A patient's arterial blood gas (ABG) results include a pH of 7.32, a PaCO2 of 56 mm Hg, and an HCO3 of 24 mEq/L. Which acid-base imbalance would the nurse use when developing the patient's plan of care?

Choice A rationale:

Eliminating excess H+ ions (hydrogen ions) is a primary mechanism the kidneys use to buffer acidosis. In acidosis, there is an excess of hydrogen ions in the body, leading to a decrease in pH. The kidneys help regulate the body's pH by excreting hydrogen ions to lower acidity.

Choice B rationale:

Excreting excess water is not a specific acid-base mechanism related to acidosis. While maintaining proper hydration is important for overall health, it does not directly influence the body's acid-base balance in the context of acidosis.

Choice C rationale:

Eliminating excess CO2 is primarily a respiratory mechanism, not a kidney function. CO2 elimination is more related to the lungs' ability to regulate the body's pH by adjusting respiratory rate and depth.

Choice D rationale:

Reabsorbing additional HCO3- ions (bicarbonate ions) is a renal mechanism to buffer acidosis. Bicarbonate ions act as a base and can neutralize excess hydrogen ions, raising the pH of the body fluids.

Choice E rationale:

Reabsorbing additional sodium ions is not a specific acid-base mechanism related to acidosis. While sodium ions are important for various physiological processes, they do not play a direct role in buffering acidosis.

Choice A rationale:

Purpura refers to purple or red discolorations on the skin caused by bleeding underneath the skin. It is larger than petechiae and ecchymosis and could be a sign of a more serious underlying condition. Petechiae are small, red or purple dots that appear on the skin due to minor bleeding from broken capillaries. In the context of leukemia and thrombocytopenia (low platelet count), petechiae are common due to impaired clotting mechanisms.

Choice B rationale:

Bruising occurs due to damage to blood vessels underneath the skin, resulting in the leakage of blood into the surrounding tissues. Bruises are typically larger than petechiae and can occur with various conditions, including trauma. In this case, the small 1-mm red macules are more indicative of petechiae.

Choice D rationale:

Ecchymosis refers to a larger area of subcutaneous bleeding or bruising. It is larger than both petechiae and purpura and often results from more significant trauma or bleeding disorders. The description of multiple 1-mm red macules is characteristic of petechiae rather than ecchymosis.