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Difficulty: MediumReduction of Risk Potential

A 54-year-old client with a mechanical bowel obstruction has been receiving continuous nasogastric suctioning for the past 48 hours. During the morning assessment, the client reports numbness around the mouth and exhibits frequent muscle twitching in the extremities. Arterial blood gas results reveal a pHpH of 7.54, PaCO2PaCO_2 of 40 mm Hg, and HCO3−HCO_3^- of 34 mEq/L. Which action is the priority for the nurse to implement to reduce the client's risk for severe physiological complications?

  1. Notify the healthcare provider of the clinical findings and anticipate an order for a serum electrolyte panelAnswer
  2. B
    Guide the client to take slow, controlled breaths into a paper bag to retain carbon dioxide
  3. C
    Place the client in a flat, supine position with the lower extremities elevated to manage early signs of shock
  4. D
    Assign an unlicensed assistive personnel to remain at the bedside and monitor the client's vital signs every 15 minutes

Answer

The correct action is to notify the healthcare provider and anticipate orders for a serum electrolyte panel to address the client's metabolic alkalosis and suspected hypocalcemia.
The correct answer directly addresses the root cause of the client's deterioration. The client is experiencing uncompensated metabolic alkalosis due to continuous gastric acid loss from the nasogastric tube. Alkalosis causes calcium to bind more tightly to protein, reducing ionized calcium levels and resulting in hypocalcemia (manifested by perioral numbness and muscle twitching). Requesting a serum electrolyte panel is critical to confirm the deficits and safely guide the necessary intravenous replacement therapy, thereby reducing the risk of life-threatening complications like cardiac arrhythmias or tetany.

Step-by-Step Solution

1
Analyze the arterial blood gas (ABG) results.
The elevated pHpH (7.54) indicates alkalosis, and the elevated HCO3−HCO_3^- (34 mEq/L) with a normal PaCO2PaCO_2 indicates uncompensated metabolic alkalosis.
Identifying the specific acid-base imbalance is necessary to determine the physiological root cause of the client's symptoms.
2
Correlate the ABG findings with the client's clinical history and current symptoms.
Prolonged nasogastric suctioning removes hydrochloric acid from the stomach, causing metabolic alkalosis. Alkalosis decreases the amount of ionized calcium in the blood, leading to symptomatic hypocalcemia (perioral numbness and muscle twitching).
Connecting diagnostic data to physical assessment findings differentiates expected conditions from impending severe complications like tetany or seizures.
3
Determine the priority nursing intervention based on the assessment.
The nurse must immediately notify the healthcare provider to obtain serum electrolyte levels (especially calcium and potassium) to initiate targeted replacement therapy.
Electrolyte derangements of this severity are life-threatening and require collaborative medical intervention to prevent cardiac arrhythmias or respiratory arrest from tetany.

Key Concept

Metabolic Alkalosis and Associated Hypocalcemia
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Topics

Reduction of Risk Potential

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