Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states "I haven’t felt good for about a week, but couldn’t afford to miss work." He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 L via NC and an arterial blood gas. Tony’s ABG results:

pH = 7.28
PaCO2 = 55 mm Hg
PaO2 = 70 mm Hg
HCO3 = 30 mEq/L

Required:

a. Determine Tony’s acid-base imbalance
b. Describe possible causes of the imbalance
c. Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance
d. List the multidimensional care strategies that are appropriate for the care of Tony