studies on acid base balance powerpoints

case studies on acid base balance

1. ABG CASE STUDIES CLASSROOM AND GROUP DISCUSSION

2. CASE STUDY 1 MR. FRANK Mr. Frank is a 60 year old with pneumonia. He is admitted with dyspnea, fever, and chills. His blood gas is below: Ph 7.28 Co2 56 P02 70 hco3 25 Sao2 89% What is your interpretation? What interventions would be appropriate for mr . frank?

3. Answers for mr. frank Mr. frank has uncompensated respiratory acidosis with hypoxemia as a result of his pneumonia. This is due to inadequate ventilation and perfusion. The treatment goals for mr. Frank would be to improve both ventilation and oxygenation. Ventilation may improve with the use of bronchodilators and pulmonary hygiene. If not, mr. franks may require cpap, bipap, or intubation and mechanical ventilation. Oxygen therapy should consist of only the minimal amount necessary to increase his oxygen saturation to normal (95%)

4. Case study 2 ms. strauss Ms. Strauss is a 24 year old college student. She has a history of crohn’s disease and is complaining of a four day history of bloody-watery diarrhea. A blood gas is obtained to assess her acid-base balance: Ph 7.28 Co2 43 P02 88 Hco3 20 Sao2 96% What is your interpretation? What interventions would be appropriate for ms. Strauss?

5. Answers for ms. strauss Mrs. Strauss has an uncompensated metabolic acidosis . This is due to excessive bicarbonate loss from her diarrhea. It is interesting to note that she has no compensation. Normally, the respiratory center compensates quickly for metabolic disorders. However, in ms. Strauss case she would have to hyperventilate in order to compensate. This may not be possible in her present condition, and should be evaluated further. Treatment would consist of control of diarrhea and bowel rest. It should not be necessary to administer bicarbonate in her present condition.

6. Case study 3 mr. karl Mr. karl is a 80 year old nursing home resident admitted with urosepsis. Over the last 2 hours he has developed shortness of breath and is becoming confused. His abgs shows the following results: Ph 7.02 Co2 55 P02 77 Hc03 14 Sa02 89% What is your interpretation? What interventions would be appropriate for mr. Karl?

7. Answers for mr. karl Mr. karl has metabolic and respiratory acidosis with hypoxemia . The metabolic acidosis is caused by his sepsis. The respiratory acidosis is secondary to respiratory failure. The presentation of sepsis and associated respiratory failure is consistent with ards Treatment must be aggressive, because is acidosis is severe. His respiratory status needs to be stabilized, and would probably require mechanical ventilation. If hypotension exists, aggressive fluid and vasopressor support would be warranted. This patient is at high risk for further complications and should be managed in an icu. Bicarbonate should not be administered until the underlying sepsis and respiratory failure is treated.

8. Case study 4 Mrs. lauder Mrs. Lauder is a thin, elderly-looking 61 year old copd patient. She has an abg done as part of her routine care in the pulmonary clinical. The results are as follows: Ph 7.37 C02 63 P02 58 Hc03 35 Sao2 89% What is your interpretation? What interventions would be appropriate for Mrs. Lauder?

9. Answers for mrs. lauder Mrs. Lauder has a fully compensated respiratory acidosis with hypoxemia . Full compensation is evidenced by the normal ph in spite of her acid/base disorder. This is her baseline and doesn’t require treatment.

10. Case study 5 ms. Steele Ms. Steele is a 17 year old with intractable vomiting. She has some electrolyte abnormalities, so a blood gas is obtained to assess her acid/base balance: Ph 7.50 C02 36 P02 92 Hc03 27 sao2 97% What is your interpretation? What interventions would be appropriate for ms. Steele?

11. Answers for ms. steele Ms. Steele has an uncompensated metabolic acidosis . This is due to vomiting that results in excessive loss of stomach acid. treatment consists of fluid, antiemetics, and management of her electrolyte disorders.

12. Case study 6 mr. longo mr. Longo is a 18 year old comatose, quadriplegic patient who has the following abg done as part of a medical workup: Ph 7.48 C02 22 P02 96 Hco3 16 Sa02 98% What is your interpretation? What interventions would be appropriate for mr. longo?

13. Answers for mr. longo As a result of his neurological condition, mr. longo has chronic hyperventilation syndrome. His blood gas shows a fully compensated respiratory alkalosis . This is a chronic and stable condition for him and probably requires no treatment

14. Case study 7 mr. casper Mr. casper is a 55 yea old with gerd. He takes about 16 tums antacid tablets a day. An abg is obtained to assess his acid/base balance: Ph 7.46 C02 42 P02 86 Hc03 29 Sa02 97% What is your interpretation? What interventions would be appropriate for mr. Casper?

15. Answers for mr. casper Mr. casper has overmedicated himself with tums, effectively absorbing too much stomach acid. His abg shows a partially compensated metabolic alkalosis . Treatment consists of better control of his gerd, possibly with h2 blockers (Pepcid)or proton-pump inhibitors(Prilosec)

16. Case study 8 mrs. dobins Mrs. Dobins is found pulseless and not breathing this morning. After a couple of minutes of cpr she responds with a pulse and starts breathing on her own. A blood gas is obtained: Ph 6.89 C02 70 P02 42 Hco3 13 Sa02 50% What is your interpretations? What interventions would be appropriate for mrs. Dobins?

17. Answers for mrs. dobins Mrs. Dobins has severe metabolic and respiratory acidosis with hypoxemia . The metabolic component comes for her decreased perfusion, and the respiratory component comes from inadequate ventilation Treatment would consist of intubation, mechanical ventilation, blood pressure and circulatory support.

18. Case study 9 mr. simmons After resuscitation mrs. Dobins, you find mr. Simmons to be in respiratory distress. He has a history of type 1 diabetes mellites and is now febrile (wow, what a bad day!). His abgs shows: Ph 7.00 C02 59 P02 86 Hc03 14 Sa02 91% What is your interpretation? What interventions would be appropriate for Mr. simmons?

19. Answers for mr. simmons Wow! Mrs. Simmons too! He, like mrs. Dobins, has metabolic and respiratory acidosis with hypoxemia . However, his cause is different. His respiratory acidosis is probably the result of pneumonia (also causing the fever). His pneumonia has altered his glucose metabolism, causing hyperglycemia and diabetic ketoacidosis. Treatment should be three-pronged: 1) increase his oxygenation with oxygen therapy like cpap, bipap, or mv, 2) treat his pneumonia with antibiotics, antipyretics, and good pulmonary hygiene., and 3) administer insulin and iv fluids to decrease his blood glucose and treat his dka.

20. Case study 10 ms. berth Ms. Berth was admitted for a drug overdose. She is being mechanically ventilated and a blood gas is obtained to assess her for weaning,. The results are as follows: Ph 7.54 C02 19 P02 100 Hc03 16 Sa02 98% What is your interpretation? What interventions would be appropriate for ms. Berth?

21. Answer for ms. berth Ms. Berth is being over-ventilated which caused a p artially-compensated respiratory alkalosis . Treatment would consist of decreasing ventilatory support, or trying other modes of ventilation to decrease her minute volume. She will be difficult to wean from the ventilator in this condition due to the metabolic compensation. Therefor attempts should be made to allow her c02 to increase back to normal before weaning can proceed.

22. credits Wesley granger phd rrt Copyright 2011 focus publications Inc. Cengage learning