Acid Base Imbalance Case 1. An 18-year-old male arrives via EMS to the emergency department. He is experiencing Tachypnea, dizziness, numbness and paraesthesia. He is anxious, respirations are 28 per minute and shallow. ABG s are drawn and reveal ; PH: 7.52 PaCO2: 25 HCO3: 25 PaO2 :96 1. Prior to obtaining the ABG s an Allen s test should be performed. Explain the rationale for this. 2. Based on the above data what blood gas ab normality is the client experiencing. 3. Explain two appropriate nursing interventions and the rationales behind using them for this client. 1. The Allen s test is a test of collateral circulation a positive result is yielded when the skin flushes after release of the ulnar artery. If found to be negative the client is at increased risk for necrosis of tissues if the blood flow to the radial artery should be compromised. 2. Acute respiratory alkalosis, partially compensated 3. Have the client take slow deep breaths into a paper bag to allow re entrance of some of the CO2, this also helps decrease the PH. Administer NS to help the kidneys eliminate bicarb from the system faster. Correct the underlying condition
Case 2 A 34-year-old female presents to the emergency room with urinary frequency, thirst, abdominal pain for the past three day. Skin is warm and flushed, speech is clear and appropriate. She appears uncomfortable. You can smell a fruity odor on the clients breath. Vital signs: Bp: 110/72 HR: 100 bpm RR: 28 Temp: 99.4 degrees Arterial blood gases : ph: 7.28 PaCO2: 34 HCO3: 20 PaO2: 92 1. What additional questions would be helpful for the client to answer? 2. What would your interpretation of the clients ABGs be? 3. Cardiac monitoring maybe initiated on this pt as the T wave may change in size, dysrhythmias may occur what dysrhythmias may occur and how will the T wave change?. Explain the reasoning for these changes. 4. Would you administer NaHCO3? Why or why not? 1. Assess for history of diabetes and compliance 2. Acute metabolic acidosis 3. Tall peaked T-waves with prolonged PR intervals, widened QRS complex, depressed P-wave. These are caused by osmotic dehydration and hyperkalemia associated with ketoacidosis. 4. The client may try to compensate for the decreased ph by increasing respiratory rate, this would cause acute respiratory alkalosis.
Case 3 A 65-year-old female presents to the emergency department with complaints of nausea, vomiting, and diarrhea, and intermittent stomach pain for approx. one month. She states that she has been taking an increased amount of liquid medicine for her stomach problems over the past few days. Upon assessment, the nurse notes that the client is shaking. Vital signs Bp: 126/90 mmhg HR: 96 bpm RR: 10 ABG S ph: 7.55 PaCO2: 40 HCO3: 32 PaO2: 94 1. Interpret the ABG results 2. What would produce a change in the client's serum Ca++ level, thereby causing shaking of her hands? 3. Explain why the respiratory rate is only 10 when the PaCO2 is only 40? 1. Chronic metabolic alkalosis 2. An increase in ph promotes Ca++ binding with protein, therefore serum calcium levels drop. Calcium acts as a sedative on skeletal muscles they become easily excited. 3. The client is in metabolic acidosis. The respiratory system is the first to compensate for the ph elevation. It is doing so by decreasing the Respiratory rate in an effort to hold onto CO2 acid
Case 4 A 44-year-old male is brought into the ER after ingestion of 25 Percodan tablets. He is confused, pale, and tremors are noted in both hands. Vitals Bp: 92/60 mmhg HR: 116 RR: 8 ABG s ph: 7.20 PaCO2: 58 HCO3: 26 PaO2: 89 1. What is the interpretation of this client's arterial blood gases? 2. Why is ventilatory assistance a priority nursing intervention for this client? 1. Uncompensated respiratory acidosis. 2. This client has ingested opioid narcotics, which will continue to depress the respiratory drive. This will then in turn lower the 02 saturation and effect tissue perfusion and perfusion of vital organs. Thus making intubation necessary to support the respiratory drive.
Case 5 72-year-old male is brought to the emergency department with a chief complaint of difficulty breathing and he has a history of COPD. over the past few days simple tasks and moving around have become increasingly more difficult. His pulse ox reading is 90%. 1. What would the expected PaO2 reading? 2. His ABG s read ph: 7.35 PaCO2: 50 HCO3: 30 Provide an explanation of the overall state of his blood gas results and an individual analysis of each result. 1. Remember the 30-60-90 rule: 02: 90% then PaO2 60 mmhg 2. ph is normal, this shows that the renal compensatory system is in working order. PCO2 is high, this is from the chronic COPD which leads to impaired gas exchange HC03: high, metabolic compensation The overall analysis of this set of ABG s is respiratory acidosis