metabolic alkalosis dsm

The nurse is caring for a patient with metabolic alkalosis. Which set of ABGs should the nurse interpret as uncompensated metabolic alkalosis in this patient?

pH 7.52; PaCO2 48 mmHg; HCO3 29 mEq/L ABGs of pH 7.52; PaCO2 48 mmHg; and HCO3 29 mEq/L indicate uncompensated metabolic alkalosis. ABGs of pH 7.24; PaCO2 36 mmHg; HCO3 18 mEq/L indicate uncompensated metabolic acidosis. ABGs of pH 7.42; PaCO2 29 mmHg; HCO3 17 mEq/L indicate compensated respiratory alkalosis. ABGs of pH 7.38; PaCO2 38 mmHg; HCO3 24 mEq/L indicate normal arterial blood gas values.

ABG's in metabolic alkalosis show:

pH greater than 7.45. Bicarbonate level greater than 26 mEq/L. PaCO2 (with compensatory hypoventilation) greater than 45 mmHg.

The nurse is completing an assessment on a female teenager with suspected metabolic alkalosis and a history of an eating disorder. Which question should the nurse ask the family of the patient that could best help to identify a potential cause?

"Does your daughter purge frequently with her eating disorder?" Young women who practice self-induced vomiting, such as purging, are at an increased risk of metabolic alkalosis due to the loss of hydrogen ions. The use and abuse of diuretics and laxatives can lead to metabolic acidosis, not alkalosis. Asking about intake of nutritional foods will not provide information to help determine the cause of the metabolic alkalosis

An older adult patient is being discharged for treatment of metabolic alkalosis. Which teaching should the nurse include concerning decreased thirst sensation due to changes of aging?

"It is important that you keep track of and make sure to drink 8-10 glasses of water a day."

The nurse is administering IV fluids rapidly to address deficient fluid volume in a patient with metabolic alkalosis. Which independent nursing intervention would best help to prevent fluid volume overload in this patient?

Administering the IV fluids via an infusion pump

A patient diagnosed with metabolic alkalosis is complaining of numbness and tingling around the mouth and in both upper extremities. The nurse should understand that which statement supports the etiology of this condition?

Administration of sodium bicarbonate increases serum bicarbonate, making body fluids more alkaline. Excess bicarbonate leads to increased alkalinity. Hypokalemia, not hyperkalemia, leads to a loss of hydrogen ions, making body fluids more alkaline and causing metabolic alkalosis. Salicylate toxicity increases acid production leading to metabolic acidosis, not alkalosis. Chronic kidney disease results in acid retention, leading to metabolic acidosis, not metabolic alkalosis.

To monitor for fluid volume deficit, the nurse should:

Assess intake and output accurately, monitoring fluid balance. Assess vital signs, central venous pressure (CVP), and peripheral pulse volume at least every 4 hours. Weigh daily under standard conditions. Administer IV fluids as prescribed using an electronic infusion pump. Monitor serum electrolytes, osmolality, and arterial blood gas (ABG) values

The excess of which electrolyte in relation to the amount of hydrogen ions contributes to the development of metabolic alkalosis?

Bicarbonate An excess of bicarbonate (not sodium, potassium, or calcium), in relation to hydrogen ions causes metabolic alkalosis.

Which surgery, when performed with younger children, particularly predisposes them to metabolic alkalosis?

Cardiac Although metabolic alkalosis can occur at any age, a higher incidence is seen in younger children post-cardiac surgery. This may be due to renal immaturity, diuretic use, use of blood products, and other factors due to the management of the child during and after surgery.

Which extracellular fluid anion is replaced by bicarbonate when depleted, leading to metabolic alkalosis?

Chloride Chloride is an extracellular fluid anion that is replaced by bicarbonate when depleted, leading to increased alkalinity. Sodium is an extracellular fluid cation, potassium is an intracellular fluid cation, and calcium is an extracellular fluid cation.

