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A client in the emergency department (ED) has baseline arterial blood gas (ABG) of pH 7.35, PaCO2 60 mm Hg, HCO3-35 mEq/L and PaO2 60 mm Hg. Which interpretation should the nurse conclude when analyzing these findings?

Reference Ranges:

  • Arterial Blood Gas
  • pH [7.35 to 7.45]
  • PaCO2 [35 to 45 mm Hg]
  • HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]
  • PaO2 [80 to 100 mm Hg]

A.

Compensated respiratory acidosis with hypoxia.

B.

Compensated respiratory alkalosis with normal oxygenation.

C.

Acute respiratory acidosis.

D.

Normal acid base balance.

Answer and Explanation

The Correct Answer is A

A. Compensated respiratory acidosis with hypoxia: The pH is at the low end of normal (7.35), PaCO₂ is elevated (60 mm Hg), and HCO₃⁻ is also elevated (35 mEq/L), indicating the kidneys are compensating for chronic respiratory acidosis. The PaO₂ is low (60 mm Hg), confirming hypoxia.

B. Compensated respiratory alkalosis with normal oxygenation: Respiratory alkalosis would be indicated by a high pH and low PaCO₂, which are not present here. Also, the client is hypoxic, not normally oxygenated, as shown by the PaO₂ of 60 mm Hg.

C. Acute respiratory acidosis: In acute respiratory acidosis, the PaCO₂ would be high with a low pH and little to no elevation in HCO₃⁻. The elevated HCO₃⁻ here shows that compensation has occurred, indicating the condition is not acute.

D. Normal acid-base balance: Although the pH falls within normal limits, the PaCO₂ and HCO₃⁻ are significantly abnormal. The body has compensated for the respiratory acidosis, but the acid-base balance is not normal due to the underlying pathology and associated hypoxia.


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Related Questions

Correct Answer is A

Explanation

A. First degree AV heart block: The rhythm is regular, P waves are present and consistent, and each P wave is followed by a QRS. The defining feature is the consistently prolonged PR interval (greater than 0.20 seconds), which indicates a delay in conduction through the AV node.

B. Junctional escape rhythm: A junctional escape rhythm originates in the AV node, typically has a slower rate (40-60 bpm), and P waves are either absent, inverted, or occur after the QRS complex. This strip has P waves preceding each QRS and a normal rate.

C. Sinus bradycardia: Sinus bradycardia has a heart rate less than 60 bpm. This strip shows a rate of approximately 75 bpm.

D. Normal sinus rhythm: While many parameters (rate, regularity, P wave presence, QRS width) might suggest a sinus rhythm, a normal sinus rhythm requires a PR interval within the normal range (0.12-0.20 seconds). This strip has a prolonged PR interval.

Correct Answer is D

Explanation

A. Encourage deep breathing and coughing: While deep breathing can help mobilize secretions, this client is in acute respiratory distress and likely experiencing pulmonary edema. He may be too compromised to perform these exercises effectively until his breathing is stabilized.

B. Provide emotional support to alleviate anxiety: Emotional support is important but not priority when physical symptoms such as dyspnea, tachycardia, and cold, clammy skin signal acute decompensation. Physiologic stabilization must occur before psychological needs.

C. Insert an indwelling urinary catheter: Monitoring fluid output is relevant in managing heart failure, but inserting a catheter does not address the client's immediate respiratory distress. This intervention can be performed after the client's breathing is supported.

D. Place the client in high-Fowler’s position: High-Fowler’s position improves lung expansion and decreases preload by promoting venous pooling in the lower extremities, thus reducing pulmonary congestion. It is the most immediate and effective non-invasive intervention for relieving acute dyspnea.

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