Metabolic acidosis: A decrease in serum HCO3 of less than 24 mEq/L and an increase in the hydrogen ion concentration in the systemic circulation (Burger & Schaller, 2022). Pathophysiology: This occurs when non-carbonic acid concentrations rise, bicarbonate (base) is lost from extracellular fluid, or the kidneys are unable to replenish it. This can happen suddenly, as in the case of lactic acidosis brought on by inadequate circulation or hypoxemia, or more gradually, as in the case of renal failure (failure to excrete acid) or diabetic ketoacidosis (excess production of keto acids from lack of insulin) (Huether & McCance, 2014). Clinical manifestations: Alteration in the neurologic, respiratory, gastrointestinal, and cardiovascular systems are signs of metabolic acidosis. Initial symptoms of severe acidosis include lethargy and a headache, which can escalate to a coma. Respiratory compensation is indicated by deep, fast breathing (Kussmaul breaths). It's typical to have anorexia, nausea, vomiting, diarrhea, and abdominal pain. Extreme acidosis may make it harder for the heart to contract normally and result in potentially fatal dysrhythmias (Huether & McCance, 2014). Evaluation and treatment: Lab results, symptoms, and medical history are used to make the definitive diagnosis of metabolic acidosis. The results of the laboratory tests will reveal arterial blood pH below 7.35 and bicarbonate concentration below 24 mEq/L. A movement to the right can be seen in the oxyhemoglobin curve. For a buffering solution to be used effectively, the underlying issue must be identified. Administration is necessary to raise the pH to a safe level during severe acidosis (pH 7.1), especially if there is renal failure. Deficits in water and sodium must also be made up (Huether & McCance, 2014). Metabolic alkalosis: An initial rise in serum bicarbonate, which causes a blood pH increase to >7.45 (Tinawi, 2021). Pathophysiology: Increased bicarbonate concentration, which is often brought on by an excessive loss of metabolic acids.  Prolonged vomiting, stomach suctioning, a high intake of bicarbonate, hyperaldosteronism with hypokalemia, and diuretic medication are all conditions that might lead to metabolic alkalosis (Huether & McCance, 2014). Clinical Manifestations: Volume loss and electrolyte deficits are linked to several common symptoms including weakness, cramping, and overactive reflexes. Some people may have paresthesias, tetany, and seizures. To maximize carbon dioxide retention, respirations are shallow and sluggish. With severe alkalosis, disorientation and seizures happen. A potential issue is atrial tachycardia. As oxyhemoglobin's dissociation decreases and the likelihood of dysrhythmias rises, the oxyhemoglobin curve shifts to the left (Huether & McCance, 2014). Evaluation and treatment:A sodium chloride solution is necessary for the treatment of contraction alkalosis or hypochloremic alkalosis. As a result, HCO3 may be expelled as NaHCO3 in the urine .

1. Metabolic acidosis: A decrease in serum HCO3 of less than 24
mEq/L and an increase in the hydrogen ion concentration in the
systemic circulation (Burger & Schaller, 2022).
Pathophysiology: This occurs when non-carbonic acid
concentrations rise, bicarbonate (base) is lost from extracellular
fluid, or the kidneys are unable to replenish it. This can happen
suddenly, as in the case of lactic acidosis brought on by
inadequate circulation or hypoxemia, or more gradually, as in
the case of renal failure (failure to excrete acid) or diabetic
ketoacidosis (excess production of keto acids from lack of
insulin) (Huether & McCance, 2014).
Clinical manifestations: Alteration in the neurologic,
respiratory, gastrointestinal, and cardiovascular systems are
signs of metabolic acidosis. Initial symptoms of severe acidosis
include lethargy and a headache, which can escalate to a coma.
Respiratory compensation is indicated by deep, fast breathing
(Kussmaul breaths). It's typical to have anorexia, nausea,
vomiting, diarrhea, and abdominal pain. Extreme acidosis may
make it harder for the heart to contract normally and result in
potentially fatal dysrhythmias (Huether & McCance, 2014).
Evaluation and treatment: Lab results, symptoms, and medical
history are used to make the definitive diagnosis of metabolic
acidosis. The results of the laboratory tests will reveal arterial
blood pH below 7.35 and bicarbonate concentration below 24
mEq/L. A movement to the right can be seen in the
oxyhemoglobin curve. For a buffering solution to be used
effectively, the underlying issue must be identified.
Administration is necessary to raise the pH to a safe level
during severe acidosis (pH 7.1), especially if there is renal
failure. Deficits in water and sodium must also be made up
(Huether & McCance, 2014).
Metabolic alkalosis: An initial rise in serum bicarbonate, which
causes a blood pH increase to >7.45 (Tinawi, 2021).

2. Pathophysiology: Increased bicarbonate concentration, which is
often brought on by an excessive loss of metabolic acids.
Prolonged vomiting, stomach suctioning, a high intake of
bicarbonate, hyperaldosteronism with hypokalemia, and diuretic
medication are all conditions that might lead to metabolic
alkalosis (Huether & McCance, 2014).
Clinical Manifestations: Volume loss and electrolyte deficits are
linked to several common symptoms including weakness,
cramping, and overactive reflexes. Some people may have
paresthesias, tetany, and seizures. To maximize carbon dioxide
retention, respirations are shallow and sluggish. With severe
alkalosis, disorientation and seizures happen. A potential issue
is atrial tachycardia. As oxyhemoglobin's dissociation decreases
and the likelihood of dysrhythmias rises, the oxyhemoglobin
curve shifts to the left (Huether & McCance, 2014).
Evaluation and treatment:A sodium chloride solution is
necessary for the treatment of contraction alkalosis or
hypochloremic alkalosis. As a result, HCO3 may be expelled as
NaHCO3 in the urine and the renal impulse to increase ECF
volume by holding Na+ is reduced. Potassium therapy treats
alkalosis brought on by hypokalemia or hyperaldosteronism.
The potassium reduces hydrogen loss from the distal tubule by
causing hydrogen to migrate back into the ECF (Huether &
McCance, 2014).
References
Burger MK, Schaller DJ. Metabolic Acidosis. [Updated 2022 Jul
19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK482146/
Huether, S., McCance, K. (2014).
Pathophysiology: The Biologic Basis for Disease in
Adults and Children (7th ed.). Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323088541
Tinawi M. (2021). Pathophysiology, Evaluation, and

