Acid-Base

The nurse is caring for a client with respiratory insufficiency. The arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 30 mm Hg (30 mm Hg), and the nurse is told that the client is experiencing respiratory alkalosis. Which additional laboratory value would the nurse expect to note?

A sodium level of 145 mEq/L2A potassium level of 3.0 mEq/L3A magnesium level of 1.8 mEq/L4A phosphorus level of 3.0 mg/dL 2 Signs/symptoms of respiratory alkalosis include tachypnea, change in mental status, dizziness, pallor around the mouth, spasms of the muscles of the hands, and hypokalemia. The remaining options identify normal laboratory results.

The nurse is monitoring a group of clients for acid-base imbalances. Which clients are at highest risk for metabolic acidosis? Select all that apply.

Client with asthma2Client with pancreatitis3Malnourished client4Client with diabetes mellitus5Client with status epilepticus6Client with severe prolonged diarrhea 2,3,4,5,6 Clients who produce excessive acid, under produce bicarbonate, or overly eliminate bicarbonate develop metabolic acidosis. Clients with malnourishment, diabetes mellitus, and status epilepticus produce excessive acids leading to metabolic acidosis. Clients with pancreatitis under produce bicarbonate and develop metabolic acidosis. Clients with severe prolonged diarrhea develop metabolic acidosis due to the over elimination of bicarbonate. The client with asthma could develop an acid-base imbalance from a respiratory problem.

A 3-year-old child is hospitalized because of persistent vomiting. Which conditions would the nurse expect this child to be at high risk for? Select all that apply.

Diarrhea2Dehydration3Metabolic acidosis4Metabolic alkalosis5Hyperactive bowel sounds 2,4 Vomiting will cause the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. The child who is vomiting is also at risk for fluid volume deficit or dehydration. Diarrhea may not accompany vomiting. Hyperactive bowel sounds are not specifically associated with vomiting.

A client's arterial blood gases reveal a pH of 7.51 and a bicarbonate level of 31 mEq/L. The nurse prepares for the administration of which medication that would be prescribed to treat this acid-base disorder?

Furosemide2Acetazolamide3Spironolactone4Sodium bicarbonate 2 Acetazolamide is a diuretic used in the treatment of metabolic alkalosis. This medication causes excretion of sodium, potassium, bicarbonate, and water by inhibiting the action of carbonic anhydrase. Administration of sodium bicarbonate would aggravate the already existing condition and is contraindicated. Furosemide is a loop diuretic, and spironolactone is a potassium-retaining diuretic. These are of no value when there is a need to excrete bicarbonate.

The nurse is collecting data from a client with a suspected diagnosis of gastric ulcer. The client tells the nurse that oral antacids are taken frequently throughout the day. The nurse continues to collect data from the client, understanding that the client is at risk for which acid-base disturbance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis: 2 Increases in base components occur as a result of oral or parenteral ingestion of bicarbonates, carbonates, acetates, citrates, and lactates. Excessive use of oral antacids containing sodium or calcium bicarbonate can cause metabolic alkalosis. Eliminate the options dealing with respiratory problems. Eliminate acidosis because of the ingestion of antacids.

A client who has fallen from a roof and fractured his ribs has arterial blood gas (ABG) results of: pH 7.48, Paco2 32 mm Hg, Pao2 89 mm Hg, and HCO3- 22 mEq/L. How would the nurse interpret the client's blood gas results?

Normal results2Respiratory acidosis3Metabolic acidosis4Respiratory alkalosis 4 The client has respiratory alkalosis. Normal ranges for pH are 7.35 to 7.45, for Paco2 35 to 45 mm Hg, and for bicarbonate 22 to 26 mEq/L. With acidosis, the pH would be less than 7.35; with alkalosis, the pH would be greater than 7.45. Carbon dioxide levels would be elevated in respiratory acidosis. Bicarbonate levels would be low if a metabolic acidosis is present.

