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. Expect fluctuations of symptoms with temperature change: While symptom fluctuations may occur due to various factors, temperature changes are not a hallmark feature of Huntington's Disease (HD). HD is characterized by progressive motor, cognitive, and psychiatric symptoms, including involuntary movements (chorea), cognitive decline, and mood disturbances. Although other neurological conditions may show symptom fluctuations with temperature changes, this is not specific to HD.

B. New surgical techniques offer the best hope for a cure: There are currently no cures for Huntington's Disease, and while medical management can help manage symptoms (such as using medications for chorea or psychiatric symptoms), surgical techniques do not offer a cure for HD. The disease is progressive, and interventions typically focus on symptom management rather than cure. Families should be informed that while research is ongoing, a cure is not currently available.

C. Information about genetic testing: Huntington's Disease (HD) is a genetic disorder caused by a mutation in the HTT gene. It is inherited in an autosomal dominant pattern, meaning that a person with a parent who has HD has a 50% chance of inheriting the disease. Genetic testing is a critical part of the diagnosis process, and it can confirm the presence of the mutated gene before symptoms appear, which is important for family planning and early intervention. However, while genetic testing can provide information about whether an individual will develop the disease, it does not alter the course of the disease or provide a cure. It is essential to provide this information to clients and families, so they understand the role of genetic counseling and testing in managing the disease.

D. The disease process is intense but short in duration: Huntington's Disease is progressive and long-lasting. The disease usually begins in mid-adulthood (typically between ages 30-50), and the symptoms worsen over time. Individuals with HD may live for 15-20 years after symptom onset. The disease duration is long-term, not short, and it becomes increasingly debilitating as it progresses. The intensity of symptoms increases over time, and the disease is not characterized by a short duration.

A. Suction the client as needed B. Administer pantoprazole sodium IV C. Apply sequential compression device (SCD) D. Perform oral care with chlorhexidine

Correct Answer is A

Explanation

A. Suction the client as needed: Suctioning is an essential nursing intervention for clients on mechanical ventilation to maintain effective ventilation. Ventilated clients are at risk for accumulating secretions in the airway, which can obstruct the endotracheal tube or tracheostomy, impairing ventilation and oxygenation. Regular or as-needed suctioning helps to clear secretions, ensuring that the airway remains patent and effective ventilation is maintained. This intervention directly supports the goal of maintaining optimal respiratory function and preventing complications such as atelectasis, pneumonia, or hypoxia.

B. Administer pantoprazole sodium IV: Pantoprazole is a proton pump inhibitor used to decrease stomach acid, typically to prevent stress ulcers in critically ill patients. While this is an important aspect of care for preventing gastrointestinal complications in ventilated patients, it does not directly support ventilation. Therefore, administering pantoprazole is not as directly related to ensuring effective ventilation as suctioning or other respiratory interventions.

C. Apply sequential compression device (SCD): While applying an SCD is important for preventing deep vein thrombosis (DVT) and promoting circulation in immobile patients, it does not directly address the client's ventilation or respiratory function. This intervention is more relevant for preventing venous thromboembolism, not for managing ventilation or airway clearance.

D. Perform oral care with chlorhexidine: Oral care with chlorhexidine is an important practice to reduce the risk of ventilator-associated pneumonia (VAP) and promote overall oral hygiene. It helps decrease the colonization of bacteria in the mouth and reduces the risk of infection. However, while oral care is an essential component of care for a ventilated patient, suctioning directly addresses the goal of effective ventilation by maintaining airway patency, making it the most immediate and relevant intervention for supporting ventilation.

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The nurse is teaching the client and family about Huntington's Disease (HD). What information should the nurse include?

Correct Answer is C

Explanation

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Correct Answer is A

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