The nurse is caring for a client whose arterial blood gas reveals fully compensated metabolic acidosis. Which results are consistent with this finding?

Table 9.9 Normal Arterial Blood Gas Values

ABG Value.                                                             Normal Value

pH                                                                             7.35-7.45

PaCO2                                                                                                            35-45 mmHg

HCO3-                                                                         22-26mEq/L

Base excess                                                               -2 to +2

PaO2                                                                            80-95 mmHg

SaO2                                                                            >95%

pH 7.36, Pa02 98 mmHg, PaCO2 27 mmHg, HCO3 16 mEq/L, 02 sat 99%

pH 7.47, Pa02 91 mmHg, PaCO2 52 mmHg. HCO3 30 mEg/L, 02 sat 96%

pH 7.45, P302 86 mmHg, PaCO2 56 mmHg, HCO3 28 mEg/L, 02 sat 94%

PH 7.32, PaO2 88 mmHg. PaCO2 54 mmHg. HCO3 29 mEq/L. 02 sat 94%

Answer and Explanation

The Correct Answer is A

A. pH 7.36, PaO2 98 mmHg, PaCO2 27 mmHg, HCO3 16 mEq/L, O2 sat 99%: This set of ABG results is consistent with fully compensated metabolic acidosis. pH 7.36: This is within the normal range (7.35-7.45), indicating that compensation has occurred, as the pH has returned to normal levels. PaCO2 27 mmHg: The PaCO2 is low, suggesting that the respiratory system has compensated for the metabolic acidosis by increasing ventilation to excrete CO2, thus reducing the acid load. HCO3 16 mEq/L: The bicarbonate level is low, which is consistent with metabolic acidosis as the primary disturbance. The PaO2 and O2 saturation are normal, indicating adequate oxygenation. Since the pH is within the normal range and the PaCO2 and HCO3 levels reflect the compensatory changes needed to correct the metabolic acidosis, this is a case of fully compensated metabolic acidosis.

B. pH 7.47, PaO2 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, O2 sat 96%:

This result indicates alkalosis rather than acidosis. The pH is alkalotic (7.47), and PaCO2 is elevated (52 mmHg), which suggests respiratory acidosis as the primary disturbance. The HCO3 is also high (30 mEq/L), which is consistent with metabolic compensation for respiratory acidosis, not for metabolic acidosis. Therefore, this is not consistent with fully compensated metabolic acidosis.

C. pH 7.45, PaO2 86 mmHg, PaCO2 56 mmHg, HCO3 28 mEq/L, O2 sat 94%:

The pH is normal, but PaCO2 is elevated (56 mmHg), indicating respiratory acidosis rather than metabolic acidosis. The HCO3 is also elevated (28 mEq/L), which is consistent with compensation for respiratory acidosis, not metabolic acidosis. This result suggests respiratory acidosis with compensated metabolic alkalosis rather than metabolic acidosis.

D. pH 7.32, PaO2 88 mmHg, PaCO2 54 mmHg, HCO3 29 mEq/L, O2 sat 94%:

The pH of 7.32 indicates acidosis, but it is not within the normal range, so this is not fully compensated. The PaCO2 is elevated (54 mmHg), indicating respiratory acidosis, and the HCO3 is elevated (29 mEq/L), showing metabolic compensation. However, since the pH has not yet returned to normal (it remains acidotic), this is an example of partially compensated respiratory acidosis, not fully compensated metabolic acidosis.

respiratory acidosis, not fully compensated metabolic acidosis.

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Correct Answer is C

Explanation

A) Arrange for social service consult for assistance with medication purchase:
While arranging for social service support can be beneficial in ensuring the client has access to necessary medications, this is not directly related to fall prevention at home. Falls in Parkinson's disease are more closely associated with mobility, balance, and environmental factors, which should be the focus of interventions aimed at reducing fall risk. Medication access is important but secondary to safety measures related to physical environment and mobility.

B) Have the client seen by a nursing assistant 3 times a week for hygiene:
While assistance with hygiene can certainly help support the client’s daily needs, the frequency of visits for hygiene care alone does not specifically address fall prevention. Falls are more directly linked to issues such as impaired balance, freezing episodes, and poor mobility—issues that should be addressed through environmental modifications and specific interventions aimed at improving safety during ambulation and transfers.

C) Ensure adequate lighting in areas where the client will ambulate:
Ensuring adequate lighting in areas where the client will ambulate is a critical intervention for fall prevention in individuals with Parkinson's disease. Parkinson's disease often causes balance and coordination problems, and inadequate lighting can increase the risk of tripping or falling, especially at night or in poorly lit areas. Proper lighting helps the client see obstacles and navigate their environment safely. This intervention directly addresses a key factor in fall risk and is an important part of the plan of care.

D) Refer the client to a nutritionist to address dietary measures:
Referral to a nutritionist can be helpful in managing some aspects of Parkinson's disease, particularly for addressing issues like constipation, weight management, or dysphagia. However, dietary measures do not have a direct impact on fall prevention. Fall prevention should focus more on mobility, strength, environmental safety, and managing the symptoms of Parkinson's disease that affect balance and movement.

A. Muscle rigidity and bradykinesia B. Facial pain and ptosis C. Diarrhea and nausea D. Ecchymosis and petechiae

Correct Answer is A

Explanation

A. Muscle rigidity and bradykinesia: Parkinson's disease (PD) is characterized by a combination of motor symptoms due to the degeneration of dopamine-producing neurons in the brain. The hallmark motor symptoms include muscle rigidity (stiffness of muscles, making movement difficult) and bradykinesia (slowness of movement). These symptoms are typically present early in the disease and can lead to difficulties with daily activities such as walking, speaking, and performing fine motor tasks. These two signs are primary indicators of Parkinson's disease.

B. Facial pain and ptosis: Facial pain and ptosis (drooping eyelids) are not typical symptoms of Parkinson's disease. PD can affect facial expression (resulting in a masked face), but it does not usually cause facial pain. Ptosis is more commonly seen in conditions like Horner's syndrome, myasthenia gravis, or as a side effect of medications, but it is not a hallmark symptom of Parkinson's disease.

C. Diarrhea and nausea: While gastrointestinal symptoms such as constipation can be seen in Parkinson's disease due to autonomic dysfunction and decreased gut motility, diarrhea and nausea are not typical primary symptoms. In fact, constipation is a more common issue in PD. Nausea could result from the use of medications like levodopa, but it is not a defining feature of the disease itself.

D. Ecchymosis and petechiae: Ecchymosis (bruising) and petechiae (small red or purple spots on the skin) are not characteristic of Parkinson's disease. These findings are more often associated with platelet disorders, bleeding disorders, or vascular conditions. While Parkinson's disease can involve complications like falls (which could lead to bruising), these are not direct symptoms of the disease itself. The primary symptoms involve motor and autonomic dysfunction.

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