Which clients would the nurse determine is at risk for development of metabolic alkalosis? Select all that apply.

Client with emphysema2Client who is hyperventilating3Client with chronic kidney disease4Client who has been vomiting for 2 days5Client receiving oral furosemide 40 mg daily6Client admitted with acetylsalicylic acid overdose 4,5 Metabolic alkalosis is caused by any condition that creates the acid-base imbalance through either an increase in bases or a deficit of acids, such as the client who has been vomiting for 2 days and the client receiving furosemide daily. Recall that clients with emphysema and hyperventilation are at risk for a respiratory acid-base disturbance. Chronic kidney disease and aspirin overdose will result in metabolic acidosis.

A client is in respiratory alkalosis induced by gram-negative sepsis. The nurse assists in implementing which measure as the effective means to treat the problem?

Administer prescribed antibiotics.2Have the client breathe into a paper bag.3Administer prescribed as-needed (PRN) antipyretics.4Request a prescription for a partial rebreather oxygen mask. 1 The most effective way to treat an acid-base disorder is to treat the underlying disorder. In this case, the problem is sepsis, which is most effectively treated with antibiotic therapy. Antipyretics will control fever secondary to sepsis but do nothing to treat the acid-base disorder. The paper bag and partial rebreather mask will help the client rebreathe exhaled carbon dioxide, but again, these do not treat the primary cause of the imbalance.

The nurse is caring for an adult client with respiratory distress syndrome. A review of the arterial blood gas results indicates that the client is experiencing respiratory alkalosis. The nurse would then examine the results of serum electrolytes to see whether which electrolyte imbalance is present?

Hypokalemia2Hyponatremia3Hyperkalemia4Hypercalcemia 1 Signs and symptoms of respiratory alkalosis include a decrease in the respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesias such as tingling of the fingers and toes, hypokalemia, hypocalcemia, tetany, and seizures. Signs and symptoms do not include hyponatremia, hypercalcemia, or hyperkalemia.

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 2 The loss of gastric fluid via nasogastric suction or vomiting causes a metabolic condition. This also results in an alkalotic condition as a result of the loss of hydrochloric acid through gastrointestinal fluid losses. Also, the options denoting a respiratory problem—respiratory acidosis and alkalosis—can be easily eliminated.

The nurse has assisted with obtaining a blood specimen for arterial blood gas (ABG) analysis. The nurse avoids doing which to properly obtain and send the specimen?

Place the specimen on ice.2Record the client's temperature on the requisition.3Record the percent of oxygen on the requisition.4Obtain a 3-mL syringe that is used for parenteral medication. 4 The specimen is drawn into a heparinized syringe to prevent clotting of the blood. A 3-mL syringe used to administer parenteral medication is not used. The specimen should be placed on ice after it is obtained. The requisition is fully completed, identifying pertinent client information such as body temperature and amount of oxygen in use.

31 of 37GO A client is determined to be in respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of which electrolyte disorder that could accompany the acid-base imbalance?

Hypokalemia2Hypercalcemia3Hypernatremia4Hypochloremia 2 Signs and symptoms of respiratory alkalosis include tachypnea, hyperpnea, weakness, paresthesias, tetany, dizziness, convulsions, coma, hypokalemia, and hypocalcemia. Remember that potassium, which is intracellular, and hydrogen ions exchange places to compensate and achieve an equilibrium with acid-base imbalances. The clinical picture does not include hypercalcemia, hypernatremia, or hypochloremia.

A client has the following laboratory values: a pH of 7.55, an HCO3- level of 22 mEq/L (22 mmol/L), and a Pco2 of 30 mm Hg (30 mm Hg). Which action would the nurse plan to take?

