Focus Health History Case Study

FocusHealth History Case Study

FocusHealth History Case Study

A22-year-old woman reported being “sick with the flu” for over aweek. She is vomiting severally every day, has difficulty in keepingthe liquids or food down, and has also been using excessiveanti-acids doses in an attempt to calm a feeling of nausea. On mostoccasions, she experiences severe dehydration. She was taken to ahospital nearby, after fainting at home. A sample of an arterialblood gas sample was drawn from her body, and then an IV was used tohelp in her dehydration. The following is the arterial blood gas:

Test Result Normal levels

pH 7.5 7.35– 7.45

PaCO2 40mm Hg 35-45 mm Hg

PaO2 95mm Hg 80-100 mm Hg

SaO2 97% 95-100%

HCO3– 32 mg/liter 22-26 mg/liter

Thepatient’s acid-base disturbance would be classified based herabnormality in regard to how her body responds to liquids and foods.Her body’s normal balance of both acids and bases causes her plasmapH to deviate completely out of her normal. Reference to theinformation recorded of her arterial blood gas it is evident thatthe patient’s acid-base disturbance is abnormal. Normal levels aresupposed to range between 7.35 – 7.45, but the patient’s wasrecorded to be 7.5. The reason for her “sickness with flu” is dueto production of too much acid by the body (Widmaier et al., 2011).This is also explained by high levels of HCO3-in a bid to form more bicarbonate.

Inreference to the case study, the patient is experiencing acid-basedisturbance. Acid-base disturbance is caused by excess production ofboth acids (acidosis) and bases (alkalosis) by the body. Thedisturbance is caused based on both respiratory and metabolicetiology of disturbance in the patient’s body as seen above. Ithappens when the body produces too much acids or when there isfailure of the kidneys to remove excessive acids.

Decreasedproduction of hydrogen ion concentration would lead excessive bases,which eventually cause the disturbance. In the above patient recordsfor example, pH and HCO3-, are above the normal and has in turncreated the imbalance. The patient is vomiting, sick with flu, feelsdehydrated, and has difficulty keeping foods and liquids down. Allthese have altered the patient’s physiology. The patient is alsosuffering from a condition, which results in changes in the levels ofacids and bases in the body, according to Sommers et al., (2007). Thesymptoms also result in anxiety and stress, which in turn lead tohyperventilation and reduced ventilation.

Renaland respiratory systems can help in compensating for acid-basedisturbance. To begin with, renal system compensation ensuresabsorption or excretion of acids and bases are carried out throughthe kidneys ability to produce HCO3-. The carbonates are used toreplenish depleted supplies. Considering the above recordedstatistics show normal HCO3- to be in between 22 to 26mEq/L (Sommerset al., 2007). When plasma is acidic, the kidneys are mandated toreabsorb excess carbonate ions and retain hydrogen ions.

Onthe other hand, respiratory system is able to compensate for theacid-base imbalance by use of the lungs (Widmaier et al., 2011). Thelungs are able to blow off unwanted acids as carbon dioxide forcompensation of metabolic acidosis, or rather to some extent, areable to hold on tightly to the acids through carbon dioxide forcompensation of metabolic alkalosis. In metabolic acidosis, the bodyof the patient will continue to increase respiration to force morecarbon dioxide be blown off, and thus more acid in the patient’sblood are reduced. Metabolic alkalosis carries out hypoventilation tocorrect fully the patient’s pH. However, the patent’s respiratorysystem can only allow carbon dioxide retention of no greater than50-55 mm/Hg.

Physicianshandling the 22-year-old’s situation would likely use pharmacologicintervention to correct her acid-base disturbance. The nursingdiagnosis, which includes vomiting, difficult in handling foods andliquids, and continuous dehydration, requires correct identificationof the acid-base disorder. First, pharmacologic intervention dependson correct identification of the disorder, while repairing the causalfactors. For severe acidosis, physicians are required to usebicarbonate and mild acidosis should be tamed by use of moderatelyprepared chloride-responsive alkalosis (Widmaier et al., 2011). Mostcommon intervention is often the use of insulin. The patientidentified above should be treated with insulin, and the infusionshould be continued for 30 minutes. If the nausea persists and thepatient cannot eat or drink, then the physician should apply dextroseinfusion should be used for treatment of the imbalance.

Comparingthe difference using complete assessment, educational needs for thepatient as described in the case study above requires properdescription and the kind of approach that will assist her in handlingher situation. First, the patient should be aware of her acid-baseimbalance. She should be made aware of how the hydrogen ions affecther pH and the influence the pH regulation would have on the cellularregulations, cell permeability, and cell functions (Sommers et al.,2007). My approach to making awareness on all this will be throughthe use of charts and practical procedures. The approach will handlebetter understanding of acidosis and alkalosis. The educational needswill demand the patient to know how she will handle hyperventilation,and how her lungs will likely try to eliminate carbon dioxide withouthaving to force it out. Mt approach will also include experiments.


Sommers,M. S., Johnson, S. A., &amp Beery, T. A. (2007). Diseasesand disorders: A nursing therapeutics manual.Philadelphia: F.A. Davis Co.

Widmaier,E. P., Raff, H., Strang, K. T., &amp Vander, A. J. (2011). Vander`shuman physiology: The mechanisms of body function.New York: McGraw-Hill.