RN- ACID-BASE II
Respiratory acidosis
pH-<7.35 and PaCO2 >45
Metabolic acidosis
pH<7.35 and HCO3<22
Metabolic alkalosis- a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly
A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance? Metabolic alkalosis Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client's regular use of baking soda
increased restlessness. The results of the arterial blood gas test are as follows: pH, 7.52; partial pressure of carbon dioxide, 38 mm Hg (5.1 kPa); bicarbonate, 34 mg/L (34 mmol/L). The nurse should plan care based on the fact that these findings indicate which of the following acid-base imbalances?
A client exhibits increased restlessness. The results of the arterial blood gas test are as follows: pH, 7.52; partial pressure of carbon dioxide, 38 mm Hg (5.1 kPa); bicarbonate, 34 mg/L (34 mmol/L). The nurse should plan care based on the fact that these findings indicate which of the following acid-base imbalances? Metabolic alkalosis. Explanation: The pH of 7.52 indicates that the body is in a state of alkalosis. The partial pressure of carbon dioxide value is normal and the bicarbonate value is elevated. The increased bicarbonate value indicates that the acid-base imbalance is metabolic alkalosis. Restlessness can be a clinical finding in metabolic alkalosis.
pulmonary embolism -respiratory alkalosis
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Light-headedness or paresthesia Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.
anxious and the respiratory rate is 28 and arterial blood gases (ABG's) pH 7.51, CO2 30, HCO3 23 nonrebreather mask
A client is admitted after a motor vehicle crash and states that he is very anxious and the respiratory rate is 28 and arterial blood gases (ABG's) pH 7.51, CO2 30, HCO3 23. Which nursing action would be a priority? Place a nonrebreather mask Explanation: The client hyper-ventilating is exhibiting respiratory alkalosis. The priority action is to provide nonrebreather to increase CO2. Monitoring the pulse oximetry, treating the anxie
diabetic ketoacidosis.
A client is diagnosed with diabetic ketoacidosis. Which of the following findings would the nurse anticipate? Arterial pH 7.33 Explanation: In diabetic ketoacidosis, the client is acidic with a pH below 7.35. The potassium level is typically low. The client is hyperglycemic. Potassium level may be high or low depending upon renal function and potassium replacement. Also, blood blood glucose will be elevated. Platelet count should be within normal limits.
metabolic acidosis- shock
A client presents to the ED in shock. During what phase of shock does the nurse know that metabolic acidosis is going to most likely occur? Decompensation Explanation: The decompensation stage occurs as compensatory mechanisms fail. The client's condition spirals Into cellular hypoxia, coagulation defects, and cardiovascular changes. As th ..
colon cancer/colostomy
A client who is experiencing colon cancer is scheduled to undergo a colostomy. Which interventions would be appropriate to include in a preoperative teaching plan? Select all that apply. • Demonstrate turning, coughing, deep breathing, splinting, and leg ROM exercises, and provide rationales for each procedure. • Arrange for an ET to speak with the client about colostomy care. • Explain the need for early postoperative ambulation. • Encourage the client to express feelings about changes in body image. Explanation: Preoperatively, the client will require instruction regarding the need for turning, coughing, deep breathing, splinting, and leg ROM exercises. The client will also need to learn about colostomy care and the reason for early postoperative ambulation. Addressing feelings about body image changes is also appropriate at this time. Rating pain and discomfort and instructing the client about signs and symptoms of intestinal obstruction are part of the postoperative care.
A client with a suspected drug overdose- respiratory acidosis
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Explanation: Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.
excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following?
A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following? Respiratory acidosis Explanation: An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.
acute respiratory failure (ARF)
A nurse assesses arterial blood gas results for a client in acute respiratory failure (ARF). Which of the following results are consistent with this disorder? pH 7.28, PaO2 50 mm Hg Explanation: ARF is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.
4-year-old child who developed acute renal failure Oliguria Azotemia Acidosis Severe hypocalcemia
A nurse is caring for a 4-year-old child who developed acute renal failure after a traumatic injury and hemorrhaging. Place the following events in the order in which they most likely occurred during progression of the severe renal deterioration. Use all of the options. Oliguria Azotemia Acidosis Severe hypocalcemia
endotracheal intubation
A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a client diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO3 22, and SO2 98%. What nursing interventions demonstrate the nurse's understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient? The nurse prepares for endotracheal intubation and mechanical ventilation for the client Explanation: This client is experiencing respiratory alkalosis related to heatstroke. The pH level is elevated in hyperventilation; the client's hyperventilation will "blow off
acute respiratory failure
Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? pH 7.24 Explanation: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with a decreased arterial pH.
Fat embolism syndrome
Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.
increased intracranial pressure (ICP)
For a client with suspected increased intracranial pressure (ICP), an appropriate respiratory goal is to: promote carbon dioxide elimination. Explanation: The goal of treatment for ICP is to prevent acidemia by eliminating carbon dioxide because an acid environment in the brain causes cerebral vessels to dilate and therefore increase
COPD decreased carbon dioxide elimination
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to what acid-base imbalance? Respiratory acidosis Explanation: Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.