Focused assessment data gathered from the patient interview include:

Current manifestations such as numbness and tingling, muscle spasms, dizziness, or other symptoms. Duration of symptoms. Any precipitating factors such as bicarbonate ingestion, vomiting, diuretic therapy, or endocrine disorders. Current medications.

The nurse is caring for a patient with severe muscle spasm, metabolic alkalosis, and a history of primary hyperaldosteronism. Based on this diagnosis, which assessment should the nurse include in the physical examination of this patient?

Deep tendon reflexes During the physical examination of a patient who is diagnosed with metabolic alkalosis, the nurse would assess deep tendon reflexes. Reviewing the patient's current medication list and asking the patient how long she has been experiencing dizziness are appropriate nursing actions, but these would be completed during the health history. The date of the last menstrual cycle is not pertinent information when assessing a patient for metabolic alkalosis.

Which effect of loop diuretic therapy contributes most directly to the development of metabolic alkalosis in older adults?

Depletion of sodium, chloride, and potassium Loop diuretics interfere with reabsorption of sodium, chloride, water, and other minerals such as potassium, thus potentially leading to the development of metabolic alkalosis. Loop diuretics do lower blood pressure and increase excretion of fluids, but these are not most directly tied to the development of metabolic alkalosis. Loop diuretics are excreted more slowly in older adults, but this is the most direct cause of changes leading to metabolic alkalosis.

A patient reports numbness and tingling in her fingers. The nurse notes that the individual has recently taken "a lot" of antacids due to "an upset stomach." Which additional clinical finding should the nurse anticipate when conducting the patient's assessment?

Dizziness The individual likely has metabolic alkalosis, caused by the ingestion of too many antacids. Clinical manifestations of metabolic alkalosis include dizziness, hypotension, muscle spasm, and hypokalemia.

A preschool-age patient requires a nasogastric tube for gastric suctioning. Due to the risk of developing metabolic alkalosis, for which symptom should the nurse monitor?

Dysrhythmia Metabolic alkalosis may be caused by gastric suctioning due to the loss of hydrogen ions. Cardiac dysrhythmia, bradypnea, and hypotension would indicate the patient is experiencing metabolic alkalosis. Increased temperature may indicate infection.

The nurse is reviewing the results of a patient's arterial blood gas (ABG). Which ABG interpretation would indicate that this patient is experiencing metabolic alkalosis?

Elevated pH, elevated HCO3 Evidence of metabolic alkalosis is an elevated pH and an elevated HCO3. A decreased pH and elevated HCO3 would indicate partially compensated respiratory acidosis. An elevated pH and normal HCO3 would indicate respiratory alkalosis. A decreased pH and normal HCO3 indicates respiratory acidosis.

Metabolic alkalosis is a primary problem seen in:

Excessive ingestion of antacids. Excessive use of bicarbonate. Lactate administration in hemodialysis.

Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction.

Gastric secretions are highly acidic; when lost, the alkalinity of body fluids increases. Increased alkalinity is due to the loss of acid and selective retention of bicarbonate by the kidneys as chloride is depleted.

Metabolic alkalosis may also develop from:

Hyperaldosteronism. Hypochloremia. Hypokalemia. Nasogastric suctioning. Use of loop diuretics. Vomiting.

Medications that can increase the older adult's risk of developing metabolic alkalosis include:

Loop diuretics. Antacids that contain bicarbonate. Bicarbonate.

Nursing management for infants and children experiencing metabolic alkalosis includes:

Ongoing monitoring of level of consciousness and neuromuscular irritability. Monitoring for nausea and vomiting. Carefully assessing respiration rate and depth. Obtaining arterial blood gases (ABGs) as ordered. Positioning to facilitate ease of respiration and to prevent aspiration of vomitus.

Other appropriate outcomes include:

Patient's oxygen saturation level is 95% or greater. Patient's fluid and electrolyte volumes will return to normal or near normal. Patient reports use of antacids that are acceptable for use, reducing the risk of recurring metabolic alkalosis. Patient describes proper self-administration procedure for oral potassium supplements. The patient describes when to notify the healthcare provider related to changes in daily weight. Patient's arterial pH returns to normal range. Patient will remain free from injury.

