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Difficulty: MediumReduction of Risk Potential

A nurse is assigned to care for a client with a mechanical bowel obstruction who has had a nasogastric (NG) tube connected to low intermittent suction for the past 4848 hours. The client's morning arterial blood gas (ABG) results reveal a pH of 7.527.52, a PaCO 2_2 of 4242 mm Hg, and an HCO 3−_3^- of 3434 mEq/L. Which of the following nursing interventions should be implemented to reduce the risk of further physiological complications? Select all that apply.

  1. Monitor the client's serum potassium level and continuous electrocardiogram (ECG) rhythm.Answer
  2. Assess for physical signs of neuromuscular irritability, such as muscle twitching or tetany.Answer
  3. C
    Administer a prescribed intravenous sodium bicarbonate infusion.
  4. D
    Place the client in a flat, supine position to minimize abdominal tension.
  5. E
    Auscultate for bowel sounds immediately after performing deep abdominal palpation.

Answer

The appropriate interventions are to monitor the client's serum potassium level along with continuous ECG rhythm, and to assess for physical signs of neuromuscular irritability such as muscle twitching or tetany.
The correct choices address the direct systemic consequences of metabolic alkalosis induced by gastric suctioning. Gastric fluid is rich in hydrochloric acid and potassium; its continual removal leads to metabolic alkalosis and hypokalemia. Alkalosis further drives potassium into cells, increasing the risk of life-threatening cardiac dysrhythmias, necessitating ECG monitoring. Furthermore, alkalosis causes more calcium to bind to serum albumin, decreasing the amount of active ionized calcium and increasing the risk for neuromuscular excitability, such as tetany.

Step-by-Step Solution

1
Analyze the provided arterial blood gas (ABG) values.
The pH (7.527.52) is elevated (alkalosis), the PaCO 2_2 (4242 mm Hg) is normal, and the HCO 3−_3^- (3434 mEq/L) is elevated. This indicates uncompensated metabolic alkalosis.
Accurately identifying the primary acid-base imbalance is the first step in anticipating physiological complications and determining corrective nursing actions.
2
Identify physiological risks associated with metabolic alkalosis and continuous gastric suctioning.
The client is at high risk for both severe hypokalemia (due to direct gastric losses and intracellular shifts) and hypocalcemia (due to increased calcium-albumin binding).
Understanding the systemic effects of the acid-base imbalance allows the nurse to prioritize targeted assessments like ECG monitoring and checking for tetany.
3
Evaluate the safety and appropriateness of the proposed nursing interventions.
Monitoring electrolytes and neuromuscular status are indicated. Conversely, administering bicarbonate, laying the client flat, and palpating before auscultating are contraindicated or unsafe practices.
Evidence-based practice requires avoiding contraindicated medications, maintaining airway safety precautions (elevating the head of the bed), and adhering to proper physical assessment protocols to reduce risk.

Key Concept

Metabolic Alkalosis and Complication Prevention in Gastric Suctioning
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Topics

Reduction of Risk Potential

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