Posted: March 29th, 2023

Clients with acid-base

Describe strategies for safe, effective multidimensional nursing care for clients with acid-base

imbalances.

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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,

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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,

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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

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PaCO2 – 55 mm Hg

PaO2 – 70 mm Hg

HCO3 – 30 mEq/L

Instructions

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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

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imbalance

4. List the multidimensional care strategies that are appropriate for the care of Tony/

Resources

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Acid-base imbalance:
Based on Tony's ABG results, he has respiratory acidosis. This is because his pH is below the normal range of 7.35-7.45, and his PaCO2 is elevated, which indicates an accumulation of carbon dioxide in his bloodstream.

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Possible causes of the imbalance:
Tony's respiratory acidosis could be caused by his chronic obstructive pulmonary disease (COPD) and asthma. These conditions cause airway obstruction and make it difficult for Tony to breathe, leading to hypoventilation and the retention of carbon dioxide in his body.

Signs and symptoms of the acid-base imbalance:
As a result of the respiratory acidosis, Tony is experiencing shortness of breath, labored breathing, increased respiratory rate, increased heart rate, low blood pressure, and decreased oxygen saturation. He may also feel fatigued and have a persistent cough.

Multidimensional care strategies:
To provide safe and effective care for Tony's acid-base imbalance, a multidimensional approach is necessary. This may include:

Oxygen therapy: Tony requires supplemental oxygen to improve his oxygen saturation levels.
Medication management: Tony may require bronchodilators or corticosteroids to manage his asthma and COPD symptoms.
Respiratory support: If Tony's condition deteriorates, he may require mechanical ventilation to assist with