A child is being treated for metabolic alkalosis secondary to prolonged vomiting. While the vomiting has decreased due to medication administration, the child is still experiencing episodes of vomiting. Which instruction should the nurse include in teaching to the family to best prevent injury due to vomiting?

Positioning Infants and children experiencing prolonged vomiting are at risk for aspiration; therefore, teaching the parents about proper positioning is important to prevent injury due to aspiration. Prolonged vomiting can result in damage to teeth but is not the highest priority. Droplet precautions are not required for prolonged vomiting in the pediatric patient. Providing the toddler with foods cut into small pieces does not decrease the risk of injury in a vomiting pediatric patient.

The nurse is caring for a patient admitted for metabolic alkalosis. Which laboratory value does the nurse anticipate for a patient experiencing this acid-base imbalance?

Potassium of 3.0 mEq/L

The nurse is caring for a patient admitted for metabolic alkalosis. Which laboratory value does the nurse anticipate for a patient experiencing this acid-base imbalance?

Potassium of 3.0 mEq/L The potassium level will be less than 3.5 mEq/L in a patient experiencing metabolic alkalosis. Therefore, a potassium level of 3.0 mEq/L will be seen in a patient with metabolic alkalosis. A patient experiencing metabolic alkalosis will have a chloride level less than 95 mEq/L. A patient who is experiencing metabolic alkalosis will have a normal total calcium that is between 4.5 and 5.5 mEq/L. A patient experiencing metabolic alkalosis will have a low sodium level that is below 135 mEq/L.

Other causes of metabolic alkalosis in children include:

Prolonged vomiting (as seen in pyloric stenosis). Nasogastric suctioning. Cystic fibrosis. Use of diuretics. Hypokalemia.

Which is the desired overall outcome for a patient with metabolic alkalosis?

Restore and maintain normal acid-base balance.

For which clinical manifestation should the nurse monitor when caring for a patient with metabolic alkalosis?

Seizures Manifestations of metabolic alkalosis include seizures, depressed respiratory drive, muscle spasm, and hypotension. They do not include tachypnea, muscle weakness, or hypertension.

A 7-year-old child is admitted with intractable nausea and vomiting. The patient's current arterial blood gas (ABG) results are as follows: pH 7.50; pCO2 46 mmHg; pO2 95 mmHg; HCO3 34 mEq/L. According to the patient's ABGs, what pharmacologic therapy should the nurse expect to be ordered?

Sodium chloride The patient's ABGs reveal metabolic alkalosis, likely due to vomiting and loss of hydrogen ions. Sodium chloride is a pharmacologic treatment used for metabolic alkalosis. Sodium bicarbonate is a treatment used for metabolic acidosis, and this could worsen her acid-base balance. Magnesium chloride and calcium chloride are electrolyte replacements. While the patient may have electrolyte abnormalities, the question refers to the best treatment according to the ABGs, and these choices are not the best answers.

Pharmacologic Therapy for Metabolic Alkalosis

Treatment includes potassium chloride and sodium chloride solutions. Acidifying solutions (dilute hydrochloric acid or ammonium chloride) may be used in severe alkalosis. Additional drugs may be used to treat the underlying cause of alkalosis.

Which diagnostic study reflects the kidney's ability to regulate hydrogen ion and bicarbonate concentrations in the blood?

Urine pH

Which intervention should the nurse include in the plan of care for an older adult patient experiencing metabolic alkalosis to most accurately reflect fluid balance?

Weighing daily under standard conditions Fluid volume deficit is a risk for patients experiencing metabolic alkalosis. The most accurate indicator of fluid balance is daily weights under standard conditions (same time, same amount of clothes, etc.). Assessing intake and output, vital signs, and serum electrolytes can provide clues as fluid volume deficit progresses.