Competency
Describe strategies for safe, effective multidimensional nursing care for clients with acid-base imbalances.
Scenario
Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states “I haven’t felt good for about a week, but couldn’t afford to miss work.” He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 L via NC and an arterial blood gas.
Tony’s ABG results:
pH 7.28
PaCO2 – 55 mm Hg
PaO2 – 70 mm Hg
HCO3 – 30 mEq/L
Instructions
In a 1-2 page Word document:
1. Determine Tony’s acid-base imbalance
2. Describe possible causes of the imbalance
3. Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance
4. List the multidimensional care strategies that are appropriate for the care of Tony
### Acid-Base Imbalance in Tony
#### 1. Determining Tony’s Acid-Base Imbalance
Tony’s arterial blood gas (ABG) results indicate the following:
– **pH**: 7.28 (Normal range: 7.35-7.45)
– **PaCO2**: 55 mm Hg (Normal range: 35-45 mm Hg)
– **PaO2**: 70 mm Hg (Normal range: 80-100 mm Hg)
– **HCO3**: 30 mEq/L (Normal range: 22-26 mEq/L)
Based on these results, Tony is experiencing **respiratory acidosis**. This is characterized by a low pH (indicating acidosis) and an elevated PaCO2 (indicating a respiratory cause). The HCO3 is elevated, suggesting a compensatory metabolic response.
#### 2. Possible Causes of the Imbalance
Possible causes of Tony’s respiratory acidosis include:
– **Chronic Obstructive Pulmonary Disease (COPD)**: His history of COPD likely contributes to the retention of CO2, as the lungs cannot expel it effectively.
– **Asthma**: Asthma exacerbations can lead to airway obstruction, increasing CO2 retention.
– **Infection**: His symptoms of cough, fever, and feeling exhausted suggest a possible respiratory infection, which can worsen his underlying respiratory conditions and contribute to hypoventilation.
#### 3. Signs and Symptoms Resulting from the Acid-Base Imbalance
Tony is exhibiting several signs and symptoms consistent with respiratory acidosis, including:
– **Shortness of Breath**: Indicative of difficulty in expelling CO2.
– **Tachypnea (Respiratory rate of 36 breaths per minute)**: An attempt to compensate for the acidosis by increasing the breathing rate.
– **Labored Breathing**: Due to respiratory distress and increased effort to breathe.
– **Tachycardia (Heart rate of 115 beats per minute)**: A compensatory response to low oxygen levels.
– **Hypotension (Blood pressure 90/40 mm Hg)**: Possibly due to sepsis or respiratory distress.
– **Low Oxygen Saturation (Pulse oximetry 84% on room air)**: Reflecting hypoxemia due to impaired gas exchange.
#### 4. Multidimensional Care Strategies for Tony
To manage Tony’s condition, a comprehensive approach is required:
**a. Respiratory Support**
– **Oxygen Therapy**: Administer oxygen via nasal cannula (NC) to maintain adequate oxygen saturation. Monitor and adjust the flow rate as necessary.
– **Bronchodilators**: Administer bronchodilators (e.g., albuterol) to relieve bronchospasm and improve airway patency.
– **Steroids**: Use corticosteroids to reduce airway inflammation.
**b. Monitoring and Diagnostics**
– **Continuous Monitoring**: Regularly monitor vital signs, oxygen saturation, and respiratory status.
– **Repeat ABGs**: Perform follow-up ABGs to assess the effectiveness of interventions and adjust treatment accordingly.
– **Chest X-Ray**: Obtain a chest x-ray to identify any underlying infections or complications such as pneumonia.
**c. Pharmacologic Management**
– **Antibiotics**: If an infection is suspected or confirmed, administer appropriate antibiotics to treat the underlying infection.
– **Diuretics**: If there is evidence of fluid overload, consider diuretics to reduce pulmonary congestion.
**d. Patient Education and Support**
– **Education**: Teach Tony about the importance of medication adherence, avoiding respiratory irritants, and recognizing early signs of exacerbation.
– **Smoking Cessation**: If Tony smokes, provide resources and support for smoking cessation, as smoking can exacerbate COPD and asthma.
**e. Coordination of Care**
– **Multidisciplinary Team**: Collaborate with respiratory therapists, pulmonologists, and dietitians to provide comprehensive care.
– **Follow-up Care**: Arrange for follow-up appointments to monitor his chronic conditions and prevent future exacerbations.
By implementing these multidimensional care strategies, healthcare providers can effectively manage Tony’s respiratory acidosis, improve his clinical outcomes, and prevent further complications.
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