Ph Balance

A​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ 75-year-old man was admitted with shortness of breath and lower extremity edema. He has been unwell for about a week and had multiple bouts of diarrhea over the previous 5 days. He does not take any medications. He was hyperventilating and was very distressed when EMS arrived. Admission arterial blood gas is listed below. He was on high concentration oxygen by mask on arrival to the emergency department. Chemistry Results Na+ = 127 HCO3- ​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​20 HCO- = 30meq/L 3 K+ = 5.2 BUN 50.5 Glucose 9.5 mmols/l Cl- 79 Creatinine 0.38 Anion gap 33 mmols/l Arterial Blood Gases pH 7.58 pCO2 21 mmHg pO2 154 mmHg HCO3 19 mmol/l Questions Answer the Following Questions: What is this patient’s acid-base disorder? Discuss why you how you came to that conclusion. Is the patient compensating? What are the pathophysiological responses that the body is attempting to use to compensa​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​te?

Sample Solution

Abstract conceptualisation : although initially anxious about the social interaction involved in this task I made great friends and cemented pre-existing friendships within the group which I will take away from this task. I have learned that despite being anxious the apprehension experienced when I first met my group members wasn’t as bad as I thought it would be and I coped really well. This was the first time I have ever been group leader I have learned that I am good with organising people and delegating tasks. However I might be overly controlling and rigid. This comes down to having overly high expectations of myself and others. My slight perfectionist personality streak came out resulting from self-inflicted pressuring myself to come out of university with a good degree. I have also learned that I am not very good with coping with conflict, when there was conflicting ideas about how to present the presentation. This conflict which caused me to take a back seat as leader and to dissociate from the group I think this is due to prior childhood trauma. Other members of the group, because of different life experiences to mine, were comfortable and sat with the disagreement with some members thriving off it. Most of the group as a whole were anxious about the pentation although one member wasn’t because they are used to giving presentations.

Active experimentation: based on what I have learned from this experience in future team work (and If I am ever involved in a MDT) I will try and be less overbearing and controlling. This will be achieved by putting more trust in people and their ability to work effectively and letting them run with their own ideas instead of micromanaging them. This strategy was found to be effective in MDT team (Fay, Borrill, Amir, Haward & West, 2006). I will try not to retreat from conflict by engaging and contributing rather than avoiding and/or running away from it. I think as a non-confrontational person if I develop the confidence to participate when there is conflict in future I will be able to help the group resolve differences and negotiate a solution in a calm and inclusive manner. This will make me a better leade

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