Acid-Base and Electrolyte Case StudyNameInstitutionInstructorCourseDate Acid-Base and Electrolyte Case StudyThis case study involves an 85-year-old woman who has breathing problems for the last two days, has a decreased urine output, warm and dry skin, and has been lethargic. More tests were done in regards to acid-base and electrolyte levels which provided different results for different tests. These results will guide an effective diagnosis and treatment process (Grodin, 2016). 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.
Based on the laboratory results, different values are abnormal that may indicate an underlying condition. The patient’s sodium level is 147 which is higher than the normal 135 to 145 milliequivalents per liter (Hamilton, Morgan, Connolly, & Maxwell, 2017). This means that the concentration of sodium in the patient’s blood is high which may be attributed to the patient’s age factor which is indicated to alter the body’s sodium balance.
This may result in a hypernatremia condition that can lead to dehydration, kidney problems, and diarrhea (Hamilton et al., 2017). The level of chloride is also high in the blood compared to the normal 97-107 mEq/L. This can lead to hyperchloremia resulting in an electrolyte imbalance, as the patient’s chloride level is 110 mEq/L. The patient’s pH level is 7.33 which is below the normal 7.35 and 7.45 for blood pH (Hamilton et al., 2017). This indicates an abnormality in the patient’s pH level which may include metabolic acidosis that may lead to acidemia.
A low pH level is caused by increased production of hydrogen ions by the body leading to a low pH in the blood (Hamilton et al., 2017). The patient’s partial pressure of carbon dioxide (PCO2) is also high as the normal level is 35-45 mm Hg. The patient has a level of 48 indicating hypercapnia which is associated with a respiratory acidosis (Hamilton et al., 2017). The patient has a normal bicarbonate level as well as partial pressure of oxygen. However, the patient’s urine specific gravity is above the normal range of 1.002 to 1.030 which means that the kidneys are not functioning normally. This may be attributed to a high level of dehydration (Hamilton et al., 2017). What Specific Electrolyte Disturbance Does The Patient Have?From the results of the laboratory tests, there is an indication of abnormal electrolytes which include chloride and sodium. This also means that there is an electrolyte disturbance that may be attributed to underlying health issues (Ashelford, Raynsford, & Taylor, 2016). From the current symptoms that include fatigue, warm and dry skin, and a decreased urine output, in collaboration with the abnormal lab results, these indicate underlying kidney problems (Ashelford, Raynsford, & Taylor, 2016). Most of the electrolytes are elevated which have resulted in hyperchloremia and hypernatremia conditions. Too much chloride in the body may be attributed to severe dehydration as well as kidney problems. Too much sodium in the blood is also attributed to excess dehydration as well as excess loss of body fluids (Ashelford, Raynsford, & Taylor, 2016). What Clinical Manifestations Would The Nurse Expect To See With This Electrolyte Abnormality Presented Above?Clinical manifestations expected by the nurse due to this electrolyte abnormality include fatigue, excessive thirst, general weakness, and high blood pressure for hyperchloremia. This involves a high chloride level which is referred to as acidosis where the blood is acidic above the normal level (Ashelford, Raynsford, & Taylor, 2016). This may indicate an underlying kidney problem since chloride regulation is a function of the kidneys. Hyperchloremia occurs when there are high levels of chloride in the blood which can be attributed to excess salt intake, severe diarrhea, long-term use of certain medications, and metabolic acidosis which is a condition where the kidneys do not effectively eliminate excess acid from the body (Ashelford, Raynsford, & Taylor, 2016). Clinical manifestations for excess sodium level in the body include excessive thirst, lethargy which involves extreme fatigue and general body weakness. Excess sodium levels may also result in seizures as they this may affect nerve functioning (Ashelford, Raynsford, & Taylor, 2016). This may be attributed to old age, as is the case. This is because elderly patients have a decreased sense of thirst with most of them having underlying