Acid-Base Balance Disorders

Acid-Base Balance Disorders: Disorders involving acid-base balance are common in the health care settings. Such is the case given the wide-range of causes that are attributable to the imbalance. Central to their management is the establishment of the underlying cause and rectifying them. The types of acid-base disorders affect two systems, namely, the respiratory and the renal system.

Thus, one can have respiratory acidosis/alkalosis or metabolic acidosis/alkalosis. The pH value (concentration of Hydrogen ions) of an individual normally ranges between 7.35 and 7.45. A pH of below 7.35, implies that one is acidotic while a pH of above 7.45 points to the alkaline nature of an individual.  Central to this discussion is a case study of an individual who exhibits a predisposal to metabolic acidosis due to the nature of the cause. In essence identifying the type of acid-base disorder, its cause, body compensatory mechanism and explanation of the role of a bicarbonate buffer system in the body are the key elements of this discussion. Also, an explanation of how a nurse can win the attention of the patient and the family to enhance co-operation is another valuable aspect of this paper.

Type of Acid-Base Disorder and its Etiology

To begin with, prediction ofthe acid-base disorder, that Shauna is at risk of developing and description of the likely etiology is of the importance. She is a real candidate of metabolic acidosis given her prolonged diarrhea. Other examples befitting of the etiological factors include but not limited to excessive chloride treatment, early stages of renal insufficiency, use of diuretics, salicylate poisoning and parenteral nutrition without bicarbonate or its producing solute (Porth, 2014). However, central to this scenario, the prolonged diarrhea is the primary cause of this derangement.

Diarrhea causes the acid-base imbalance in two ways. Firstly and most important, the loss is through the loss of intestinal content in diarrhea. Metheny, (2012) is of the opinion that physiologically, the intestinal secretions, constitute many ions including bicarbonate as a major component. As such, during prolonged diarrhea episodes, an urge to eliminate microbial organism causing discomfort in the human stomach is inevitable. Thus, the intestines increase the amount of the secretions in the gut in an attempt to flush out the microorganism resulting in a watery stool,  commonly referred to as diarrhea. A further implication of this increased loss is that the individual loses a significant amount of intestinal content, which translates to a low bicarbonate level in the intestinal lumen for reabsorption. Consequently, one’s pH reduces and ultimately develops metabolic acidosis (Porth, 2014).

Secondly, another possible explanation for the low pH value in diarrhea is the tendency of the intestinal lumen to increase the amount of bicarbonate ion secreted. Such is the case due to the high acidity that the microbial infection brings to the host’s intestinal lumen. Therefore, as an action to neutralize the acidity, there is an increase in the bicarbonate secretion, which further worsens and loss of the alkaline component. Eventually, the individual develops metabolic acidosis (Metheny, 2012).

That said, identification of the body’s compensatory mechanism is also an invaluable element that increases the understanding of Shauna’s condition. In situations that involve acid-base imbalance, the body finds its way to correct the imbalance and restore homeostasis. For instance, in metabolic acid-base imbalance, the respiratory system is responsible for the corrective measure. On the contrary, the respiratory disorders of the acid-base disequilibrium will depend upon the renal system to rectify this derangement (Brown, 2013). Similarly, to this scenario, the respiratory system is instrumental in ensuring that Shauna regains her health state once more. A case in point of the vitality of the respiratory system is evident in its attempt to decrease the acidity of the blood.  Such is the case given the immediacy of Shauna’s increased respiration rate and depth of the respiration. The hyperventilation is inevitable since it facilitates the individual’s getting more oxygen thereby reducing the concentration of CO2, which is responsible for increased acidity through the formation of carbonic acid. Consequently, the individual’s pH value rises to reach the level of normalcy and thereby restore a homeostatic nature of the body prior the condition(Porth, 2014). That notwithstanding, there is another school of thought that since the kidneys are in good shape and are not responsible for the derangement, they can contribute to the attainment of Shauna’s normal equilibrium state. Such is the case since the kidneys will respond to the imbalance by increasing the secretion of hydrogen ions that determine the acidity of s internal body environment. Furthermore, there is reabsorption of bicarbonate ions at the proximal convoluted tubule (Winkelman, Ignatavicius, Workman, & Ignatavicius, 2013). Thus, the outcome is an increased pH value.

Importance and Function of Bicarbonate Buffer System

Nevertheless, the full comprehension of this condition is also dependent on the understanding of the function and importance of a bicarbonate buffer system in the body. According to Preston and Wilson, (2013) buffer systems are essential in the control of the increase and decrease of Hydrogen ions, which determine the pH value of an individual. The primary buffer system in the body is the bicarbonate-carbonic acid, which occupies the extracellular fluid. The importance of this system is manifest through how it functions in the body. As such, this type of buffer system constitutes of two components, namely, the carbonic acid, which serves as the acidic component and the bicarbonate, which is the alkaline component. Thus, whenever there is an increase in the pH value, the carbonic acid reduces the alkalinity. On the other hand, a low pH value results in a higher amount of bicarbonate, causing a stabilization of the pH value (Preston & Wilson, 2013). In light of these relationships, the conclusion of this matter is that the bicarbonate system is important in buffering the pH levels of the body.

Steps to Developing a Co-operative Relationship with the Client

Lastly, it is vital to identify how one can develop long-lasting and co-operative relationship with the client and her family during the patient and family education sessions. In connection to this scenario, Potter, Perry, Hall, and Stockert, (2016) proposes that a nurse can enhance cooperation from the patient and the family through greeting them and introducing him/herself to them upon first interaction. Besides, offering them a place to sit will promote their comfort and will encourage them to open up more easily. The nurse should also allow the patient to talk and listen keenly to his/her complaints. If in any pain, the nurse should relieve the pain to encourage their cooperation during the interview session. Finally, one should also avoid a judgmental outlook on the patient and employ professional communication that will increase the chances of winning their trust (Potter, Perry, Hall, & Stockert, 2016). Evidently, with such measures in place, an individual is on course to enhance the co-operation of Shaun and her significant others.

Conclusion

In closure, it is without a doubt that acid-base disorders pose a significant health care challenge due to the range of etiologic factors. Thus, a nurse must teach a patient in a non-judgmental manner, which will improve their co-operation, about the causes of the disorder so that in future they can be aware of such possibilities. Failure to do so, however, will only result to knowledge-deficit among patients, which can be self-destructive.

References

Brown, D. (2013). Lewis’s Medical Surgical Nursing (1st ed.). Elsevier Health Sciences APAC.

Metheny, N. (2012). Fluid and electrolyte balance (5th ed.). Sudbury, MA: Jones & Bartlett Learning.

Porth, C. (2014). Essentials of Pathophysiology:4th International Edition (1st ed.). Philadelphia: LIPPINCOTT WILLIAMS AND WILKINS.

Potter, P., Perry, A., Hall, A., & Stockert, P. (2016). Fundamentals of Nursing (9th ed.). Mosby.

Preston, R. & Wilson, T. (2013). Physiology (1st ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Winkelman, C., Ignatavicius, D., Workman, M., & Ignatavicius, D. (2013). Clinical companion, Ignatavicius Workman, Medical-surgical nursing (1st ed.). St. Louis, MO: Elsevier Saunders.

 

 

 

 

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