Strategies for Safe and Effective Multidimensional Nursing Care for Clients with Acid-Base Imbalances

Background

56-year-old Tony, a Hispanic male, presents to an ER with two-week shortness of breath
complaint. He admits not feeling good for nearly a week but could not fail to report to work.
Tony also complained of feeling exhausted, fever, and cough. Past clinical history includes
diabetes, COPD, and asthma. A physical exam shows that Tony is struggling to breathe. Other
vital signs include an 84 percent pulse oximetry reading, a 90/40 mm Hg, blood pressure, 115
beats per minute heart rate, and a 36 breaths per minute respiratory rate. ABG results are pH
7.28, PaCO 2 55 mm Hg, PaO 2 70 mm Hg, and HCO 3 30 mEq/L. This case study evaluates Tony’s
acid-base imbalance, possible causes, and resulting signs and symptoms. It also proposes a
multidimensional care strategy appropriate for addressing the acid-base imbalance.

Tony’s Acid-Base Imbalance

With a pH level of 7.28, Tony’s acid-base imbalance falls under the “acidosis” category.
In normal conditions, the body keeps the blood pH level at 7.4 ± 0.5. Therefore, a pH exceeding
7.45 indicates alkalosis, and a pH below 7.35 indicates acidosis (Rudall & Moswela, 2011).
Specifically, Tony is suffering from “respiratory acidosis” because his PaCO 2 (55 mm Hg) is
greater than 6 mm Hg. Metabolic acidosis occurs when a patient is acidotic and has an HCO3 –
less than 22 mEq/L. Tony’s HCO3 – currently stands at 30 mEq/L, disqualifying him from
metabolic acidosis. Typically, respiratory acidosis occurs when excessive carbon dioxide
accumulates in the blood, primarily due to the failure of the respiratory system to remove carbon
dioxide and let in oxygen efficiently. Tony’s respiratory acidosis is chronic because it has

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persisted for nearly a week and is linked with a history of respiratory diseases like asthma and
COPD.

Possible Causes of the Imbalance

Respiratory acidosis mainly occurs when a physical block, disease, or condition limits the
patient’s breathing ability, resulting in excessive carbon dioxide accumulation in the
bloodstream. The blood might become too acidic at a certain point, and any further carbon
dioxide automatically triggers the kidneys to release additional ammonium and hydrogen cations
to absorb the bicarbonate anions. Some of the potential causes of Tony’s chronic respiratory
acidosis include asthma, chronic obstructive pulmonary disease (COPD), and obesity –
conditions shown in his medical history. Other potential causes include sleep apnea, thoracic
skeletal muscle deformations, nerve and muscular diseases, and pulmonary fibrosis or other lung
tissue diseases. Blocked airways, cardiac arrest, Guillain-Barre Syndrome, muscular dystrophy,
Myasthenia gravis, stroke, and certain medications (pain drugs, benzodiazepines, and opioids)
could also be the potential triggers for Tony’s respiratory acidosis (Hasan, 2013).
Signs and Symptom’s the Patient is Exhibiting due to Acid-Base Imbalance
The major symptoms Tony is exhibiting due to respiratory acidosis include shortness of
breath, feeling exhausted, fever, and cough, all of which are associated with insufficient blood
oxygen and excess carbon dioxide concentration. Other potential symptoms can include
headaches, confusion, drowsiness, flushed skin, tremors, trouble walking, irregular sleep
patterns, memory loss, sweating, and slower tendon reflexes.

Multidimensional Care Strategies Appropriate for Tony’s Care

1. Pharmacologic treatment using corticosteroids and bronchodilator drugs to reverse
   airway obstruction (Hasan, 2013).

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2. Oxygen therapy to improve oxygen level.
3. Noninvasive positive-pressure ventilatory support (breathing machine).
4. Lifestyle changes, including smoking cessation, regular physical exercise, and eating
   healthy diets (fruits and vegetables).

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References

Hassan, A. (2013). Handbook of blood gas/acid-base interpretation. Springer Science &
Business Meida.
Rudall, N., & Moswela, O. (2011). How to interpret arterial blood gas results. The
Pharmaceutical Journal. https://pharmaceutical-journal.com/article/ld/how-to-interpret-
arterial-blood-gas-results