Ch. 12 Iggy Acid-Base

Normal PaO2 levels

80-100

Normal Bicarbonate (HCO3)

21-28

Normal PaCO2 range

35-45

Normal pH range

7.35-7.45 (Below 7.35 = Acidity) (Above 7.45= Alkaline)

Which prescribed intervention does the nurse implement first for a patient with metabolic acidosis from shock?

Administer intravenous fluids.

A patient has chronic respiratory acidosis. Which nursing assessments are appropriate for this patient? Select all that apply. Assessing the color of nail beds Listening for crackles at lung bases Checking respiratory status once per shift Checking for the use of accessory muscles Assessing for cyanosis of mucous membranes

Assessing the color of nail beds Checking for the use of accessory muscles Assessing for cyanosis of mucous membranes

Which changes associated with an acid-base imbalance does the nurse assess for in an older adult patient admitted with pneumonia? Generalized edema Dry mucous membranes Dark, concentrated urine Clear, straw-colored urine Thready peripheral pulses New-onset mental status changes

Dark, concentrated urine Thready peripheral pulses New-onset mental status changes

A patient has been having acute diarrhea for more than 24 hours from a viral infection. Which acid-base imbalance is most likely to manifest? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis

Which conditions can cause metabolic acidosis?

Diarrhea Liver failure Kidney failure

When caring for a patient with metabolic acidosis, what must the nurse keep in mind regarding acid-base chemistry?

Fluids with lower pH have higher acidity. (Fluids with lower pH have a higher level of free hydrogen ions and therefore have higher acidity.)

The nurse is caring for a patient who has taken a large quantity of furosemide to promote weight loss. The nurse anticipates the finding of which acid-base imbalance? pH of 7.31 PaO 2 of 78 mm Hg HCO 3 - of 34 mEq/L PaCO 2 of 56 mm Hg

HCO 3 - of 34 mEq/L (Diuretics (non-potassium-sparing),cause metabolic alkalosis. )

Which electrolyte abnormality does the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? Hyponatremia Hypernatremia Hypokalemia Hyperkalemia

Hyperkalemia (Serum potassium (hyperkalemia) occurs during metabolic acidosis as the body attempts to maintain pH by moving potassium ions from the cell in exchange with hydrogen ions moving into the celL)

When caring for a group of patients at risk for respiratory acidosis, the nurse identifies which person as at highest risk? An athlete in training Patient who smokes cigarettes Person with uncontrolled diabetes Pregnant woman with hyperemesis gravidarum

Patient who smokes cigarettes (Cigarette smoking worsens gas exchange, leading to disorders that contribute to hypoventilation and respiratory acidosis. )

The nurse is caring for a patient with metabolic alkalosis. What manifestations of metabolic alkalosis is the nurse likely to assess? Select all that apply. Decrease in heart rate Numbness around the mouth Increase in handgrip strength Presence of Kussmaul respiration Hyperactivity of deep tendon reflexes

Numbness around the mouth Hyperactivity of deep tendon reflexes (Hypercalcemia occurs with alkalosis, which can cause hyperactivity of deep tendon reflexes. Alkalosis overexcites the nervous system leading to tingling or numbness around the mouth.)

Which patient would be appropriate to assign to the new nurse working on the medical-surgical unit? Patient with emphysema and cellulitis with a PaCO 2 level of 58 mm Hg Patient with reactive airway disease, wheezing, and a PaO 2 level of 62 mm Hg Patient with diabetic ketoacidosis and change in mental status who has a pH of 7.18 Patient with a small bowel obstruction and vomiting with a bicarbonate level of 40 mEq/L

Patient with emphysema and cellulitis with a PaCO 2 level of 58 mm Hg

A patient having continuous nasogastric (NG) suction after abdominal surgery has become irritable and anxious. An assessment reveals hyperreflexia, the patient's heart rate is 90 beats/min, and the respiratory rate is 24 breaths/min. Which action by the nurse is correct? Contact the provider to discuss administering intravenous bicarbonate. Request an order to evaluate serum electrolytes and disruption of NG suction. Notify the Rapid Response Team because of increased cardiovascular symptoms. Suggest that the patient receive hypertonic intravenous (IV) fluids to replace electrolytes.

Request an order to evaluate serum electrolytes and disruption of NG suction. -(Patients undergoing NG suction are at risk for metabolic alkalosis, which has central nervous system and cardiovascular signs such as these.)

Which acid-base imbalance does the nurse anticipate the patient with morbid obesity may develop? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis (Respiratory acidosis is related to CO 2 retention secondary to respiratory depression, inadequate chest expansion, airway obstruction, or reduced alveolar-capillary diffusion).

A patient with diabetes mellitus is brought to the emergency department after vomiting for several days. The patient has rapid, deep respirations and a urine dipstick reveals ketonuria. Which process does the nurse suspect is occurring with this patient? Kidney compensation for metabolic acidosis Kidney compensation for metabolic alkalosis Respiratory compensation for metabolic acidosis Respiratory compensation for metabolic alkalosis

Respiratory compensation for metabolic acidosis (Patients with diabetes mellitus can develop metabolic acidosis. Respiratory compensation occurs through the lungs as the rate and depth of respirations increase in order to reduce hydrogen ion levels)

While assessing a patient with metabolic acidosis, the nurse suspects that the patient has lactic acidosis. The nurse makes the conclusion based on which finding? Symptoms of hypoxia Low blood glucose levels History of excessive oral antacid use Inability of kidney tubules to secrete hydrogen ions into the urine

Symptoms of hypoxia (Lactic acidosis occurs when the body has too little oxygen to meet metabolic oxygen demands, such as during heavy exercise, seizure activity, fever, and reduced oxygen intake)

Increased lactate levels are associated with?

hypoxia and metabolic acidosis

Insufficient blood glucose causes the breakdown of fatty acids and accumulation of ketones, resulting in?

ketoacidosis

Excess intake of oral antacids increases the risk of ?

metabolic alkalosis (Oral antacids contain sodium bicarbonate or calcium carbonate.)

Which arterial blood gas result does the nurse anticipate in the care of a patient diagnosed with acute kidney failure? pH 7.33, PaO 2 82 mm Hg, PaCO 2 35 mm Hg, HCO 3 - 19 mEq/L pH 7.37, PaO 2 93 mm Hg, PaCO 2 52 mm Hg, HCO 3 - 32 mEq/L pH 7.48, PaO 2 82 mm Hg, PaCO 2 32 mm Hg, HCO 3 - 25 mEq/L pH 7.49, PaO 2 72 mm Hg, PaCO 2 52 mm Hg, HCO 3 - 30 mEq/L

pH 7.33, PaO 2 82 mm Hg, PaCO 2 35 mm Hg, HCO 3 - 19 mEq/L