A nurse is caring for an older patient admitted with mild dehydration. What advice should the nurse give to best address this issue?

Rationale for Choice A:
A shift to the left in the white blood cell (WBC) count indicates an increased presence of immature neutrophils, known as bands. This is a hallmark sign of infection, as the body is rapidly producing and releasing these cells to fight off invading pathogens.
Prompt notification of the primary health care provider is crucial to initiate timely antibiotic therapy, if indicated. Early intervention with appropriate antibiotics can effectively combat the infection, prevent its progression, and potentially avert serious complications.
Delaying antibiotic treatment can allow the infection to worsen, potentially leading to sepsis, septic shock, or other life- threatening conditions.
Rationale for Choice B:
While informing the client about the significance of a shift to the left is important for education and understanding, it does not address the immediate need for medical intervention.
The priority action is to involve the primary health care provider for prompt assessment and potential initiation of antibiotic therapy.
Rationale for Choice C:
Documenting findings and continuing to monitor the client's condition is essential for ongoing assessment and evaluation, but it does not constitute a proactive intervention to address the underlying infection.
Documentation alone does not initiate treatment, and monitoring without intervention risks allowing the infection to progress.
Rationale for Choice D:
Protective isolation is not routinely indicated for clients with a shift to the left in their WBC count unless there is a specific concern for transmission of a highly contagious infection.
The decision to implement protective isolation measures would be based on the client's overall clinical presentation and potential infectious risks, as determined by the primary health care provider.

Choice A rationale:
Hyperventilation is a condition characterized by rapid and deep breathing, leading to excessive removal of carbon dioxide (CO2) from the body. This decrease in CO2 levels actually causes respiratory alkalosis, not respiratory acidosis.
CO2 is a weak acid, and its removal from the blood raises the blood pH, making it more alkaline. Key mechanisms involved in hyperventilation-induced respiratory alkalosis:
Increased alveolar ventilation: Hyperventilation increases the rate at which CO2 is expelled from the lungs, reducing its concentration in the blood.
Shift in the equilibrium of the carbonic acid-bicarbonate buffer system: The reduction in CO2 levels drives the equilibrium towards the formation of bicarbonate ions, further reducing the concentration of hydrogen ions and increasing pH.
Renal compensation: The kidneys respond to respiratory alkalosis by excreting more bicarbonate ions, which helps to normalize the blood pH.
Choice B rationale:
Asthma is a chronic respiratory disease characterized by inflammation and narrowing of the airways. This can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which asthma can cause respiratory acidosis:
Bronchoconstriction: Narrowed airways impede airflow, making it difficult to expel CO2 from the lungs.
Air trapping: Inflammation and mucus production can lead to air becoming trapped in the lungs, further increasing CO2 levels.
Hypoventilation: Severe asthma attacks can cause respiratory muscle fatigue, leading to a decrease in breathing rate and inadequate CO2 removal.
Choice C rationale:
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases characterized by chronic obstruction of airflow. This obstruction can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which COPD can cause respiratory acidosis:
Emphysema: Destruction of lung tissue reduces the surface area available for gas exchange, making it difficult to expel CO2. Chronic bronchitis: Inflammation and mucus production in the airways can obstruct airflow and trap CO2 in the lungs.
Hypoventilation: COPD can lead to respiratory muscle fatigue and a decrease in breathing rate, further impairing CO2 removal.
Choice D rationale:
Pulmonary embolism (PE) is a blockage of an artery in the lungs, usually by a blood clot. This can lead to impaired gas exchange and a decrease in oxygen levels in the blood. In severe cases, PE can also cause respiratory acidosis due to inadequate CO2 removal.
Mechanisms by which PE can cause respiratory acidosis:
Ventilation-perfusion mismatch: PE obstructs blood flow to a portion of the lungs, reducing the amount of CO2 that can be removed from those areas.
Hypoxemia: Low oxygen levels in the blood can stimulate the respiratory drive, leading to hyperventilation and CO2 retention.
Right heart failure: PE can strain the right side of the heart, leading to decreased pulmonary blood flow and impaired CO2 removal.