acid base basics and ABGs
The nurse understands that while the lungs can compensate for an imbalance quickly, this organ takes longer to respond but provides more permanent correction.
The kidneys
A patient with COPD and pneumonia presents with coarse crackles and a respiratory rate of 10. Which acid-base imbalance is the nurse most concerned about?
Respiratory acidosis
A patient with DKA presents with rapid, deep respirations. What is the specific name for this breathing pattern?
Kussmaul respirations
An elderly patient presents with a thready pulse, orthostatic hypotension, and poor skin turgor. Which late sign of dehydration should the nurse specifically assess for?
Thirst
A patient's sodium level is 118 mEq/L. The nurse must implement seizure precautions because this level of hyponatremia can lead to what life-threatening condition?
Brain swelling (cerebral edema)
A patient’s ABG results are pH 7.28, CO2 32, and HCO3 16. Based on the ROME rule and these values, which acid-base imbalance is occurring?
Metabolic Acidosis
What is the immediate priority nursing action for a patient in respiratory acidosis with a respiratory rate of 10 and shallow breaths?
Ensure patent airway
A patient has been vomiting stomach acid for two days. Which acid-base imbalance is the nurse likely to see?
Metabolic alkalosis
When assessing a patient with fluid volume excess (hypervolemia), what finding should the nurse expect when palpating the pulses?
Bounding pulses
A nurse is preparing to administer IV potassium. What are the three critical safety rules the nurse must follow?
1) Use an IV pump, 2) Never exceed 10 mEq/hr, 3) Never give as an IV bolus
A patient has a pH of 6.7. What is the clinical significance of this specific value?
this pH is considered fatal
A patient is hyperventilating due to extreme anxiety. The nurse should monitor for which signs of respiratory alkalosis?
Tetany, convulsions, numbness, palpitations, or chest pain.
What are the two primary causes of metabolic acidosis involving the "inadequate elimination" or "excess production" of acids?
Kidney failure and DKA (or lactic acidosis/starvation)
A patient has gained 3 lbs in 24 hours. What is the nurse's priority assessment regarding the potential for pulmonary edema?
Assess lung sounds for crackles
A patient has a positive Trousseau’s sign (arm twitches with BP cuff) and Chvostek’s sign (facial twitching). Which two electrolyte imbalances could this indicate?
Hypocalcemia or Hypomagnesemia
The nurse identifies a metabolic issue when the HCO3 falls outside of this normal range.
22-26
Which electrolyte imbalance should the nurse monitor for in a patient with respiratory acidosis?
Hyperkalemia
A patient presents with metabolic alkalosis. Which neurological signs should the nurse assess for?
Confusion, convulsions, numbness, tingling, and hyperreflexia
What is the most accurate indicator of a patient’s fluid status that should be performed at the same time every morning?
Daily weights
Which medication is used to bind and excrete excess potassium through the GI tract in cases of hyperkalemia?
Sodium polystyrene sulfonate
If a patient's ABGs show that the pH, CO2, and HCO3 are all outside of the normal range, the nurse documents this as what type of compensation?
Partial compensation (no values are normal)
A patient is on a mechanical ventilator and is being "over-breathed." Which acid-base imbalance does the nurse anticipate?
Respiratory alkalosis
A patient is admitted with severe diarrhea. The nurse knows this causes metabolic acidosis because the lower GI tract contains large amounts of what?
Bases (bicarbonate)
A nurse is caring for a patient in hypovolemic shock. What are the priority treatments the nurse should expect to implement?
Oxygen therapy and fluid replacement (colloids, whole blood, or crystalloids like Normal Saline/Lactated Ringers)
What is an early sign of a change in fluid or electrolyte status that a nurse should always monitor for, especially in the elderly?
Change in level of consciousness (altered mental status)