Shauna is a healthy, fit 28-year-old who decided to go on a 2-week tour of Mexico for young singles. One hot afternoon in a small market community, she grabbed
Develop cooperative relationships with clients when teaching concepts concerning pathological states to individuals and families
Select one of the case studies below, and include discussion of your strategy for winning the patients cooperation while teaching concepts concerning pathological states to them and their families.to include cellular metabolism in the content. Each case study has component of cellular injury so be sure to find sources to support. Other concepts that may be applicable are oxidative stress, free radicals and cellular injury/apoptosis.
Requirements
- Make sure all of the topics in the case study have been addressed.
- Cite at least three sources; journal articles, textbooks or evidenced-based websites to support the content.
- All sources must be within five years.
- Do not use .com, Wikipedia, or up-to-date, etc., for your sources.
Case Study 4
Disorders of Acid–Base Balance
Shauna is a healthy, fit 28-year-old who decided to go on a 2-week tour of Mexico for young singles. One hot afternoon in a small market community, she grabbed some fruit juice from a street vendor. Several hours later, she developed abdominal cramping and diarrhea.
The diarrhea became so severe that she missed 3 days of the tour and stayed in her hotel room. By the end of her illness, she felt weak and tired. Her head ached, but the mild fever had disappeared, and she was able to join her new friends for the rest of the tour.
- What is the acid–base imbalance Shauna might have experienced and its etiology?
- What are the functions and importance of the bicarbonate buffer system in the body?
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Developing Patient Cooperation: Acid-Base Balance Disorders
Expert Answer and Explanation
Shauna’s Acid-Base Balance Disorder
Metabolic acidosis
Shauna goes on a two week tour of Mexico, a known dry area, and she partakes of fruit juice on one hot afternoon thus ending up developing diarrhea and abdominal cramping. To put this into context, the region visited by Shauna is a hot and dry place, which predisposed her to dehydration and its effects.
This is not helped by the fact that when she eventually gets thirsty and decides to take fruit juice, she develops diarrhea, which further enhances the fluid and electrolyte loss off her body. It is because of the ensuing dehydration and electrolyte imbalance that she feels tired and experiences a mild headaches.
Metabolic acidosis has been defined by Ewesson (2015) as a ‘clinical disturbance characterized by an increase in plasma acidity.’ It is one of the commonest acid- base balance disorders and is usually a sign of an underlying disease process. The basic mechanisms by which this disturbance arises is when the levels of hydrogen ions in plasma (which confers acidity) increase or the levels of bicarbonate ions (that provides the basicity) is reduced (Schricker et al., 2019).
This, while might be read into as a straightforward process, is rather quite the opposite as the processes leading to the disturbance involves an array of respiratory and renal changes in function in an attempt at compensation of the initial pathological insult, with the disturbance only coming in as the end point of failure of the compensatory processes (Schricker et al., 2019).
Etiologically, causes of metabolic acidosis include ketoacidosis, lactic acidosis and chronic renal failure. Diarrhea, however, is the most common cause Ewesson (2015) and has been found to result from the disruption in the sodium- potassium and bicarbonate-chloride exchange mechanisms in the large bowel.
In acute non-infectious diarrhea, such as the one Shaun experienced, involves loss of sodium and bicarbonate ions in stool leading to hyponatremic, hyperchloremic acidosis (Urso et al., 2017). There is usually no additional anions getting into the plasma at the time, and hence this acidosis is termed normal anion gap metabolic acidosis.
Clinically, it presents as respiratory distress (Kussmaul’s breathing), lethargy due to the dehydration, neurological deficits such as confusion, coma and death as well as cardiac arrhythmias due to the ensuing hyperkalemia (Kumar, Abbas & Aster, 2017).
Functions and Significance of Bicarbonate Buffer
The bicarbonate buffer is the most important extracellular physiological buffer (Ewesson, 2015). It derives its importance from its being an open ended system of buffering where no equilibrium is achieved. This infers that, for the other physiological buffers such as proteins and hemoglobin, the extent of their buffering is only as viable as long as equilibrium between the base and the weak acid is not achieved. The bicarbonate one, however, represents an open system in which the body is able to regenerate extra bicarbonate when needed as well as eliminate excess through the kidneys thus ensuring the bicarbonate system is in a continuous state of turnover (Ewesson, 2015).
