A Nurse Is Caring For An 85-Year-Old Woman In A Hospital

A Nurse Is Taking Care Of An 85 Year Old Woman In A Hospital Based Ski

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 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 Address the following: 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, what clinical manifestations would the nurse monitor for? What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.

What are the three major mechanisms of pH regulation? While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite.

Paper For Above instruction

The laboratory findings provided for the 85-year-old woman reveal several abnormalities that indicate underlying physiological disturbances. Analyzing each result helps in understanding her current clinical state and guiding appropriate interventions.

Analysis of Laboratory Findings

The sodium level (Na) is 147 mEq/L, which is above the normal range of approximately 135-145 mEq/L. This indicates hypernatremia, often associated with dehydration, as evidenced by the patient's dry skin and decreased urine output. An elevated sodium level increases serum osmolarity, leading to cellular dehydration and neurological symptoms such as confusion or lethargy.

The chloride level (Cl) is 110 mEq/L, slightly above the normal range of roughly 98-106 mEq/L. This mild hyperchloremia may result from dehydration or excessive chloride intake. Hyperchloremia often accompanies hypernatremia and contributes to an acid-base imbalance by promoting a metabolic acidosis pattern, although her blood pH is currently low.

Electrolyte Disturbance and Clinical Manifestations

The patient's laboratory results show a normal serum potassium (K) of 4.0 mEq/L, within the standard range of about 3.5-5.0 mEq/L. Despite the normal level, the clinical picture suggests an ongoing fluid imbalance. If her potassium level increased (hyperkalemia), typical clinical manifestations would include muscle weakness, fatigue, cardiac arrhythmias, and potential changes on EKG such as peaked T waves.

Blood Gas Analysis and Interpretation

The arterial blood gas (ABG) results show a pH of 7.33, which is below the normal range of 7.35-7.45, indicating acidemia. The partial pressure of carbon dioxide (PCO2) is 48 mm Hg, above the normal 35-45 mm Hg, suggesting respiratory retention or hypoventilation. The bicarbonate (HCO3) level is 27 mEq/L, within normal limits but slightly elevated, indicating a compensatory response to primary respiratory acidosis.

This ABG pattern signifies primary respiratory acidosis, likely due to hypoventilation caused by her recent breathing difficulties. The compromised gas exchange results in elevated CO2 levels and decreased blood pH. The body attempts compensation through renal mechanisms, increasing bicarbonate retention; however, in acute settings, compensation may not be fully realized yet.

Mechanisms of pH Regulation

The three major mechanisms of pH regulation are:

1. Buffer Systems: The primary buffer system in blood is the bicarbonate buffer system, which neutralizes excess acids or bases by reversible chemical reactions.
2. Respiratory Regulation: The lungs regulate pH by controlling the elimination of CO2; an increase in CO2 leads to acidosis, while decreased CO2 results in alkalosis.
3. Renal Regulation: The kidneys modulate pH by reabsorbing bicarbonate into the blood and excreting hydrogen ions in the urine, providing long-term pH balance.

In conclusion, understanding these laboratory and physiological mechanisms offers vital insights into patient management. The patient's hypernatremia, hyperchloremia, and respiratory acidosis highlight the importance of assessing fluid status and respiratory function, especially in elderly patients with compromised health.

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