health conditions that may affect water as well as the sodium balance (Ashelford, Raynsford, & Taylor, 2016). If The Patient Had An Increase In Her Potassium Level, What Clinical Manifestations Would The Nurse Monitor For?The patient’s potassium level is between the normal ranges. However, in the case that the patient had an increased potassium level, the patient would have hyperkalemia which is a condition that may affect the heart as well as the muscles (Pochineni & Rondon-Berrios, 2018). This is a dangerous condition that may even lead to death. Potassium is an important electrolyte needed by the nerves, muscles, and the heart to properly function. The kidneys are responsible for regulating the potassium level which means that an abnormal level may indicate an underlying kidney problem (Pochineni & Rondon-Berrios, 2018). Some of the symptoms associated with this condition include weakness of the body, muscle tingling, chest pain, irregular heartbeats as well as palpitations of the heart, breathing problems, and nausea. In severe cases, a high potassium level can lead to heart failure resulting in death (Pochineni & Rondon-Berrios, 2018). What Blood Gas Abnormality Is Seen In This Patient? Discuss The Rationale For Your Answer.The patient has a high level of partial pressure carbon dioxide (PCO2) compared to the normal range of 35 and 45 mmHg. The patient’s pCO2 level is 48 which is abnormal level that may be attributed to a high blood acid level (Grodin, 2016). This means that the patient is hyperventilating and has a respiratory acidosis since the patient’s pH level is less than 7.35. The two main gases that are involved in respiration are oxygen and carbon dioxide where carbon dioxide is dissolved in the blood as a waste product after a normal metabolism (Grodin, 2016). Hyperventilation indicates a high level of pCO2 in the blood that may be caused by underlying conditions that may include pneumonia, chest injury, and weaknesses in respiratory muscles. Diseases may also alter partial pressure of carbon dioxide. A high level of CO2 creates an acidic environment which is also indicated by other blood tests. This may result in respiratory acidosis a condition that may lead to respiratory failure (Grodin, 2016). What Are the Three Major Mechanisms Of pH Regulation?There are different mechanisms of pH regulation in the body which can be done by the respiratory systems which are responsible for gas exchange in the lungs. This is important in maintaining an acid-base balance in the body (Hamm, Nakhoul, & Hering-Smith, 2015). Blood which is too alkaline will trigger slow breathing which will in turn increase the amount of carbon dioxide partial pressure level. If the pH level is low, the breathing rate can increase to expel more carbon dioxide in the effort of raising the pH to its normal level (Hamm, Nakhoul, & Hering-Smith, 2015). Regulation of pH level is also a function of the kidneys where the kidneys can excrete hydrogen ions through the urine as well as reabsorb bicarbonate from the urine in maintaining a normal pH level (Hamm, Nakhoul, & Hering-Smith, 2015). These two functions are important in maintaining a normal pH level which also complements the lungs. The last mechanism for pH regulation is through renal physiology where the tubular cells reabsorb more bicarbonate from the tubular fluid in the case of acidosis (Hamm, Nakhoul, & Hering-Smith, 2015). The collecting duct cells in turn secrete more hydrogen to generate more bicarbonate. In the case of alkalosis, the kidneys may excrete more bicarbonate decreasing hydrogen ion secretion from the tubular cells to maintain a normal pH level (Hamm, Nakhoul, & Hering-Smith, 2015).ReferencesAshelford, S., Raynsford, J., & Taylor, V. (2016). Pathophysiology and Pharmacology for Nursing Students. London: Learning Matters.Grodin, J. L. (2016). Pharmacologic Approaches to Electrolyte Abnormalities in Heart Failure. Current Heart Failure Reports, 13(4), 181″189. P. K., Morgan, N. A., Connolly, G. M., & Maxwell, A. P. (2017). Understanding Acid-Base Disorders. The Ulster medical journal, 86(3), 161″166.Hamm, L. L., Nakhoul, N., & Hering-Smith, K. S. (2015). Acid-Base Homeostasis. Clinical journal of the American Society of Nephrology: CJASN, 10(12), 2232″2242. doi:10.2215/CJN.07400715.Pochineni, V., & Rondon-Berrios, H. (2018). Electrolyte and Acid-Base Disorders in the Renal Transplant Recipient. Frontiers in Medicine.