3. Management of Metabolic Alkalosis.
Cureus,
13(1), e12841. https://doi.org/10.7759/cureus.12841
BRCA 1 and BRCA 2 are genes linked to the production of
proteins critical in repairing damaged DNA. Every human has a

4. pair of the BRCA 1 and BRCA 2 inherited from each parent.
Unfortunately, one can inherit harmful variants of the BRCA 1
and BRCA 2 genes. The harmful variants increase the chances
of one developing cancers, mainly breast and ovarian cancer.
When a person that carries any mutation inherits 50% of the
detrimental variants of the genes, they exhibit a 1 in 2 chance of
developing cancer (National Cancer Institute, 2020). According
to studies, about 55% - 72% of women with the harmful genes
of BRCA 1 and 2 develop breast cancer in their old age
(National Cancer Institute, 2020). On the other hand, 1.2% of
women develop ovarian cancer during their lifetime (National
Cancer Institute, 2020). The number is significant among
women who inherited harmful BRCA genes. About 39%-44% of
women with inherited harmful BRCA genes have cancer in their
old age (National Cancer Institute, 2020). Surveillance
screening for harmful mutations is not yet recommended for the
general public (National Cancer Institute, 2020). However,
experts recommend surveillance for people with an increased
risk of carrying harmful BRCA variants. In my opinion, genetic
testing is a critical diagnosing measure that can help people
understand their health status and ways of addressing issues or
maintaining their health status. A negative result may relieve a
person concerning the future risk of developing cancer.
Similarly, one may feel relieved that their children are at low
risk of inheriting harmful BCRA genes. Also, a positive result
has benefits as one can make an informed decision concerning
their health. Genetic testing has minimal harmful effects
(National Cancer Institute, 2020).
Reference:
National Cancer Institute. (2020, November 19). BRCA gene
mutations: Cancer risk and genetic testing fact sheet.
https://www.cancer.gov/about-cancer/causes-
prevention/genetics/brca-fact-sheet
The Sun Top Nursing Home is currently a 100-bed facility

5. located in a two-story building. Due to demand, two additional
two-story buildings will be opening within the next two years.
When completed, the units will be 1 North, 2 North, 1 East, 2
East, 1 West, and 2 West.
The Centers for Medicare & Medicaid Services (CMS)
implements quality initiatives to assure quality health care for
Medicare beneficiaries through accountability and public
disclosure. CMS uses quality measures in its various quality
initiatives that include quality improvement, pay for reporting,
and public reporting. Quality measures are tools that help us
measure or quantify healthcare processes, outcomes, patient
perceptions, and organizational structure and/or systems that are
associated with the ability to provide high-quality health care
and/or that relate to one or more quality goals for health care.
These goals include effective, safe, efficient, patient-centered,
equitable, and timely care.
Long Stay Quality Measures
· Percent of Residents Experiencing One or More Falls with
Major Injury (Long Stay)
· Percent of Residents who Self-Report Moderate to Severe Pain
(Long Stay)
· Percent of High-Risk Residents with Pressure Ulcers (Long
Stay)
· Percent of Residents Assessed and Appropriately Given the
Seasonal Influenza Vaccine (Long Stay)
· Percent of Residents Assessed and Appropriately Given the
Pneumococcal Vaccine (Long Stay)
· Percent of Residents with a Urinary Tract Infection (Long
Stay)
· Percent of Low-Risk Residents Who Lose Control of Their
Bowels or Bladder (Long Stay)
· Percent of Residents Who Have/Had a Catheter Inserted and
Left in Their Bladder (Long Stay)
· Percent of Residents Who Were Physically Restrained (Long
Stay)
· Percent of Residents Whose Need for Help with Activities of

6. Daily Living Has Increased (Long Stay)
· Percent of Residents Who Lose Too Much Weight (Long Stay)
· Percent of Residents Who Have Depressive Symptoms (Long
Stay)
· Percent of Long-Stay Residents Who Received An
Antipsychotic Medication. (RTI International, 2019)
The Chief Nursing Officer/Director of Quality Improvement is
concerned that as the facility expands, the Centers for Medicare
& Medicaid Services (CMS) Long Stay Quality Measures results
will reflect negatively upon the facility. The quality of care of
the facility is good, but documentation in the MDS 3.0 is often
with errors or omissions. The Chief Nursing Officer requested
assistance in comparing the MDS 3.0 documentation with
information abstracted after the resident’s discharge in
preparation to a new training initiative for the staff hiring
anticipated with the building expansion. For this assignment,
· Review the quality indicators and select two of the quality
measures.
· Create a proposal to compare and contrast the MDS 3.0
findings with the information abstracted after the resident’s
discharge.
· Determine the number of resident cases to be used in the
study.
· Identify the codes abstracted from the residents’ health
records related to each selected quality measure.
· Identify data that is not currently abstracted from the health
records related to each selected quality measure.
· Outline the end of study report format.