A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following?
Respiratory acidosis Explanation: An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.
dyspnea and abdominal pain. pH 7.28, PaCO2 50 mm Hg, HCO3- 23 mEq/L.
The ICU nurse is caring for a client who experienced trauma in a workplace accident. The client reports dyspnea and abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 23 mEq/L. The nurse should recognize the likelihood of what acid-base disorder? Mixed acid-base disorder Explanation: Clients can simultaneously experience two or more independent acid-base disorders. A normal pH in the presence of changes in the PaCO2 and plasma HCO3&nd
chemotherapy 2 days ago and is now reporting severe diarrhea, decreased urination, cardiac dysrhythmias, and parasthesias with tetany Laboratory reports reveal hyperkalemia, hyperuricemia, and hypocalcemia.
The client with leukemia received induction chemotherapy 2 days ago and is now reporting severe diarrhea, decreased urination, cardiac dysrhythmias, and parasthesias with tetany. Laboratory reports reveal hyperkalemia, hyperuricemia, and hypocalcemia. Which of the following actions would the nurse anticipate? IV fluids to increase urine output and allopurinol to inhibit uric acid. Explanation: The client likely has tumor lysis syndrome which occurs when a person with cancer (such as leukemia) initiate treatment, causing the rapid destruction and breakdown of large number
nursing interventions most important?
The following blood gas values were obtained on a client in the emergency room. Based on these values, which of the following nursing interventions is most important? pH < 7.35, PaCO2 > 45 mm Hg, HCO3 24 mEq/L You selected: Initiating intravenous fluids as ordered; monitoring urine pH and blood urea nitrogen Explanation: Respiratory acidosis means that the client is not getting rid of CO2. Oxygen and hydration should be given. pH > 7.45 PaCO2 <35, and normal HCO3 indicates respiratory alkalosis. Metabolic acidosis would have a normal PaCO2, pH < 7.35, and HCO3 < 22. Metabolic alkalosis would also have a normal PaCO2. However, pH would be > 7.45, and HCO3 >26.
pneumonia
The nurse is analyzing the arterial blood gas (AGB) results of a client diagnosed with severe pneumonia. What ABG results are most consistent with this diagnosis? pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L Explanation: Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3- occurs. It may be either acute or chronic. The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and HCO3-: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO2: 45 mm Hg, and HCO3-: 22 mEq/L indicate a normal result/no imbalance.
ERKD- end-stage kidney disease-Metabolic acidosis
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
chronic respiratory acidosis in older adults?
What factor has the potential to lead to chronic respiratory acidosis in older adults? Thoracic skeletal changes Poor respiratory exchange as the result of chronic lung disease, inactivity, or thoracic skeletal changes may lead to chronic respiratory acidosis. Decreased renal function in olde
acute renal failure • Hyperkalemia. • Metabolic acidosis. • Hypermagnesemia.
When caring for a client with acute renal failure, the nurse should assess the client carefully for which of the following? Select all that apply. • Hyperkalemia. • Metabolic acidosis. • Hypermagnesemia. Explanation: Hyperkalemia (elevated serum potassium) is the most life-threatening electrolyte imbalance that can develop as a result of acute renal failure. Additional electrolyte imbalances include a decrease in serum calcium levels (hypocalcemia) and elevated magnesium levels (hypermagnesemia). Acute renal failure also leads to the development of metabolic acidosis.
ICP- respiratory acidosis?
Which of the following may occur with respiratory acidosis? Increased intracranial pressure (ICP) Explanation: If respiratory acidosis is severe, intracranial pressure may increase, resulting in papilledema and dilated conjunctival blood vessels. Increased blood pressure, increased pulse, a
Metabolic acidosis- diseases and conditions associated with this condition
end-stage kidney disease
Respiratory alkalosis (what leads to?)
means lungs are blowing off too much CO2
Respiratory acidosis (what leads to?)
means lungs are unable to blow off CO2
Metabolic alkalosis (what leads to?)
occurs because of the excessive loss of potassium, hydrogen, and chloride in the vomitus. Frequent vomiting can induce an excessive loss of these acids to alkalosis
Metabolic alkalosis
pH>7.45 and HCO3>26
Respiratory alkalosis
pH>7.45 and PaCO2<35
respiratory alkalosis- diseases and conditions associated with this condition
status asthmaticus
Metabolic acidosis (what leads to?)
the kidneys are unable to excrete increased loads of acid Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids. A client with severe diarrhea loses large amounts of bicarbonate, resulting in metabolic acidosis.
Metabolic alkalosis- diseases and conditions associated with this condition
vomitus (excessive)
Respiratory acidosis- diseases and conditions associated with this condition
worsened asthmaticus, CHF