Perform Allen's test.2Prepare the client for dialysis.3Administer insulin as prescribed.4Encourage the client to slow down breathing. 4 The client is experiencing respiratory alkalosis based on the laboratory results of a high pH and a low Pco2 level. Interventions for respiratory alkalosis are the voluntary holding of breath or slowed breathing and the rebreathing of exhaled CO2 by methods such as using a paper bag or a rebreathing mask as prescribed. Performing Allen's test would be incorrect, because the blood specimen has already been drawn, and the laboratory results have been completed. Dialysis and insulin administration are interventions for metabolic acidosis.

An anxious client is experiencing respiratory alkalosis from hyperventilation as a result of anxiety. The nurse would do which action to help the client experiencing this acid-base disorder?

Put the client in a supine position.2Provide emotional support and reassurance.3Withhold all sedative or antianxiety medications.4Tell the client to breathe very deeply but more slowly. 2 An anxious client benefits from emotional support and reassurance, which in turn reduces anxiety and may lower the respiratory rate. The client may benefit from the administration of a sedative or antianxiety medication, if it is prescribed. The client should try to breathe more slowly and shallowly. Lying supine provides no benefit to the client.

The nurse is reviewing the arterial blood gas results of the client. Blood gas results indicate a pH of 7.30 and a Pco2 of 50 mm Hg, and the nurse has determined that the client is experiencing respiratory acidosis. Which additional laboratory values would the nurse expect to note in this client?

Sodium of 145 mEq/L2Potassium 5.4 mEq/L3Magnesium 2 mEq/L4Phosphorus 2.3 mEq/L 2 Serum potassium levels are often high in acidosis as the body attempts to maintain electroneutrality during buffering. In acidosis, extracellular hydrogen ion content increases, and hydrogen ions then begin to move into intracellular fluid. To keep the intracellular fluid electrically neutral, an equal number of potassium ions must leave the cell, creating a relative hyperkalemia. Sodium, magnesium, and phosphorus would remain within normal range.

The nurse determines that which clients are at high risk for metabolic acidosis? Select all that apply.

Clients with asthma2Clients with diabetes3Clients with pneumonia4Clients with kidney failure5Clients with severe anxiety6Clients with malnourishment 2,4,6 Diabetes mellitus, kidney failure, and malnutrition lead to metabolic acidosis by increasing acids in the body. Asthma, pneumonia, and severe anxiety lead to respiratory, not metabolic, imbalances.

Arterial blood gases (ABGs) are obtained on a client with pneumonia. The ABG results are pH, 7.50; Pco2, 30 mm Hg; HCO3-, 20 mEq/L; and Po2, 75 mm Hg. The nurse interprets these results and determines that which acid-base condition exists?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 4 Normal pH is 7.35 to 7.45. Normal Pco2 is 35 to 45 mm Hg. Remember that when a respiratory condition exists, an opposite effect will be found between the pH and the Pco2. In respiratory alkalosis, the pH will be elevated and the Pco2 level decreased.

The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Intestinal secretions high in bicarbonate may be lost through enteric drainage tubes, an ileostomy, or diarrhea. The decreased bicarbonate level creates the actual base deficit of metabolic acidosis. The remaining options are unlikely to occur in a client with severe diarrhea.

A client has had a set of arterial blood gases drawn. The results are pH, 7.34; Paco2, 37 mm Hg; Pao2, 79 mm Hg; and HCO3,- 19 mEq/L. The nurse interprets that the client is experiencing which acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Metabolic acidosis occurs when the pH falls below 7.35, and the bicarbonate level falls below 22 mEq/L. With respiratory acidosis, the pH drops below 7.35 and the carbon dioxide level rises above 45 mm Hg. With respiratory alkalosis, the pH rises above 7.45 and the carbon dioxide level falls below 35 mm Hg. With metabolic alkalosis, the pH rises above 7.45 and the bicarbonate level rises above 26 mEq/L.

The nurse is assisting to admit a client with a diagnosis of acute Guillain-Barré syndrome. The nurse knows that if the disease progresses to a severe level, the client will be at risk for which acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 3 Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, which leads to respiratory acidosis resulting from progressive respiratory insufficiency as the paralysis ensues.

