with chloride..so lateral chloride exchanger which pump chloride into the cells for exchanging bicarbonate,it increases the plasma and helps buffer the acidosis..

4, medications:

Sodium bicarbonate intravenous infusion will act as a antacids, mineral and electrolyte, urinary pH modifier , it also corrects the acid base imbalance..