ABG respiratory acidosis
The nurse is caring for a client with a collapsed lung following a motor vehicle accident and reviews the client's newly resulted arterial blood gas values. Which of the following results most closely match this client's condition? A.PaCO2 54, HCO3 24, pH 7.33 B.PaCO2 30, HCO3 22, pH 7.48 C.PaCO2 45, HCO3 29, pH 7.5 D.PaCO2 36, HCO3 18, pH 7.29
A PaCO2 54, HCO3 24, pH 7.33 Normal lab values are as follows: pH 7.35-7.45, PaCO2 35-45, and HCO3 22-26. This client's lab values reflect respiratory acidosis. When a client has a condition that prevents airflow in the lungs, it leads to CO2 retention, which then leads to respiratory acidosis. PaCO2 45, HCO3 29, pH 7.5 These lab values reflect metabolic alkalosis, which would not be expected in a client with a collapsed lung. PaCO2 30, HCO3 22, pH 7.48 These lab values reflect respiratory alkalosis, which means the client is blowing off excess CO2. When a client has a collapsed lung, airflow is impeded resulting in retained CO2. This increases the PaCO2 and decreases the pH, resulting in respiratory acidosis. PaCO2 36, HCO3 18, pH 7.29 These lab values reflect metabolic acidosis, which is not a likely result in a client with a collapsed lung. Instead, the client's ABG values are expected to reflect respiratory acidosis because of lung trauma.
A client presents to the emergency department in anaphylactic shock. The nurse calls for assistance, grabs the crash cart, obtains vital signs, and starts an IV. Vital signs are as follows: Blood pressure 75/48, pulse 115, oxygen 73%, respiratory rate 30. Labs are drawn. The nurse suspects respiratory acidosis. Which of the following actions by the nurse are appropriate to help correct this client's condition? Select all that apply. A.Protect the client's airway B.Administer IV sodium bicarbonate C.Provide supplemental oxygen D.Help the client use an incentive spirometer E.Give epinephrine as ordered
A,C,E E. Give epinephrine as ordered Epinephrine helps decrease upper airway edema and is a bronchodilator. The nurse should give epinephrine as ordered as soon as possible. A.Protect the client's airway The client may be experiencing bronchospasm and laryngeal edema as a result of the histamine response, and may need an artificial airway. The nurse will need to monitor airway status and be prepared to assist the respiratory therapist or provider with intubation. E. Provide supplemental oxygen Supplemental oxygen is necessary for this client, because the client's pulse ox reflects 73%, when it should be between 88-100%. Help the client use an incentive spirometer An incentive spirometer is used when the client needs to re-inflate alveoli, and is utilized by inhaling slowly for as long as possible. This would be impossible for a client in anaphylactic shock to use, and therefore counterproductive. Administer IV sodium bicarbonate This IV fluid would not help correct the client's respiratory acidosis. Sodium bicarbonate can be given IV for acidosis when the cause is metabolic, such as uncontrolled diabetes, shock, dehydration, or renal disease. To correct respiratory acidosis, the client must have improved airflow so that gas exchange can occur.
A client is admitted to the ICU with confirmed opioid overdose. The ABG results reflect a pH of 7.27, PaCO2 of 55, and an HCO3 of 26. Based on the client's condition and blood-gas analysis, the nurse must work to correct which of the following? A.Shallow respirations B.Decreased level of consciousness C.Rapid respirations D.Decreased GI motility
A. Shallow respirations An overdose on opioids can cause a client to have slow and/or shallow respirations. Normal lab values are as follows: pH 7.35-7.45, PaCO2 35-45, and HCO3 22-26. Since this client is in respiratory acidosis, the nurse will need to perform interventions that will increase the rate and/or depth of breathing. This may include administering naloxone or preparing the client for invasive or non-invasive intubation. Rapid respirations Rapid respiration can lead to respiratory alkalosis, but this client is in respiratory acidosis. Additionally, an opioid overdose does not lead to rapid respirations, but rather a slow, shallow breathing pattern. Decreased GI motility While narcotics can cause decreased GI motility, this does not affect a client's PaCO2. Decreased level of consciousness An opioid overdose causes a decreased level of consciousness, but this is not the reason for the client's respiratory acidosis. Instead, this client's breathing pattern has led to respiratory acidosis.