The nurse reviews the arterial blood gas results of a client and notes that the results indicate a pH of 7.30, Pco2 of 52 mm Hg, and HCO3- of 22 mEq/L. Which interpretation would the nurse correctly make about these results?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 3 Normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this situation, the pH is low and the Pco2 is increased. In an acidotic condition, the pH is decreased. Therefore, the values identified in the question indicate a respiratory acidosis.

A client has the following laboratory values: pH of 7.55, HCO3- of 22 mm Hg, and a Pco2 of 30 mm Hg. Which action would the nurse take?

Prepare the client for dialysis.2Administer insulin as prescribed.3Suction the client to improve respiratory status.4Encourage the client to slow down his breathing. 4 The client is in respiratory alkalosis based on the laboratory results of a high pH and low Pco2. Interventions for respiratory alkalosis are voluntary holding of the breath or slowed breathing and rebreathing exhaled CO2 by methods such as using a paper bag or rebreathing mask, as prescribed. Dialysis and administration of insulin are interventions for metabolic acidosis. Suctioning the client would improve respiration status and treat respiratory acidosis.

The nurse is caring for a client with kidney failure. The nurse is told that the blood gas results indicate a pH of 7.30 and a HCO3- of 20 mm Hg, and that the client is experiencing metabolic acidosis. The nurse reviews the laboratory results and finds which value to be of concern?

Sodium level, 145 mEq/L2Potassium level, 5.6 mEq/L3Magnesium level, 2.6 mg/dL4Phosphorus level, 4.5 mg/dL 2 Signs/symptoms of metabolic acidosis include weakness, malaise, and headache. Hyperkalemia will occur because the cells will draw hydrogen into the cell and in exchange will push potassium out of the cell into the blood. The pH will be lower than 7.35, and the HCO3- ion level will be lower than 22 mEq/L. The remaining options identify normal laboratory values, whereas a potassium level of 5.6 mEq/L indicates hyperkalemia

The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 32 mm Hg (32 mm Hg). The nurse determines that these results are indicative of which acid-base disturbance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 4 The normal pH is 7.35 to 7.45. If a respiratory condition exists, an opposite relationship will be seen between the pH and the Pco2, as is seen in the correct option. If an alkalotic condition exists, the pH is increased. During an acidotic condition, the pH is decreased so both metabolic acidosis and respiratory acidosis can be eliminated. Metabolic alkalosis can also be eliminated be

The registered nurse (RN) reviews the results of the arterial blood gas (ABG) values with the licensed practical nurse (LPN) and tells the LPN that the client is experiencing respiratory acidosis. The LPN would expect to note which on the laboratory result report?

pH 7.50, Pco2 52 mm Hg .2 pH 7.35, Pco2 40 mmHg 3. pH 7.25, Pco2 50 mm Hg 4. pH 7.50, Pco2 30 mm Hg 3 The normal pH is 7.35 to 7.45, and the normal Pco2 value is 35 mm Hg to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis, the pH is down and the Pco2 is up. Therefore, the pH of 7.25 and the Pco2 of 50 mm Hg (50 mm Hg) option is the only one that reflects an acidotic condition. Options with an elevated pH (options 1 and 4) indicate an alkalotic condition. Option 2 identifies normal values for pH and Pco2.

A client who has received sodium bicarbonate in large amounts is at risk for developing metabolic alkalosis. The nurse checks this client for which signs and symptoms characteristic of this disorder?

Disorientation and dyspnea2Drowsiness, headache, and tachypnea3Tachypnea, dizziness, and paresthesias4Decreased respiratory depth and rate and dysrhythmias 4 The client with metabolic alkalosis is likely to exhibit a decrease in respiratory rate and depth, nausea, vomiting, diarrhea, restlessness, numbness and tingling in the extremities, twitching in the extremities, hypokalemia, hypocalcemia, and dysrhythmias. Disorientation and dyspnea could be associated with hypoxemia. Tachypnea, dizziness, and paresthesias are often associated with hyperventilation and respiratory alkalosis. Drowsiness, headache and tachypnea are not associated with metabolic alkalosis.

