Acid-Base and Electrolyte Case Study

Acid-Base and Electrolyte Case Study

A nurse is taking care of an 85-year-old woman in a hospital based skilled nursing facility. In report, the nurse is told the patient has not been breathing well for the past 2 days. She has been lethargic, her skin is warm and dry, and she has a decreased urine output. The following laboratory findings were returned from the laboratory immediately after morning report: Acid-Base and Electrolyte Case Study

• Na: 147
• Cl 110
• K 4.0
• Blood Gases:
• pH 7.33
• PCO2 48
• HCO3 27
• Po2 96
• Urine:
• Urine Specific Gravity 1.040

Address the following:

1.Identify each of the abnormal laboratory findings in the above results. Specify how they differ from a normal range and identify what condition each abnormality indicates.

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2.What specific electrolyte disturbance does the patient have?

3.What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?

4.If the patient had an increase in her potassium level, what clinical manifestations would the nurse monitor for?

5.What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.

6.What are the three major mechanisms of pH regulation?

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Normal sodium level in blood ranges between 135 and 145 milliequivalents (mEq/L) per liter (Costa & Soares, 2017). The patient’s concentration of sodium is higher than normal which suggests the presence of hypernatremia condition. The Chlorine levels of 110 mEq/L are also higher than the normal which is 97-107 mEq/L. This indicates potential hyperchloremia. The pH levels of 7.33 also deviate from the normal range of between 7.35 and 7.45. The patient could thus be having acidemia. The normal PCO2 in blood is 38 to 42 mm Hg and therefore, a high of 48 mmHg suggests the presence of hypercapnia. The normal Urine Specific Gravity is between 1.002 and 1.030 (Zubac et al., 2018). High results of 1.040 demonstrate that the patient is dehydrated. Acid-Base and Electrolyte Case Study

Specific electrolyte disturbances include sodium, chlorine and levels of pH. Hypernatremia is characterized by lethargy which causes extreme weaknesses and fatigue together with confusion (Costa & Soares, 2017).  On the other hand, hyperchloremia causes high blood pressure, dry mucous membrane, excessive thirst, weakness of muscles and fatigue. Acidemia also causes lethargy and dehydration while hypercapnia symptoms include confusion, lethargy, reduced neural activity, flushed skin and muscle twitches among others (Shchelochkov, Carrillo & Venditti, 2016). If the patient had an increase in potassium level, she would have trouble breathing, chest pains, nausea, numbness and tingling, tiredness and palpations symptoms associated with hyperkalemia.

The blood gas abnormality seen in this patient is both the pH OF 7.33 and 48 mmHg of PCO2. The normal range for these blood gas components are between 7.35 and 7.45 and a range of 38 to 42 mm Hg respectively (Giordano et al., 2016). The three major mechanisms of pH regulation are the buffers, respiratory and renal mechanisms. Buffer mechanism includes phosphates, proteins as well as H2CO2 : HCO3-.

References

Costa, J. M., & Soares, J. B. (2017). Symptomatic Hyponatremia after Bowel Preparation: Report of Two Cases and Literature Review. Acta medica portuguesa, 30(11), 824-826.

Giordano, M., Ciarambino, T., Castellino, P., Malatino, L., Di Somma, S., Biolo, G., … & Adinolfi, L. E. (2016). Diseases associated with electrolyte imbalance in the ED: age-related differences. The American journal of emergency medicine, 34(10), 1923-1926.

Shchelochkov, O. A., Carrillo, N., & Venditti, C. (2016). Propionic acidemia. In GeneReviews®[Internet]. University of Washington, Seattle.

Zubac, D., Reale, R., Karnincic, H., Sivric, A., & Jelaska, I. (2018). Urine specific gravity as an indicator of dehydration in Olympic combat sport athletes; considerations for research and practice. European journal of sport science, 18(7), 920-929.

Acid-Base and Electrolyte Case Study