The nurse is caring for a client who overdosed on opioids. Which of the following is the most important goal for this client? A.Proper oxygenation B.Fever control C.Pain control D.Minimize nausea and vomiting
A. Proper oxygenation The most concerning side effect of this class of medications is respiratory depression, so the main goal for nursing care is proper oxygenation. Pain control The client may experience withdrawals when treated for opioid overdose, including increased pain due to a decreased amount of drug in the body. This is not the most important goal for the client. Remember - ABC's first - airway, breathing, circulation. Minimize nausea and vomiting The client will have nausea and vomiting when withdrawing from opioids, but this is less of a concern than proper oxygenation. Fever control While a client will often experience fever and chills during withdrawals, the nurse will be most concerned with proper oxygenation and ventilation. A fever is not immediately life threatening.
The nurse is working in the emergency department caring for a client who presents with slow, shallow respirations related to a suspected narcotic overdose. The provider orders blood work, including ABGs. Which of the following acid-base imbalances would the nurse expect for this client? A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic alkalosis D.Metabolic acidosis
B Respiratory acidosis Respiratory alkalosis Because the client is unable to breath at an adequate rate or volume, the source of the acid-base imbalance is respiratory. Because the client is not blowing off CO2, the client is acidic, because CO2 increases the acidity of the blood. B Respiratory acidosis This client's ABG's would most likely show a pH of less than 7.35, which is acidic. The PaCO2 would most likely be greater than 45 mm Hg, which is the cause of the low pH level. Since this client is hypoventilating, he or she is not able to blow off CO2 fast enough. Metabolic alkalosis The source of this imbalance is respiratory, not metabolic. It is acidosis due to the client not blowing off CO2. Metabolic acidosis The source of this imbalance is respiratory, not metabolic. The client is, however, acidotic.
The nurse is caring for a client with respiratory acidosis due to a benzodiazepine overdose. Which of the following nursing interventions are appropriate for this client? Select all that apply. A.Monitor respiratory status B.Provide supplemental oxygen C.Insert a nasogastric tube D.Administer flumazenil as ordered E.Administer alprazolam as ordered
B, D, A B.Provide supplemental oxygen A client in respiratory acidosis is breathing shallow and/or slow to the point where they cannot blow off adequate CO2 and it builds up in the blood, causing an acidic pH. The nurse should provide oxygen because the client would also have a low SpO2. D.Administer flumazenil as ordered Flumazenil is the antidote to benzodiazepines, so it is appropriate to administer this drug. Administer alprazolam as ordered If this client is conscious, they may be restless and anxious from a lack of oxygenation. Since alprazolam (Xanax) is a benzodiazepine, it is inappropriate to give. A. Monitor respiratory status The nurse will monitor respiratory status. This client is at risk for respiratory failure and may need to be intubated, so it is appropriate for the nurse to closely monitor this client's breathing. Insert a nasogastric tube Based on the information given, this client is not in need of a nasogastric tube.
The student nurse is shadowing an experienced nurse, who asks the student to name some causes of CO2 retention. The student nurse responds correctly by naming which of the following causes? Select all that apply. A.Salicylate overdose B.Hemothorax C.Atelectasis D.Asthma E.Opioid overdose
B. Hemothorax A hemothorax results in decreased lung expansion, which causes CO2 retention. C. Atelectasis Atelectasis causes CO2 retention because the alveoli are collapsed, which prevents air from flowing in and out. Gas exchange cannot occur, so CO2 builds up in the bloodstream. D.Asthma Asthma causes airways to constrict, which reduces airflow into the lungs. This restricts gas exchange from occurring, leading to CO2 retention. E.Opioid overdose Opioids affect the central nervous system, and an overdose leads to a decreased respiratory drive. This causes shallow, slow breathing which means too little CO2 is released from the bloodstream. Salicylate overdose CO2 is lost, not retained, from a salicylate overdose. Salicylates affect the metabolic system. An overdose causes metabolic acidosis, which causes the respiratory system to compensate. A person will become tachypneic in order to blow off CO2, which then leads to respiratory alkalosis.
