Question

For each of the following situations, decide if the client is experiencing or is at risk for acidosis or alkalosis, fully-compensated, partially-compensated, or uncompensated.

List 2 things you could do to help improve the situation.

Scenario 1

A client recovering from surgery in the post-anesthesia care unit (PACU) is difficult to arouse two hours following surgery. The nurse in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client's respiratory rate is 7 per minute, and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT!
The STAT results come back from the laboratory and show:
pH = 7.15
Pa C02 = 68 mmHg
HC03 = 22 mEq/L
Which acid-base imbalance is the client experiencing?
List two interventions:

Scenario 2

An infant, three weeks old, is admitted to the Emergency Room. The mother reports that the infant has been irritable, difficult to breastfeed, and has had diarrhea for 4 days. The infant's respiratory rate is elevated, and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs.
The results from the ABGs come back from the laboratory and show:
pH = 7.37
Pa C02 = 29 mmHg
HC03 = 17 mEq/L
Which acid-base imbalance is the client experiencing?

List two interventions:


Scenario 3

A client, five days post-abdominal surgery, has a nasogastric tube. The nurse notes that the nasogastric tube (NGT) is draining a large amount (900 mL's in 2hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician, who orders a STAT ABG.
The results from the ABGs come back from the laboratory and show:
pH = 7.52
Pa C02 = 35 mmHg
HC03 = 29 mEq/L
Which acid-base imbalance is the client experiencing?
List two interventions:

Scenario 4

A client is admitted to the hospital and is being prepared for a craniotomy (brain surgery). The client is very anxious and scared of the impending surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness, and the STAT ABGs reveal:
The results from the ABGs come back from the laboratory and show:
pH = 7.57
Pa C02 = 26 mmHg
HC03 = 24 mEq/L
Which acid-base imbalance is the client experiencing?
List two interventions:


Scenario 5

A young woman, drinking beer at a party, falls and hits her head on the ground. A friend dials "911" because the young woman is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears.
What acid-base imbalance is this young lady at risk for if she does not get medical attention?
List two interventions:


Scenario 6

A young man is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute.
What acid-base imbalance is this young man at risk for if he does not get medical attention?
List two interventions:


Scenario 7

An 11-year old boy is admitted to the hospital with vomiting, nausea, and overall weakness. The nurse notes the laboratory results: potassium: 2.9 mEq.
What acid-base imbalance is this young man at risk for if he does not get medical attention?
List two interventions:

Answer 1

Scenario 1-acidosis (ph 7.15)

It is non compensated as respiratory rate and ph both are below normal

2 intervention-

Potassium permanganate as anti dote of morphine.

Scenario 3-

Oxygen supply

Scenario 2-acidosis (ph -7.37 normal 7.35) resp. Rate elevated.

Compensated RR elevated but Paco2 normal.

2 intervention- chloride infusion, carbonic anhydarse inhibitor

Scenario 3-alkalosis. Ph elevated.

Compensated.

Acid to neutralize, k+ supplimentation to treat cns issues.

Scenario 4- alkalosis , compensated.

Reassure patient, ask to hold breath.

Scenario 5- acidosis , compensated, rr decreased.

Femipezole for alcohal dehydrogenase inhibition

Iv fluids

Scenario 6- alkalosis.compensated.

2 intervention- opiates for numbness., Iv fluids and potaasium ion.

Scenario 7-alkalosis

K+ infusion, fluid, vit c