In state of inadequacy, the body is able to synthesize bicarbonate ions from cellular reactions in the proximal tubular cells to avert metabolic acidosis. When in excess, the stimuli for their absorption in the proximal convoluted tubule is diminished, leading to their increased losses in urine with subsequent urine alkalinization (Schricker et al., 2019).
This averts metabolic alkalosis. Noteworthy too is the fact that the bicarbonate anion is the central regulatory buffer that forms an integral link between the renal and respiratory systems as regard matters acid-base balance (Thomas, 2017). That, again, is another aspect that renders it an open system and makes it as powerful since measured compensatory responses of one of the two systems comes in to rectify a pathological response by the other, always (Thomas, 2017). That explains the Kussmaul’s breathing in acidotic states.
Strategies for Patient Cooperation
Communicating in the patient’s language
Perez-Stable & El-Toukhy (2018) describe communication as an important pillar of effective interaction between a patient and the practitioner. Effective communication involves showing concern at the patient’s plight, exuding understanding, keeping the patient apprised at what is going on and projecting confidence at the management of the condition (Perez-Stable & El-Toukhy, 2018).
In this scenario, one would make first impression by warmly welcoming the patient and encouraging them that all will be well to enhance provision of information and/history that would otherwise form a vital cog in the patient diagnostic formulation and subsequent management. During the interaction and questioning, ensuring the patient is in her most comfortable position either by provision of a comfy seat or bed is vital.
As part of exuding understanding of the patient’s plight, one would ensure to ask only relevant questions and avoid dwelling on ambiguities. For instance, in this scenario, one would desist from questioning the patient’s decision to go to Mexico and instead provide the information that next time the patient goes on such a walk it would be advisable to tag along with significant quantities of drinking water in case she gets dehydrated.
Perhaps the most telling would involve explaining to the patient the cause of her being in hospital as well as ensuring she is posted about the relevant management process put in place for her. Here, the patient is explained to in simple terms that the initial thirst she felt is because she was dehydrated.
Thereafter, when she takes the juice and has diarrhea, further fluid and electrolytes is lost, reducing her fluid status even further. The specific electrolytes loss in the stool is what drives her to feel lethargic and tired. Therefore, she is also explained to that she shall be hydrated using normal saline and replacement of other vital electrolytes will be done as needed.
Making a good first impression
‘There are no second chances to make first impression,’ is a maxim that holds true to this regard. As a practitioner, it will be very vital to ensure that that instance of first contact with the patient involves exuding of a pleasant personality (Carpman &Grant, 2016). That of caring, being a good listener, proper grooming and speaking appropriately. This will not only go a long way in ‘unlocking’ the patient to furnish one with the requisite information with vital diagnostic and management implications but also will ensure continued positive interactions for the benefit of the patient.
One would ensure calmness during the interactions with the patient, to ensure that the situation is under wraps and project the image that the situation is under control. Meanwhile, should anything go wrong, then the trust of the patient can be earned by explaining to them explicitly the occurrence and the instituted measures to mitigate the same.
As part of respecting the patient’s autonomy, it would be vital to support their decision regarding how they would like to be managed, but professionally also provide extra modalities of managing the situation so that the patient makes an informed decision. Here, effort would be taken to explain to the patient the possible complications of her condition so that she takes the slightest time possible to arrive at a decision regarding the suitability of her management plan.
References
Carpman, J. R., & Grant, M. A. (2016). Design that cares: Planning health facilities for patients and visitors (Vol. 142). John Wiley & Sons.
EWESSON, D. (2015). Metabolic acidosis.
Kumar, V., Abbas, A. K., & Aster, J. C. (2017). Robbins basic pathology e-book. Elsevier Health Sciences.
Pérez-Stable, E. J., & El-Toukhy, S. (2018). Communicating with diverse patients: How patient and clinician factors affect disparities. Patient education and counseling, 101(12), 2186-2194.
Schricker, S., Schanz, M., Alscher, M. D., & Kimmel, M. (2019). Metabolic acidosis: Diagnosis and treatment. Medizinische Klinik, Intensivmedizin und Notfallmedizin.
Thomas, C. P. (2017). Metabolic acidosis. Medscape. Ed V Batuman. New York, NY, USA: WebMD LLC.
Urso, C., Brucculeri, S., Carollo, C., & Caimi, G. (2017). Analysis of the parameters, traditional or not, for the evaluation of the metabolic acidosis. Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia, 34(1).
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