Assignment: Acid-Base and Electrolyte Case Study
Assignment: Acid-Base and Electrolyte Case Study
Acid-Base and Electrolyte Case Study
Fluid and electrolyte imbalances are crucial health concerns that threaten the health and wellbeing of the patients. The imbalances affect the physiological functioning of the patients due to their target on vital organs. Nurses and other health care providers are competent in assessing, diagnosing and treating patients suffering from different fluid and electrolyte imbalances. The purpose of this paper is to examine the electrolyte and blood gas abnormality an 85-year-old woman has alongside the associated symptoms.
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Abnormal Laboratory Findings
Some of the patient’s laboratory findings are abnormal. The first one is sodium, which is above the normal range of 135-145 mEq/L. The results that the patient’s serum sodium level is 147 means that she has hypernatremia or too much sodium in the blood. The other abnormal laboratory finding is chloride levels. The normal chloride level ranges between 96 and 106 mEq/L(Qian, 2019; Seay et al., 2020). The patient in the case study has chloride levels of 110, which is higher than the normal levels, hence, hyperchloremia. The PH is also abnormal. The normal PH range is between 7.35 and 7.45. The patient’s value is 7.33, which implies acidosis. The PCO2 is also elevated. The normal PCO2 is 35-45, which implies that the patient is acidotic. Lastly, the urine specific gravity is higher than the normal. The normal range of urine specific gravity is 1.005-1.030. The patient’s lab value is 1.040, which indicates dehydration or passage of very concentrated urine(Qureshi et al., 2022). Therefore, these abnormal laboratory results will inform the patient’s treatment choices.
Electrolyte Disturbance
As noted above, the patient has two electrolyte disturbances. They include hypernatremia and hyperchloremia.
Clinical Manifestation with the Electrolyte Abnormality
Patients with hypernatremia present with several clinical manifestations. The symptoms include excessive thirst, fatigue, lack of energy, confusion, muscle spasms and twitching, seizures, and restlessness. The muscle involvement in hypernatremia is attributed to the role that sodium plays in nerve impulse conduction, contraction, and relaxation of the muscles. In severe cases, hypernatremia can result in coma. Patients with hyperchloremia also present the hospital with a range of clinical signs and symptoms. They include fluid retention, hypertension, muscle spasms, weakness, or twitches, cardiac dysrhythmias, confusion, seizures, convulsions, and numbness or tingling of the extremities(Venkatesh, 2019). Patients may also report fever, difficulty in breathing, and changes in personality.
Increased Potassium Level
Hyperkalemia refers to the increased serum level of potassium. Patients with hyperkalemia present the hospital with a range of symptoms. One of them is tall peaked T waves in ECG tracing. Potassium is a crucial electrolyte involved in cardiac conduction system. An increase in potassium levels will alter the normal EKG finding. The other symptom that the nurse should monitor relates to the nervous system. The symptoms include tingling, numbness, and areflexia. The elevated potassium levels affect the electrolyte gradient in the brain, hence, the neurological symptoms. Patients should also be monitored for musculoskeletal symptoms such as paralysis and muscle weaknesses. Too much potassium affects nerve transmission and response of muscles to stimuli. The nurse should also monitor for gastrointestinal symptoms. They include abdominal bloating, diarrhea, nausea, and vomiting. The additional symptoms that the nurse should monitor closely include chest pain, palpitations, and slowed heart rate. It is also important to restrict sodium rich diet since it will worsen hyperkalemia(Sembulingam, 2019). Diabetic patients under treatment for hyperkalemia should be monitored closely for potassium levels since they can easily develop hypoglycemia if the potassium level is too low.
Blood Gas Abnormality
The patient in the case study has respiratory acidosis. The arterial blood gas results show the presence of acidosis due to the decreased pH. This implies that there are too much hydrogen ions in the blood than the hydroxyl ions. The results also show elevated PCO2 levels, which indicate acidosis. The high level of PCO2 implies the high number of hydrogen ion than the bicarbonates. As a result, the patient suffers from uncompensated respiratory acidosis(Sembulingam, 2019).
Mechanisms of pH Regulation
The body maintains normal pH using three mechanisms. They include the chemical buffer, renal, and respiratory system mechanisms. The chemical buffers largely comprise the bicarbonate buffer. This buffer rectifies acidosis by reacting with an acid to neutralize it hence, pH change. The buffer also responds to increased demand for hydrogen ions during alkalosis by losing more of the bicarbonate ions through the renal system. The respiratory system maintains the normal pH by blowing out excessive carbon dioxide during acidosis. It also retains carbon dioxide in alkalotic states through slow breathing. The kidneys regulate the pH through the absorption of either acids or bases based on the physiological status of the body (Venkatesh, 2019). In acidotic states, the kidneys absorb more bicarbonates while losing most acids via the urine.
Conclusion
The patient in the case study has hypernatremia and hyperchloremia. She is dehydrated and also has respiratory acidosis. These abnormalities have different symptoms that the nurse should be aware about in the treatment process. The body maintains its pH through three mechanisms that include respiratory, renal, and chemical buffer systems.
References
Qian, Q. (2019). Hypernatremia. Clinical Journal of the American Society of Nephrology : CJASN, 14(3), 432–434. https://doi.org/10.2215/CJN.12141018
Qureshi, A. I., Huang, W., Gomez, F. E., Malhotra, K., Arora, N., Chandrasekaran, P. N., Siddiq, F., French, B. R., Gomez, C. R., & Suarez, J. I. (2022). Early Hyperchloremia and Outcomes After Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 31(8), 106523. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106523
Seay, N. W., Lehrich, R. W., & Greenberg, A. (2020). Diagnosis and Management of Disorders of Body Tonicity—Hyponatremia and Hypernatremia: Core Curriculum 2020. American Journal of Kidney Diseases, 75(2), 272–286. https://doi.org/10.1053/j.ajkd.2019.07.014
Sembulingam, K. (2019). Essentials of Medical Physiology: With Free Review of Medical Physiology. Jaypee Brothers Medical Publishers.
Venkatesh, H. S. D. (2019). Basics of Medical Physiology for Nursing Students. Wolters kluwerindia Pvt Ltd.
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For this assignment, learners will review the case study and address the associated questions.
A nurse is taking care of an 85-year-old woman in a hospital-based skilled nursing facility. In the 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 the morning report:
Blood Chemistries
Na: 147
Cl: 110
K: 4.0
Arterial Blood Gases
pH: 7.33
PCO2: 48
HCO3: 27
PO2: 96
Urinalysis
Urine Specific Gravity: 1.040
Then, in a Word document copy and answer each question.
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.
What specific electrolyte disturbance does the patient have?
What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
If the patient had an increase in her potassium level, for what clinical manifestations would the nurse monitor?
What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
What are the three major mechanisms of pH regulation? Provide a brief description of each.