The licensed practical nurse (LPN) is assisting in the care of a client who overdosed on acetylsalicylic acid 24 hours ago. The LPN would report to the registered nurse (RN) which findings associated with an anticipated acid-base disturbance?

Drowsiness, headache, and tachypnea2Tachypnea, dizziness, and paresthesias3Disorientation, hypotension, and dyspnea4Decreased respiratory rate and depth and cardiac irregularities 1 The client who ingests a large amount of aspirin (acetylsalicylic acid) is at risk for developing metabolic acidosis 24 hours later. If metabolic acidosis occurs, the client is likely to exhibit drowsiness, headache, and tachypnea. In the very early hours following aspirin overdose, the client may exhibit respiratory alkalosis as a compensatory mechanism. By 24 hours after overdose, however, the compensatory mechanism fails and the client reverts to metabolic acidosis. The client with metabolic alkalosis (option 4) is likely to experience cardiac irregularities and a compensatory decreased respiratory rate and depth. Options 2 and 3 indicate respiratory acidosis and alkalosis, respectively.

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse would monitor the client for which acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 3 Respiratory acidosis most often occurs as a result of primary defects in the function of the lungs or changes in normal respiratory patterns from secondary problems. Chronic respiratory acidosis is most commonly caused by chronic obstructive pulmonary disease (COPD). Acute respiratory acidosis also occurs in clients with COPD when superimposed respiratory infection or concurrent respiratory disease increases the work of breathing. The remaining options are not likely to occur unless other conditions complicate the COPD.

Which arterial blood gas (ABG) result would the nurse anticipate in a client who develops metabolic alkalosis after profuse vomiting for 2 days?

pH 7.32; Pco2 35; HCO3- 20 2pH 7.30; Pco2 50; HCO3- 24 3pH 7.49; Pco2 45; HCO3- 30 4pH 7.52; Pco2 30; HCO3- 20 3 Vomiting results in a loss of hydrogen ions from the gastrointestinal tract, which leads to an increase in serum bicarbonate. Metabolic alkalosis occurs with an excess in serum bicarbonate. In metabolic alkalosis the pH rises, as does the bicarbonate. The only option that indicates this characteristic is option 3, pH 7.49; Pco2 45; HCO3- 30. Option 1, pH 7.32; Pco2 35; HCO3- 20, indicates metabolic acidosis. Option 2, pH 7.30; Pco2 50; HCO3- 24, indicates respiratory acidosis. Option 4, pH 7.52; Pco2 30; HCO3- 20, indicates respiratory alkalosis.

A client underwent creation of an ileostomy 2 days ago. The nurse checks the client for signs of which acid-base disorder that a client with an ileostomy is at risk for developing?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Intestinal secretions are high in bicarbonate because of the effects of pancreatic secretions. These fluids may be lost from the body before they can be reabsorbed with conditions such as diarrhea or creation of an ileostomy. The decreased bicarbonate level creates the actual base deficit of metabolic acidosis. The client with an ileostomy is not at risk for developing the acid-base disorders such as respiratory alkalosis or acidosis or metabolic alkalosis.

The nurse is caring for a client who is nervous and is hyperventilating. The nurse would monitor the client for signs of which acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 4 A client who hyperventilates blows off excessive carbon dioxide. This would have the effect of inducing alkalosis. Because a respiratory problem is triggering the alteration, it is called respiratory alkalosis. The client is not at risk for metabolic acidosis or alkalosis or respiratory acidosis from hyperventilating.

A client has been diagnosed with metabolic alkalosis. Which laboratory values are most important for the nurse to monitor for this client? Select all that apply.

