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Mastering Acid-Base Imbalances: A High-Yield
Nursing Case Study with Analysis.
Table of Contents
1. Case Study Introduction
2. Part 1: Initial Assessment & ABG Interpretation
3. Part 2: Identifying the Underlying Cause
4. Part 3: Recognizing Compensatory Mechanisms
5. Part 4: Assessing Signs & Symptoms
6. Part 5: Prioritizing Nursing Interventions
7. Part 6: Evaluating Outcomes & Client Education
8. Comprehensive Analysis & Rationales
9. Key Takeaways for NCLEX Success
Case Study Introduction
Client: Mrs. Eleanor Vance, 68-year-old female
Medical History: Type 2 Diabetes Mellitus (insulin-dependent),
Hypertension, Chronic Kidney Disease (Stage 3)
Situation: Mrs. Vance was brought to the Emergency Department by
her daughter, who found her at home confused, lethargic, and "breathing
funny." The daughter reports that Mrs. Vance has had a "stomach bug"
for the past 3 days with severe vomiting and diarrhea, and has been
unable to keep down food, fluids, or her usual medications.
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Part 1: Initial Assessment & ABG Interpretation
Initial Assessment Findings:
• Vital Signs: BP 90/58 mm Hg, HR 118 bpm (thready), RR 28
breaths/min and deep, Temp 37.2°C (99.0°F), SpO2 96% on room
air.
• Neurological: Lethargic, disoriented to place and time.
• Cardiovascular: Skin cool and dry, poor skin turgor, flat neck
veins.
• Respiratory: Deep, rapid, sighing respirations. Lung sounds clear
bilaterally.
• Gastrointestinal: Reports persistent nausea, abdomen soft,
hypoactive bowel sounds.
• Integumentary: Dry mucous membranes.
Arterial Blood Gas (ABG) Results (on room air):
ABG Component Client Result Normal Range
pH 7.30 7.35 - 7.45
PaCO₂ 30 mm Hg 35 - 45 mm Hg
HCO₃⁻ 15 mEq/L 22 - 26 mEq/L
PaO₂ 92 mm Hg 80 - 100 mm Hg
Question 1: Interpret these ABG results.
Mastering Acid-Base Imbalances: A High-Yield
Nursing Case Study with Analysis.
Table of Contents
1. Case Study Introduction
2. Part 1: Initial Assessment & ABG Interpretation
3. Part 2: Identifying the Underlying Cause
4. Part 3: Recognizing Compensatory Mechanisms
5. Part 4: Assessing Signs & Symptoms
6. Part 5: Prioritizing Nursing Interventions
7. Part 6: Evaluating Outcomes & Client Education
8. Comprehensive Analysis & Rationales
9. Key Takeaways for NCLEX Success
Case Study Introduction
Client: Mrs. Eleanor Vance, 68-year-old female
Medical History: Type 2 Diabetes Mellitus (insulin-dependent),
Hypertension, Chronic Kidney Disease (Stage 3)
Situation: Mrs. Vance was brought to the Emergency Department by
her daughter, who found her at home confused, lethargic, and "breathing
funny." The daughter reports that Mrs. Vance has had a "stomach bug"
for the past 3 days with severe vomiting and diarrhea, and has been
unable to keep down food, fluids, or her usual medications.
, 2|Page
Part 1: Initial Assessment & ABG Interpretation
Initial Assessment Findings:
• Vital Signs: BP 90/58 mm Hg, HR 118 bpm (thready), RR 28
breaths/min and deep, Temp 37.2°C (99.0°F), SpO2 96% on room
air.
• Neurological: Lethargic, disoriented to place and time.
• Cardiovascular: Skin cool and dry, poor skin turgor, flat neck
veins.
• Respiratory: Deep, rapid, sighing respirations. Lung sounds clear
bilaterally.
• Gastrointestinal: Reports persistent nausea, abdomen soft,
hypoactive bowel sounds.
• Integumentary: Dry mucous membranes.
Arterial Blood Gas (ABG) Results (on room air):
ABG Component Client Result Normal Range
pH 7.30 7.35 - 7.45
PaCO₂ 30 mm Hg 35 - 45 mm Hg
HCO₃⁻ 15 mEq/L 22 - 26 mEq/L
PaO₂ 92 mm Hg 80 - 100 mm Hg
Question 1: Interpret these ABG results.
