Acid-Base and Electrolyte Case Study

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:

1. 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.
2. What specific electrolyte disturbance does the patient have?
3. What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
4. If the patient had an increase in her potassium level, what clinical manifestations would the nurse monitor for?
5. What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
6. What are the three major mechanisms of pH regulation?

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