Question

1. On day 2 of his hospital stay, Mr. Abdul begins to complain of increased muscle weakness and cramping. Assessment findings include an irregular apical pulse and hypoactive bowel sounds. Provide a possible explanation for these findings and identify appropriate nursing action.
2. Mr. Abdul is at risk for acid base imbalance.
   1. What are the four Acid-Base imbalances?
   2. Describe the underlying causes for each
   3. Describe the clinical manifestations (i.e. signs and symptoms)
   4. What are interventions for each acid-base imbalance
   5. What is the result of Mr. Abdul arterial blood gases.
   6. What acid-base imbalance is Mr. Abdul experiencing? Give a rationale for your answer.

Answer 1

a. 4 acid base imbalance are:-

1.Respiratory acidosis- It is a condition in which there is an increase in hydrogen ion due to alveolar hypoventilation.

2. Respiratory alkalosis- it is a condition in which there is decrease in hydrogen ion due to alveolar hyperventilation.

3. Metabolic acidosis- There is increases in hydrogen ion due to abnormal metabolic process.

4. Metabolic alkalosis- there is decrease in hydrogen ion due to abnormal metabolic process.

b.causes of acid base imbalance:-

1. Respiratory acidosis- respiratory disorders , brain trauma, CNS depressants such as sedatives, narcotics, anesthesia etc.

2.Respiratory alkalosis-Hypoxia, overventilation by mechanical ventilation, fever, pain.

3.Metabolic acidosis- Diabetes mellitus, diabetic ketoacidosis, renal insufficiency, high fat diet, insufficient metabolism of carbohydrate, malnutrition, startvation, excess ingestion of aspirin and severe diarrohea.

4.Metabolic alkalosis- massive blood transfusion due to citerate in CDPA, excess vomiting, GI suctioning, antacid use,

diuretics use, hyperaldosteronism, ingestion or infusion of excess sodium bicarbonate.

c.Clinical manifestations-

1. Respiratory acidosis-Hypoventilation, hypokalemia, drowsiness, dizziness, disorientation, headache, seizures ,coma, dysrhythmia,warm fkush skin and hypotension.

2. Respiratory alkalosis- Hyperventilation, hypokalemia, hypocalcemia, lethargy, tachycardia,tetany,tremor,numbness,tingling sensation

3. Metabolic acidosis-Hyperventilation and Mainly seen is Kussmauls respiration which is an abnormal regular increased rate and depth of respiration. Remainig are same as respiratory acidosis.

4.Metabolic alkalosis-There will be hypoventilation and other are same as respiratory alkalosis.

d.Interventions-The basic intervention for all types of acid base imbalance is to correct the underlined cause and symptomatic management.

1 Respiratory acidosis-provide oxygen therapy, semi fowlers position, airway suctioning, increase hydration, promote deep breathing and coughing, ET intubation with mechanical ventilation and antibiotuc if infection is present.

2. Respiratory alkalosis-Volunatry hold breath,CO2 breath by paper bag, use of rebreather mask , proper care of patient on ventilation, injection calcium gluconate is given fir tetany .

3.Metabolic acidosis-Correct the underlined cause and injection sodium baicrbonate is given.

4. Metabolic alkalsosis- correct the underlying cause.

e. Result of ABG of Mr Abdul will be-

pH- more than normal i.e. more than 7.45

PCO2- less than normal i.e.<35mmHg

f.Mr Abdul is suffering from respiratory alkalosis because the signs of muscle weakness , cramping are indicative of hypocalcemia and disturbance in heart function because of hypokalemia.