Examkin

Question

Difficulty: MediumReduction of Risk Potential

A client who underwent a bowel resection three days ago has a nasogastric (NG) tube connected to continuous low wall suction. The client's morning arterial blood gas (ABG) results display a pH of 7.54, PaCO2 of 42 mm Hg, and HCO3- of 32 mEq/L. Based on these clinical findings, which of the following is the most appropriate nursing action to reduce the client's risk for complications?

  1. A
    Position the client flat in a supine position to facilitate optimal nasogastric drainage.
  2. B
    Prepare to administer a prescribed intravenous sodium bicarbonate infusion.
  3. Initiate continuous electrocardiogram (ECG) monitoring to assess for cardiac dysrhythmias.Answer
  4. D
    Palpate the abdominal quadrants for rigidity and guarding prior to auscultating bowel sounds.

Answer

The most appropriate action is to initiate continuous electrocardiogram (ECG) monitoring to assess for cardiac dysrhythmias.
The client's arterial blood gas values indicate metabolic alkalosis (pH > 7.45, HCO3- > 26 mEq/L), an expected complication of prolonged gastric acid loss from NG suctioning. Metabolic alkalosis is closely associated with severe hypokalemia due to the direct loss of potassium in gastric fluids and the intracellular shift of potassium to compensate for the lack of hydrogen ions. Hypokalemia drastically increases the risk for life-threatening cardiac dysrhythmias, making continuous ECG monitoring the most appropriate priority action to reduce the client's risk for physiological complications.

Step-by-Step Solution

1
Analyze the client's arterial blood gas (ABG) results.
The pH of 7.54 indicates alkalemia, and the elevated HCO3- of 32 mEq/L confirms metabolic alkalosis.
To identify the physiological imbalance caused by the continuous loss of gastric secretions from the NG tube.
2
Connect the acid-base imbalance to potential electrolyte shifts.
Metabolic alkalosis is commonly accompanied by severe hypokalemia, as potassium is lost in gastric fluids and shifts into cells in exchange for hydrogen ions.
To identify the secondary physiological risk associated with the primary imbalance.
3
Determine the priority nursing action based on the identified complication risk.
Because hypokalemia causes myocardial irritability and dangerous cardiac dysrhythmias, continuous ECG monitoring is the priority intervention.
To establish patient safety and actively monitor for life-threatening complications.

Key Concept

Metabolic Alkalosis and Hypokalemia Risk Reduction
Rate this question

Topics

Reduction of Risk Potential

More questions from this topic