Question

Lorna is a 21year old with intractable (difficult) vomiting. She has some electrolyte imbalance, so an ABG was obtained to assess her acid/base balance. Results were”

Ph 7.50 =?

C02 36 = ?

P02 92 = ?

1. What is your interpretation? Is it

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

Compensated?

Uncompensated?

Partially or Fully compensated?

2. What nursing interventions would be appropriate for Lorna?

Answer 1

What is your interpretation? Is it

Metabolic alkalosis

Vomiting generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space.ph is increased and pco2 normal.

Compensated?

Uncompensated?

Partially or Fully compensated?

The PaCO2 is within normal limits,pH is increased so the interpretation is uncompensated metabolic alkalosis. The patient is partially compensated when he has an imbalance and some compensation occurs.

Nursing Interventions

1.Monitor respiratory rate, rhythm, and depth.

2.Assess level of consciousness and neuromuscular status, strength, tone, movement; note presence of Chvostek’s or Trousseau’s signs.

3.Monitor heart rate and rhythm.

4.Record amount and source of output. Monitor intake and daily weight.

5.Restrict oral intake and reduce noxious environmental stimuli.

6.Provide seizures and safety precautions as indicated. Pad side rails, protect the airway, put bed in low position and frequent observation.

7.Encourage intake of foods and fluids high in potassium and possibly calcium (dependent on blood level), canned grapefruit and apple juices, bananas, cauliflower, dried peaches, figs, and wheat germ.

8.Review medication regimen for use of diuretics, such as thiazides (Diuril, Hygroton),furosemide (Lasix), and ethacrynic acid (Edecrin).

9.Instruct patient to avoid use of excessive amounts of sodium bicarbonate

10.Monitor laboratory studies as indicated: ABGs/pH, serum electrolytes (especially potassium), and BUN.

11.Administer medications as indicated: Correcting sodium, water, and chloride defects may be all that is needed to permit kidneys to excrete bicarbonate and correct alkalosis, but must be used with caution in patients with HF or renal insufficiency.

12.Administer Sodium chloride PO/Ringer’s solution IV unless contraindicated.

13.Administer Acetazolamide (Diamox),

Spironolactone (Aldactone), chloride-resistant alkalosis, e.g., Cushing’s syndrome.

14.Avoid or limit use of sedatives or hypnotics.

15.Encourage fluids IV/PO.

16.Administer supplemental O2 as indicated and respiratory treatments to improve ventilation.