Red blood cells2Serum bilirubin3Serum electrolytes4Arterial blood gases (ABGs)5Complete blood count (CBC) 3,4 Metabolic alkalosis occurs when the arterial blood pH is greater than 7.45, and the HCO3- is greater than 26 mEq/L. Thus, to monitor this, a client's ABGs, which measure the pH, CO2, and HCO3- in arterial blood, need to be monitored. The client with metabolic acid-base imbalances are prone to alterations in potassium so the serum electrolytes should be monitored. The client with metabolic alkalosis is initially prone to hypokalemia. Although the disorder that may be causing the metabolic alkalosis may also affect the other laboratory values, the CBC, which includes the red blood cell count, and the serum bilirubin, are not the most important values to monitor for a client in metabolic alkalosis.

The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How would the nurse correctly document this observation in the medical record?

Apnea2Bradypnea3Cheyne-Stokes4Kussmaul's respirations 4 Abnormally deep, regular, and rapid respirations observed in the client with diabetic ketoacidosis are documented as Kussmaul's respirations. During apnea, respirations cease for several seconds. During bradypnea, respirations are regular but abnormally slow. Cheyne-Stokes respirations gradually become more shallow and are followed by periods of apnea (no breathing), with repetition of the pattern.

A client presents to the emergency department with lethargy; deep, regular respirations; and a fruity odor to the breath. The client's arterial blood gas (ABG) results are pH of 7.25, Pco2 of 34 mm Hg, Po2 of 86 mm Hg, and HCO3- of 14 mEq/L. The nurse interprets that the client has which acid-base disturbance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Acidosis is defined as a pH of less than 7.35, and alkalosis is defined as a pH greater than 7.45. Respiratory acidosis is present when the Pco2 is greater than 45, and respiratory alkalosis is present when the Pco2 is less than 35. Metabolic acidosis is present when the pH is less than 7.35 and the HCO3- is less than 22 mEq/L, whereas metabolic alkalosis is present when the pH is greater than 7.45 and the HCO3- is greater than 27 mEq/L. This client's ABGs are consistent with metabolic acidosis. With a slightly alkalotic level of carbon dioxide there is evidence of some incomplete compensation.

A client with diabetes mellitus has a blood glucose level of 596 mg/dL on admission. The nurse anticipates that this client is at risk for which type of acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel, which leads to the formation of ketones. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis.

A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. The nurse trying to enhance the client's respiratory status would avoid performing which actions? Select all that apply.

Keeping the head of the bed elevated2Monitoring the client's oxygen saturation level3Increasing the liter flow to 5 L per nasal cannula4Assisting the client to turn, cough, and deep breathe5Encouraging the client to breathe slowly and shallowly 3,5 The client with respiratory acidosis is experiencing elevated carbon dioxide levels because of insufficient ventilation. The nurse would encourage the client to breathe slowly and deeply (not shallowly) to expand alveoli and to promote better gas exchange. The nurse should increase the client's oxygen flow rate per nasal cannula to no more than 2 L, not 5L. Remember that the client with chronic pulmonary disease often does not respond to a high carbon dioxide level to breathe, but only low oxygen. If the nurse increases the oxygen too high, the client will have no stimulus to breathe. Elevating the head of the bed, monitoring the client's oxygen saturation level, and assisting the client to turn, cough, and deep breathe are helpful actions on the part of the nurse.

The nurse is assisting in the care of a client who had an ileostomy created a few days ago. The client has high output of drainage from the ileostomy. Based on this the nurse monitors the client for which acid-base imbalance?

Metabolic acidosis2Metabolic alkalosis3Respiratory acidosis4Respiratory alkalosis 1 Intestinal secretions are high in bicarbonate because of the effects of pancreatic secretions. These fluids may be lost from the body before they can be reabsorbed in conditions such as diarrhea or creation of an ileostomy. The decreased bicarbonate level creates the actual base deficit of metabolic acidosis. Clients with high intestinal output are not at risk for metabolic acidosis, or respiratory or metabolic alkalosis.