Question

Adam is a 68-year-old male admitted to the hospital with a 1-month history of nausea, vomiting, and diarrhea resulting in weight loss and fatigue. He presents tachycardic with abdominal pain, fever, and chills. Adam is a retired engineer and lives at home with his wife
On HD 6, Adam undergoes an urgent laparotomy for a severe gastric ulcer with perforation. On postoperative (postop) day 1/HD 7, you visit Adam for reassessment. He is currently in the ICU on mechanical ventilation with increased drainage from a nasogastric tube.

Anthropometric Data:
Weight: 77 kg (169 lbs) on HD 7
Last weight: 73 kg (161 lbs) on HD 3

Biochemical Data: (postop day 1/HD 7):
Sodium 143 (135-145 mEq/L) Creatinine 0.2 (0.4-1.3 mg/dL)
Potassium 3.5 (3.6-5.0 mEq/L) Glucose 139 (70-139 mg/dL)
Chloride 88 (98-110 mEq/L) Calcium 7.7 (8.5-10.5 mEq/L)
Carbon Dioxide 41 (20-30 mEq/L) Phosphorus 3.0 (2.7 - 4.5 mg/dL)
Blood Urea Nitrogen 24 (6-24 mg/dL) Magnesium 1.4 (1.3 - 2.1 mEq/L)
Arterial Blood Gas:
pH 7.48 (7.35-7.45)
PaCO2 48 (35-45 mm Hg)
PaO2 90 (80-100 mm Hg)
HCO3 29 (22-26 mEq/L)

Dietary Data:
Diet Prescription: NPO

Questions
1. Describe Adam’s acid–base status.




2. What specific acid–base disorder does he have?




3. What interventions would you recommend to manage this acid–base imbalance?

Answer 1

1.Since Adam is having a pH of 7.48,he is having alkalosis. pH greater than 7.45 indicates alkalosis.Use PaCO2 to determine respiratory effect.Since PaCO2 is high it indicates Respiratory.Hence his acid base status indicates Respiratory Alkalosis.

2 Adam is having Respiratory Alkalosis.It is a deficit of carbonic acid and a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without comparable loss of base in the body fluids.

3.I would suggest to

• Monitor for signs of respiratory distress,
• Provide emotional support and reassurance to the client.
• Encourage appropriate breathing patterns.
• Assist with breathing techniques and breathing aids.
• Provide cautious care with ventillator clients so that they are not forced to take breaths too deeply or rapidly.
• Monitor electrolyte values,particularly potassium and calcium levels.
• Administer medications s prescribed.
• Prepare to administer calcium gluconate for tetany as prescribed.