Question

The patient is a 21 year old college student brought to the emergency department by his friends when he was found unconscious during a fraternity party. He was seen drinking heavily at the party and had not eaten for 2 days before the event. He takes no prescription drugs, and his current vital signs are T = 97.8, P = 48, slightly irregular and thread; R = 28, deep and regular; B/P = 88/50; His arterial blood gas results are pH = 7.31, HCO 3 = 25 mEq/L; PaCo2= 28 mm Hg; PaO2 = 99 mm Hg. What specific type of acid-base problem does this patient have? Explain. What is the most probable origin of the acid-base imbalance? Should oxygen be applied? Why or why not? What nursing interventions for safety are most appropriate for this patient? What additional laboratory and assessment data should be performed? Provide a rationale for your answer.

Answer 1

PH - 7.31(7.35-7.45)
Hco3 - 25mEq/l(22 - 26mmol/l)
Paco2 -28mmHg(35 - 45mmHg)
Pao2 -99mmHg (80-100 mmHg)
The patient has metabolic acidosis acid-base problem. patient PH <7.35, carbon dioxide <45mEq/l and bicarbonate <26mEq/l.patient had this acid-base imbalance due to heavy drinking and not eaten for 2 days, it increase gastric acid production.
Supplement of oxygen can relieve dyspnea and correct hypoxemia. due to paco2 less than 40mmHg to compensate that co2 can be given, but not greater than 50-55mmHg to compensate for the metabolic alkalosis.
Nursing intervention:
-Administer sodium bicarbonate as per doctor advice
-Monitor vitals, ABG, patient neurological status.
-use side rails to prevent falls.
-replace the fluid volume by IV fluid infusion.
-monitor intake and output
Lab test:
-serum electrolytes
-ethanol level
Assessment data:
-Assess patient neurological status for coma and seizure
-Assess patient blood pressure and respiratory status
-Assess patient pupil reaction
-assess patient ABG level frequently.