Question

A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursing facility. In the report, the nurse is told the patient has not been breathing well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report: Na: 147 Cl 110 K 4.0 Blood Gases: pH 7.33 PCO2 48 HCO3 27 Po2 96 Urine: Urine Specific Gravity 1.040

Address the following: Identify each of the abnormal laboratory findings in the above results.

Specify how they differ from a normal range and identify what condition each abnormality indicates. What specific electrolyte disturbance does the patient have?

What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?

What blood gas abnormality is seen in this patient? Discuss the rationale for your answer. What are the three major mechanisms of pH regulation?

Answer 1

The abnormal laboratory findings ,there difference from normal range ,each abnormality indicates the following  are

• Increased sodium level 147mEq/L (135_145mEq/L) indicates hypernatremia
• Decreased pH 7.33(7.36_7.44) indicates acidosis
• Increased PCO2 48 (36_44mmHg) indicates hypoventilation due to hypercapnia
• Increased HCO3 27 (22_26mEq/L) indicates some sort of metabolic problems

The specific electrolyte disturbance is an increased level of sodium called as hypernatremia

The following clinical manifestation the nurse can expect are

• Neurological :confusion,irritability, seizure,coma
• GIT:polydypsia
• Muscular :muscle spasm
• General :fatigue,dehydration

The patient is experiencing acute uncompensated respiratory acidosis (decreased pH=acidosis,Increased PCO2=hypoventilation in lungs or respiratory system,increased HCO3)

The three major mechanism of pH regulation are

1. Protein buffer system:They may be intracellular or extracellular. They contain haemoglobin responsible of oxygen transportation .The level of plasma protein less than the intracellular protein.This buffer forms the hydrogen ion acceptor or releasing in presence of acidic and basic groups maintaining the pH level
2. Phosphate buffer system:This mainly comprises of two forms of hydrogen ions namely hydrogen phosphate ion (acidosis) and dihydrogen phosphate ion (alkalosis). When the pH decreses the hydrogen phosphate ion accepts hydrogen ion nd combines with hydroxide to maintain normal pH.Similarly when the pH increases the dihydrogen phosphate ion will increase hydrogen ion and maintain the normal range of pH
3. Bicarbonate buffer system:It helps to maintain the acid and base of the body.When there is excess carbondioxide ,it converts to the biproducts of respiratory cells and releases it to maintain normal status