Two days after admission for an exacerbation of chronic obstructive pulmonary disease (COPD), an older client's arterial blood gas (ABC) indicate an acid base imbalance. The client's laboratory results reveal a low hemoglobin level, an elevated creatinine clearance, and decreased urine specific gravity. Which is the most likely cause for the acid base imbalance?

Parkinson's disease (PD) is a neurodegenerative disorder characterized by the progressive degeneration of dopaminergic neurons in the substantia nigra of the basal ganglia. This degeneration leads to a deficiency of dopamine, a neurotransmitter involved in the regulation of movement and coordination. The inability to express oneself, as seen in the client's mumbling, can be attributed to the motor symptoms of PD, particularly bradykinesia (slowness of movement) and hypomimia (reduced facial expression), which result from dopaminergic neuron degeneration.

A) Damage to Broca's area in the temporal lobe of the brain:

Damage to Broca's area typically results in expressive aphasia, which is characterized by difficulty speaking and forming coherent sentences. While speech difficulties can occur in PD, they are primarily due to motor dysfunction rather than damage to specific language centers in the brain.

B) Degeneration of dopaminergic neurons of the basal ganglia:

Correct. Degeneration of dopaminergic neurons in the basal ganglia, particularly the substantia nigra, is the primary pathological factor in Parkinson's disease. This degeneration leads to motor symptoms such as bradykinesia, tremor, and rigidity, which can affect the client's ability to speak clearly and express himself.

C) Brain atrophy with diffuse amyloid plaques disposition:

This description is more characteristic of Alzheimer's disease, a different neurodegenerative disorder characterized by brain atrophy and the deposition of amyloid plaques. While cognitive impairment can occur in PD, the primary motor symptoms are related to dopaminergic neuron degeneration rather than amyloid plaque deposition.

D) Paralysis of the pharyngeal and epiglottal area:

Paralysis of the pharyngeal and epiglottal area can lead to dysphagia (difficulty swallowing) rather than difficulty expressing oneself verbally. While dysphagia can occur in PD, it is not typically the primary factor contributing to speech difficulties in this condition.

A) Fatigue and weakness:

Correct. The client's hemoglobin and hematocrit levels are below the reference ranges, indicating mild anemia. Anemia, characterized by low red blood cell count or hemoglobin levels, can lead to symptoms such as fatigue, weakness, and shortness of breath, as the body's oxygen-carrying capacity is reduced. Fatigue and weakness are common manifestations of anemia and are indicative of tissue hypoxia due to decreased oxygen delivery.

B) Cardiac dysrhythmias:

While severe anemia can lead to cardiac complications, such as dysrhythmias, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Cardiac dysrhythmias are more commonly associated with severe anemia or acute changes in hemoglobin levels rather than the mild anemia indicated in this scenario.

C) Fever and infection:

Anemia is not typically associated with fever and infection. While anemia may occur secondary to chronic inflammatory conditions or certain infections, the client's symptoms of fatigue and weakness are more directly related to the decreased oxygen-carrying capacity of the blood due to mild anemia.

D) Decreased clotting time:

Anemia is not directly associated with changes in clotting time. While severe anemia can lead to alterations in platelet function and clotting factors, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Decreased clotting time is not a typical manifestation of mild anemia.