Which Acid-Base Disorder?
The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.
Why does potassium rise during acidosis?
The body protects itself from the acidic state by moving hydrogen ions into the cells. Therefore potassium moves out to make room for hydrogen ions and the potassium level increases.
A client with a 3-day history of nausea and vomiting. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. Arterial blood gases are? 1. A decreased pH and an increased CO 2 2. An increased pH and a decreased CO 2 3. A decreased pH and a decreased HCO3- 4. An increased pH with an increased HCO3-
4. An increased pH with an increased HCO3- Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include hypoventilation and tachycardia.
The nurse notes that a client’s arterial blood gas results reveal a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all that apply. 3. Bradypnea 4. Tachycardia 5. Hyperkalemia
4. Tachycardia Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.
The nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
Metabolic acidosis is defined as a total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes, an ileostomy, or diarrhea.
Why does potassium drop during alkalosis?
The cells release hydrogen ions into the blood in an attempt to increase the acidity of the blood; this forces the potassium into the cells and potassium levels decrease.
Pt has diabetes mellitus & metabolic acidosis. Which labs are correct? 1) pH 7.29, pCO2 35 mm HG, HCO3- 17 mmol/L 2) pH 7.31, pCO2 67 mm HG, HCO3- 32 mmol/L 3) pH 7.39, pCO2 43 mm HG, HCO3- 22 mmol/L 4) pH 7.45, pCO2 38 mm HG, HCO3- 23 mmol/L
1) pH 7.29, pCO2 35 mm HG, HCO3- 17 mmol/L The pH is below normal HCO3- below normal
In Respiratory Acidosis Ph is__ (high or low) PaCO2 is ___ (high or low) HCO3 is ___ (high or low)
In Respiratory Acidosis Ph is low PaCO2 is high HCO3 is high
A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Pco 2 is 90 mm Hg, and is HCO3- 22 mEq/L. The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation
4. Respiratory acidosis without compensation The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Pco 2 is 35 to 45 mm Hg. In respiratory acidosis the pH is decreased and the Pco 2 is elevated. The normal bicarbonate (HCO3-) level is 22 to 27 mEq/L. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance.
The nurse plans care for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
3. Respiratory acidosis Respiratory acidosis is most often caused by hypoventilation in a client with COPD. Other acid-base disturbances can occur in a client with COPD during exacerbation of the disease, but the most likely imbalance is respiratory acidosis. COPD is a respiratory condition, not a metabolic one. Respiratory alkalosis is associated with hyperventilation.
Which of the following is NOT a cause of metabolic acidosis? 1. Aspirin toxicity 2. Ileostomy 3. Hyperaldosteronism 4. Carbonic anhydrase inhibitors
3. Hyperaldosteronism 1. Aspirin toxicity-acid byproduct 2. Ileostomy loss of bicarbonate 4. Carbonic anhydrase inhibitors bicarbonate
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition? 1. Bradypnea 2. Tachypnea 3. Bradycardia 4. None of the options are correct
2. Tachypnea
A 72-year-old patient is admitted with a urinary tract infection and suspected urosepsis. The patient is febrile, confused, and hypotensive. Arterial blood gas (ABG) results are: pH 7.29, PaCO2 30 mmHg, HCO3 16 mEq/L. 1. Metabolic acidosis with partial respiratory compensation, 2. Respiratory acidosis with metabolic compensation, 3. Metabolic alkalosis with no compensation, 4. Mixed respiratory and metabolic acidosis
Urosepsis will cause lactic acidosis. The Patient is in metabolic acidosis, partial compensated.
A patient reports taking Diamox and has been reporting confusion, fatigue, and headaches. On assessment, you note the patient is exhibiting deep and rapid respirations. Which of the following arterial blood gas findings confirm the correct acid-base imbalance for this patient given their symptoms and medication usage? (Hint: Carbonic anhydrase inhibitors) 1. HCO3 12, pH 7.19, PaCO2 29 2. HCO3 23, pH 7.36, PaCO2 36 3. HCO3 10, pH 7.65, PaCO2 47 4. PaCO2 49, pH 7.55, HCO3 21
1. HCO3 12, pH 7.19, PaCO2 29 This patient is at risk for metabolic acidosis, especially since they are taking Diamox (Carbonic anhydrase inhibitors which reduces the reabsorption of bicarb). HCO3 12, pH 7.19, PaCO2 29 are the only ABGs that reflect metabolic acidosis.