Acid-Base Balance - Essay Example

? Acid Base Balance Case Study A diagnosis involves identifying the cause and nature of anything. It is mostly used in the determination of symptoms, symptom causes, solutions to issues, and mitigation of problems (De Mendonca, 2004). The patient was suffering from a disease known as the respiratory acidosis. This is so because the physical diagnosis of the patient showed that the man had a systematic blood pressure of 85 mm Hg/50 mm Hg. His heart rate was 175 beats per minute, his respiration was at the rate of 32 breaths per minute, and his temperature was 37.3 degrees Celcius. The arterial blood diagnosis revealed a pH of 7.23, pCO2 of 69mm Hg, O2 saturation of 88%, and the HCO3 2.2 meq per litre. The patient’s pH was 7.23. This was a clear indication that the patient was suffering from an acid-base disorder. The patient was extremely acidemic, and the acidemia appeared to be secondary towards the metabolic acidosis with a base mean observed to be excess more than 7mEq/I. This was linked to the problems with the compensation in the respiration that was insufficient to maintain the normal limits of the pH (Stewart, 2003). This is evidenced from the fact that his breathing was heavy; he had a weak and rapid pulse. The partial pressure of carbon dioxide was 31mm Hg in comparison to the normal range that is 40 mm Hg. The oxygen’s partial pressure was 69 mm Hg in comparison to the normal range, which is 90 to 100 mm Hg (Wilkes, 2008). Compensation is the regulation of acid-base imbalances in the body (Story, 2001). Different agents do exist to reversibly bind the ions of hydrogen and impede the pH change. The extracellular buffer involves agents such as ammonia and bicarbonate. The phosphate and proteins play the role of intracellular buffers. The patient’s body began compensating the disturbances in the acid base. This was done when the patient’s pressure started to be laboured and his blood testing showed increased elevation of creatine phosphokinase amounts of cardiac muscles. This showed a bicarbonate system of buffering which is normally the key since carbon dioxide was shifted by carbonic acid to the ions of hydrogen and biocarbonate. More often than not, acid base imbalances, which may overcome the system of buffer, could be compensated for a short time through altering the ventilation rate. This will change the carbon dioxide concentration within the blood, hence altering the body’s pH. If the body begins to compensate the disturbance in the acid base status, the blood pH will normalize. In this case, the blood pH will move towards the normal range. There are different types of acid base disturbances. The first disturbance is the mixed disorder. The existence of one derangement leads to a simple acid base disorder. It may involve alkosis and acidosis happening at the same time, hence counteracting partially with each other, or there can exist at least two conditions that may affect pH of the body. For instance, mixed acidosis involves a combination of the metabolic acidosis together with the respiratory acidosis. There is no specific arrangement as any of the arrangements is possible, except respiratory acidosis and alkalosis respiration as a person will not breathe too slowly or rather slow for the same time (Knaus, 2005). Other types of acid base imbalances that could lead to the increase in pH include carbon dioxide retention, non-volatile acid production from the protein metabolism and different molecules of organic, biocarbonate loss in the urine, acid and acid precursor’s intake (Figge, 2002). Those sources that may lead to the reduction of pH include hydrogen ion use in the metabolism of various organic anions and acid loss in the urine or through vomiting. Human errors are responsible for the false and incorrect results though implications of such errors are somewhat minor, non-existent, and sometimes merely lead to some inconveniences. In the context of health care, this might not necessarily be the case, given that there are increased chances of such consequences being more catastrophic than expected, and the incidents can be easily prevented (Shapiro, 2007). As far as the field of health care is concerned, the Swiss model of organizational accidents is quite applicable as a human factor model. According to the Cheese model, it is hypothetical that there are many levels of defence in any system. In line with this model, one such example involving levels of defence is to do with confirmation of drugs on or before administration. Marking of a surgical site during any operation is another example. In this case, levels of defence do have little ‘holes’ occurring due to the decision-making process of the senior management, limited resources, poor designing, procedures, and inadequate training. Such holes are often called ‘latent conditions’. Whenever latent conditions become aligned at certain successive levels of defence, they end up forming a window. This provides an opportunity for the occurrence of a patient safety incident. Moreover, latent conditions increase the likelihood of healthcare practitioners making ‘active errors’. These are errors occurring while delivering patient care. The combination of both active errors and latent conditions deactivates all levels of defence and a patient incident occurs. This is demonstrated by the arrow in the figure below, breaching all levels of defence. Most clinical errors are linked to medication use and are actually preventable. The Institute of Medicine estimates that the number of patients’ lives lost to preventable medication mistakes alone is over 7,000 deaths annually in USA. A study by Bates in 1995 has suggested that the complications associated with improper issuance of medications accounts for not less than 10% of all healthcare admissions and actually contributes to increased mortality and morbidity in the USA. Most studies focusing on medical errors have been conducted in hospital settings. However, medical mistakes can and do actually occur in any situation where healthcare professionals/patients are involved. The Institute of Medicine describes medical errors as the use of an inappropriate plan to achieve an objective, or failure of an intended action to be completed as intended (Zipperer and Cushman, 2001). It is necessary to emphasize that medical errors are not referred to as intentional acts of doing wrong and that not all medical mistakes rise to the level of medical negligence and malpractice. In this case, an error is a normal condition and not an abnormal event. The occurrence of an error follows limitations in the memory capacity, limited abilities of dealing with various competing demands, the weakened mental ability which includes the process of decision making based on issues such as fatigue and fear, as well as the influence emanating from effects of culture and group dynamics (Zipperer and Cushman, 2001). In retrospect, medical errors have the human component and the system component. More often than not, the providers of health care are held responsible for the occurrence of medical errors. As research has indicated, the occurrence of medical errors is not entirely as a result of the fault of individuals (Zipperer and Cushman, 2001). It is rather because of system design failures involving a chain of events bearing an examination. In line with human errors, the errors might be as a result of failure of the planned action that is completed when intended, such as the error of execution or the errors occurring due to the wrong plan in achieving a certain aim, such as error of planning (Zipperer and Cushman, 2001). This implies that there are two kinds of errors: the error of planning and the error of execution. Errors include problems with procedures, products, practices, and systems (Zipperer and Cushman, 2001). Medical errors are significant because of their effects on patient safety. Medical errors are detrimental events that are avoidable with our present state of medical knowledge. The medication errors are when a patient receives a medication that is not prescribed by the physician, not as directed by the manufacturer, or not in accordance with agreed state, national, and association of practicing nursing principles and standards (Zipperer and Cushman, 2001). References Chertow, M., 2007. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med, 104, pp. 343–348. De Mendonca, A., 2004. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med, 26, pp. 915–921. Figge, J., 2002. Serum proteins and acid–base equilibria: a follow-up. J Lab Clin Med, 120, pp. 713–719. Knaus, A., 2005. APACHE II: a severity of disease classification system. Crit Care Med, 13, pp. 818–829. Liskaser, F., 2004. Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis. Anesthesiology, 93, pp. 1170–1173. Scheingraber, S. and Rehm, M., 2009. 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