An unconscious client with an opioid overdose is triaged in the emergency department. ABG values reflect respiratory acidosis. Which of the following interventions address the cause of this client's respiratory acidosis? A.Initiate BiPAP B.Administer salmeterol C.Administer naloxone D.Give oxygen at 4 LPM
C. Administer naloxone Naloxone is the antidote to opioids. The cause of this client's respiratory acidosis is the drug overdose, which decreased the client's central nervous system-mediated respiratory drive. Administering the reversal agent to the drug is the intervention that addresses the cause of the client's respiratory acidosis. Initiate BiPAP Respiratory acidosis occurs when gas exchange is impeded at the alveolar level. By initiating BiPAP, the client will have improved ventilation and gas exchange, but this intervention does not address the cause of the client's respiratory acidosis. Since the cause is an overdose of a drug, addressing the cause means administering the reversal agent of that drug. Administer salmeterol Salmeterol is a bronchodilator. This client does not necessarily have constricted airways, so whether they would benefit from a bronchodilator is unclear based on the information given. Addressing the cause of this client's respiratory acidosis is achieved by reversing the opioid. Give oxygen at 4 LPM This client likely needs supplemental oxygen, and possibly BiPAP to counteract the effects of the drug overdose. However, this intervention does not address the cause of the respiratory acidosis. Removing the opioid from the client's system is addressing the cause, which is achieved by administering naloxone.
The student nurse is discussing acid-base imbalances with the preceptor. The student correctly explains that respiratory acidosis results when which of the following occurs? A.SaO2 is unable to be absorbed into the tissues B.PaO2 is unable to be increased by the lungs C.HCO3 is unable to be retained by the lungs D. CO2 is unable to be released from the lungs
D. CO2 is unable to be released from the lungs CO2 retention causes respiratory acidosis. CO2 is an acid, and the body regulates this through the respiratory system. When CO2 is prevented from being blown off, such as when the client has an airway obstruction or lung collapse, then respiratory acidosis occurs. HCO3 is unable to be retained by the lungs HCO3 is regulated by the kidneys, not the lungs. If HCO3 was being excessively lost by the kidneys, it would result in metabolic acidosis. Respiratory acidosis occurs when the lungs retain too much CO2. PaO2 is unable to be increased by the lungs While oxygen is obtained through the respiratory system, respiratory acidosis occurs because of an imbalance in the level of CO2, not O2. SaO2 is unable to be absorbed into the tissues CO2 is the gas that represents respiratory acidosis, not O2.
A nurse is working with a client who is in labor. The client is being monitored with an oxygen saturation probe and hemodynamic monitor because of her history of respiratory disease. During one of her contractions, the nurse notes that the client's oxygen saturation levels drop to 86 percent and remains there after the contraction has subsided. Which intervention should the nurse perform in response? A.Increase the rate of oxytocin in the IV B.Elevate the client's feet and put the head down C.Prepare for forceps delivery if needed D.Elevate the head of the bed and administer oxygen
D. Elevate the head of the bed and administer oxygen During labor, a mother and/or the fetus may develop a decrease in oxygenation, which can occur for a variety of reasons. When a pregnant client is at risk of decreased oxygen, she should be placed on an oxygen saturation monitor. If oxygen levels fall, the nurse should perform interventions to return the client to normal oxygen levels, such as elevating the head of the bed and administering oxygen. Increase the rate of oxytocin in the IV Increasing oxytocin would increase the strength of the contractions, which could cause increased oxygen needs. Elevate the client's feet and put the head down This is Trendelenburg position, which makes it more difficult for the client to breathe. Prepare for forceps delivery if needed The nurse simply needs to increase oxygenation by performing a few simple interventions. Forceps delivery is not warranted here.
