The nurse is caring for a client who is post-operative following a bowel resection. The client is NPO with a nasogastric tube connected to suction. Which acid base imbalance is this client at risk to develop?

Metabolic alkalosis

Metabolic acidosis

Respiratory alkalosis

Respiratory acidosis

Answer and Explanation

The Correct Answer is A

a. Metabolic alkalosis: Metabolic alkalosis can occur due to loss of gastric acid through suctioning of gastric contents via the nasogastric tube. Continuous suctioning of gastric contents can lead to loss of hydrogen ions (H+) and chloride ions (Cl-) from the stomach, resulting in metabolic alkalosis.

b. Metabolic acidosis: Metabolic acidosis is less likely in this scenario unless there are other factors contributing to acidosis, such as renal dysfunction or excessive administration of certain medications. Suctioning of gastric contents would lead to loss of acid, which could potentially predispose the client to metabolic alkalosis rather than metabolic acidosis.

c. Respiratory alkalosis: Respiratory alkalosis is less likely to occur in this scenario. Although the client is NPO and may be experiencing some respiratory compensation due to metabolic alkalosis, the primary acid-base disturbance would be metabolic rather than respiratory.

d. Respiratory acidosis: Respiratory acidosis is not typically associated with suctioning of gastric contents. Instead, it occurs due to inadequate alveolar ventilation, leading to retention of carbon dioxide (CO2) and subsequent respiratory acidosis. This imbalance is more commonly seen in conditions such as respiratory depression, neuromuscular disorders, or airway obstruction.

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Correct Answer is B

Explanation

a. Hemolytic anemia: Hemolytic anemia is more commonly associated with mechanical heart valves rather than tissue valves. Mechanical valves can cause damage to red blood cells as they move through the valve, leading to hemolysis and subsequent anemia. Tissue valves typically do not cause significant hemolysis.

b. Endocarditis: Endocarditis is a known complication associated with prosthetic heart valves, including tissue valves. While tissue valves generally have a lower risk of thrombosis compared to mechanical valves, they are still susceptible to bacterial colonization and subsequent endocarditis. Patients with prosthetic heart valves, regardless of type, are recommended to take antibiotic prophylaxis before certain dental or surgical procedures to reduce the risk of infective endocarditis

c. Hypertension: Hypertension is not specifically associated with tissue valve replacements. While hypertension is a common cardiovascular condition, it is not directly related to the type of prosthetic valve implanted.

d. Elevated PT/INR: Elevated prothrombin time (PT) and international normalized ratio (INR) are more commonly associated with mechanical heart valves rather than tissue valves. Mechanical valves require lifelong anticoagulation therapy with medications such as warfarin to prevent thrombosis. Tissue valves generally do not require long-term anticoagulation therapy, although they may still require short-term anticoagulation immediately after implantation.

A. Assess for decreased respiratory rate B. Diet teaching to include low protein foods C. Obtain daily weight D. Check blood glucose

Correct Answer is A

Explanation

Metabolic alkalosis is an acid-base imbalance characterized by excessive loss of acid or excessive gain of bicarbonate produced by an underlying pathologic disorder. It's essential to address this condition promptly.

a. Assess for decreased respiratory rate: Metabolic alkalosis leads to hypoventilation as the body compensates by retaining carbon dioxide. Monitoring respiratory rate is crucial to detect any signs of respiratory distress or inadequate ventilation¹.

- Priority: High

b. Diet teaching to include low protein foods: While dietary adjustments are important, addressing the underlying cause (such as vomiting, diuretic use, or excessive alkali intake) is more critical. Low protein foods alone won't correct metabolic alkalosis.

- Priority: Low

c. Obtain daily weight: Daily weight monitoring is essential for assessing fluid balance, but it doesn't directly address metabolic alkalosis. Other interventions take precedence.

- Priority: Medium.

d. Check blood glucose: Blood glucose levels are not directly related to metabolic alkalosis. Focusing on acid-base balance and electrolyte levels is more relevant.

- Priority: Low

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The nurse is caring for a client who is post-operative following a bowel resection. The client is NPO with a nasogastric tube connected to suction. Which acid base imbalance is this client at risk to develop?

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Correct Answer is A

Explanation

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The nurse is caring for a client who is post-operative following a bowel resection. The client is NPO with a nasogastric tube connected to suction. Which acid base imbalance is this client at risk to develop?