Advanced Health Assessment Discussion
Advanced Health Assessment Discussion
A 22-year-old woman reports being “sick with the flu” for the past 8 days. She is vomiting several times every day, having difficulty keeping liquids or food down, and has been using more than the recommended dose of antacids in an attempt to calm the nausea. She has become severely dehydrated. After fainting at home, she was taken to a local hospital. An arterial blood gas sample was drawn and then an IV was placed to help rehydrate her. The arterial blood gas revealed the following Advanced Health Assessment Discussion:
Test Result Normal levels
pH 7.5 7.35 – 7.45
PaCO2 40 mm Hg 35-45 mm Hg
PaO2 95 mm Hg 80-100 mm Hg
SaO2 97% 95-100%
HCO3– 32 meq/liter 22-26 meq/liter
How would you classify the patient’s acid-base disturbance and explain why?
ORDER A FREE-PLAGIARISM PAPER NOW
Given the case study, what are the possible factors causing this acid-base disturbance? Explain the pathophysiology created by these factors Advanced Health Assessment Discussion.
How would the renal and respiratory systems try to compensate for this acid-base disturbance?
What pharmacologic intervention is commonly used to correct this acid-base disturbance? Describe the pharmacological actions.
Describe the educational needs for this patient and what your approach will be.
Focused Assessment for Nurse Educators
CHIEF COMPLAINT
Sick with flu-like symptoms and frequent vomiting
HISTORY OF PRESENT ILLNESS
The 22-year-old woman presents with flu-like symptoms for the past eight days. She reports nausea, frequent vomiting making it difficult to retain fluids and food. She posited that she had used an overdose of antacids to calm nausea. She is severely dehydrated and fainted before brought to the hospital.
REVIEW OF SYSTEMS
General appearance: weak and dehydrated
HEENT: sunken eyes
Cardiovascular: has intravenous access
Respiratory: PaO2 of 95 mm Hg, SaO2-97%
Gastrointestinal: vomiting, nausea, difficulty retaining liquids or foods
Genitourinary: dark urine
Musculoskeletal: NAD
Skin: dryness, decreased skin turgor
INVESTIGATIONS
Arterial blood gas is done to check the acid-base balance and gaseous exchange effectiveness (Singh V., Khatana S., & Gupta P., 2013). Arterial blood gas for the patient had the following results; pH-7.5, PaCO2-40mmHg, PaO2-95mmHg, SaO2-97%, HCO3-32meq/litre. The pH and HCO3 was above the normal limit of 7.35 – 7.45 and 22-26 meq/liter respectively.
DIAGNOSIS
Metabolic alkalosis
MANAGEMENT
Intravenous fluids
NURSING CARE PLAN
Nursing care plan is an important part of the nursing practice for positive patient outcomes. Nursing process is used in the formulation of a patient care plans. It entails patient assessments, nursing diagnoses, expected outcomes, nursing interventions and evaluation (National Council of State Boards of Nursing, 2014). The nursing care plan for the case presentation with metabolic alkalosis is as follows Advanced Health Assessment Discussion;
Assessment: vomiting severally each day, difficulty retaining liquids or foods, fainting
Nursing diagnosis: Fluid volume deficit related severe dehydration evidenced by frequent vomiting and fainting episode.
Desired Outcome: to maintain body fluid balance within 24 hours
Nursing interventions
- Administer intravenous fluids such as normal saline to rehydrate the patient. Normal saline helps to correct low chloride associated with metabolic alkalosis.
- Encourage the patient to take orally small amounts of her preferred drinks for rehydration (Cambell, 2014).
- Monitor vital signs especially the BP and heart rate to detect hypotension and tachycardia respectively
- Monitor input and output to check for the fluid balance
- Assess the skin turgor and mucous membranes to check for dehydration
- Use antiemetic to stop vomiting and prevent further loss of fluids and electrolytes
- Monitor electrolytes such as potassium and sodium and administer the electrolytes if they are below the normal range
Evaluation: body fluid volume maintained after 24 hours
Assessment: excess use of antacids, ABG abnormal values of pH 7. 5 and HCO3 of 32 mEq/L above the normal limits.
Nursing Diagnosis: acid-base imbalance related to excessive use of antacids and vomiting evidenced by high pH and HCO3,
The desired outcome to restore the blood bicarbonate and pH levels within the normal range.
Nursing intervention
- Limit the use of antacids to the prescribed dosage. Excessive intake of antacids contributes to metabolic alkalosis.
- Administer antiemetic to stop the vomiting thus prevent further loss of acids and other electrolytes
- Give acetazolamide, a carbonic anhydrase inhibitor that helps the kidneys in excrete bicarbonate. This restores the blood pH and initiates compensatory hyperventilation that corrects the metabolic alkalosis (Jayesh, 2017).
- Monitor the ABGs values to asses therapy needs and maintain their values within the normal range
- Monitor potassium and chloride values. If low, administer sodium chloride which enables the kidney to excrete bicarbonate thus normalize the blood Ph. Replacement of potassium can be done by dietary modifications or IV potassium infusion Advanced Health Assessment Discussion.
- Monitor the respiratory to check decreased respiratory rate which could lead to hypoxia.
Evaluation: blood acid-base balance restored back to the normal range.
In conclusion, assessing the patient ensures appropriate planning of care. Patient assessment is a systematic gathering of all data and information significant to current and past health status, identification of the specific problem and planning of patient care (Jarvis, 2016). A focused assessment entails a detailed assessment of the specific body system/s that relates to the chief complaints and other current problems. It involves identifying the patient problem and treating it. A comprehensive assessment involves is a broad and thorough initial and ongoing assessment of the patient’s condition including history taking, vital signs, and review of all body systems. Its aids in the planning of care and addressing emerging changes in health status of the patient, notes alterations from the initial condition, understand the physical and psychosocial components of the patient’s problem and use the information to formulate nursing care plan (National Council of State Boards of Nursing, 2014).
References
Cambell, N. (2014. Recognizing and preventing dehydration among patients. Nursing Times; 110:46, 20-21
Jarvis, C. (2016). Physical examination & health assessment. Seventh edition. St. Louis, Mo.: Elsevier
Jayesh, V. (2017).Acid-Base Imbalances Nursing Care Plan & Management. Nursing Path
National Council of State Boards of Nursing. (2014). NCSBN Model Nursing Practice Act and Model Nursing Administrative Rules. Chicago, IL: Author Advanced Health Assessment Discussion.
