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Acid-Base Imbalance: Tony’s Scenario (Essay Sample)


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 4 L via NC and an arterial blood gas.


Acid-Base Imbalance: Tony’s Scenario
Institutional Affiliation
Tony’s acid-base imbalance
According to ABG results, Tony’s pH is 7.28, compared to normal human body pH that ranges from 7.35 to 7.45; depicting Tony has a respiratory acidosis (Gulanick & Myers, 2021). In normal adults, carbon dioxide pressure in the blood is 35-45 mmHg. In the case of Tony, PaCO2 is 55 mmHg, showing increased blood acidity. The normal pressure of oxygen in blood is 80-100 mmHg. Tony’s PaO2 is 70 mm Hg, which is low due to increased CO2 production as result of poor ventilation and less oxygen supply (Gulanick & Myers, 2021). The normal body levels for HCO3 are 22 to 28mEq/L compared to the case of Tony, which is 30 mEq/L, showing compensation to neutralize acidity. 
Possible Causes of the Imbalance
Tony is suffering from acidosis, a respiratory condition characterized by low pH. The low pH is caused by high production of CO2, which increases blood acidity (Gulanick & Myers, 2021). The production of CO2 also results in poor ventilation as well as limitation of oxygen intake in the bloodstream thus the depicted below normal pressure of oxygen in blood 70 mmHg. Increase in PCO2 is caused by decrease in oxygen supply levels due to inadequate ventilation. Therefore, an increase in PaCO2 causes the blood becomes more acidic as well as reduced pH (Patel & Sharma, 2020).  HCO3 depicts the levels of bicarbonate in the blood. Like in the case of Tony, the level of HCO3 is above the normal levels, which is 22 to 28mEq/L. This means that the body is reacting to compensate or neutralize levels of blood acidity. As the HCO3 increases, the blood becomes more alkaline and the pH increases.
Signs and Symptoms of Acidosis Exhibited by Tony
Respiratory acidosis is commonly characterized by increased pulse and respiratory rate, increased blood pressure, weakness, dullness, headache, and mental cloudiness (Gulanick & Myers, 2021). Similar to the Tony’s case, he exhibited several signs and symptoms.
* Increased respiratory rate (36 breaths per minute)
* Increased pulse rate (115 beats per minute)
* Increased blood pressure (blood pressure 90/40 mmHg)
* Higher levels of CO2
* Rapid developing hypercapnia
* Fever
* Fatigue/Feeling exhausted
* Chronic obstructive pulmonary disease
* Diabetes
* Coughs
Multidimensional Care Strategies for Respiratory Acidosis
Treatment and management of acidosis demands multidimensional care strategies due to its complex nature. The diagnoses help identify the severity of the condition as well as the underlying medical conditions of the patient (Gulanick & Myers, 2021). The treatment of the condition should be aimed at improving respiration and ventilation.
The patient should be given chest therapy. The chest therapy should be given at specific time as prescribed by the doctor. The therapy helps in clearing secretions thus improving ventilation, allowing excess CO2 to be eliminated.
The patient should be given necessary medication

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