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Difficulty: HardPhysiological Adaptation

A client is admitted to the intensive care unit after ingesting a toxic quantity of aspirin (acetylsalicylic acid) approximately 8 hours ago. The client is lethargic, diaphoretic, and exhibits deep, rapid respirations at 34 breaths/min. Arterial blood gas (ABG) results reveal a pH of 7.18, PaCO2 of 22 mm Hg, and HCO3 of 10 mEq/L. Which of the following interventions should the nurse anticipate implementing as the highest priority?

  1. Administer a prescribed intravenous continuous infusion of sodium bicarbonateAnswer
  2. B
    Administer a prescribed intravenous sedative to decrease the client's work of breathing
  3. C
    Prepare for immediate endotracheal intubation to take over the work of breathing
  4. D
    Administer a rapid intravenous bolus of 0.9% sodium chloride

Answer

The nurse should anticipate administering a prescribed intravenous continuous infusion of sodium bicarbonate to alkalinize the client's blood and urine.
Intravenous sodium bicarbonate is the definitive antidote for severe salicylate (aspirin) toxicity. It works through two distinct physiological mechanisms: it alkalinizes the blood plasma to draw toxic salicylate out of the central nervous system, and it alkalinizes the urine to promote 'ion trapping'. Ion trapping prevents the renal tubules from reabsorbing the salicylate molecule, thereby drastically increasing its excretion from the body.

Step-by-Step Solution

1
Analyze the arterial blood gas (ABG) results.
pH 7.18 indicates severe acidemia. HCO3 10 mEq/L indicates metabolic acidosis. PaCO2 22 mm Hg indicates a compensatory respiratory alkalosis.
Identifying the primary acid-base imbalance is necessary to understand the body's physiological response and determine appropriate treatment.
2
Evaluate the clinical presentation in the context of the overdose.
The client ingested a toxic amount of aspirin, causing high anion gap metabolic acidosis. The deep, rapid respirations (Kussmaul respirations) are the body's attempt to compensate by blowing off CO2.
Links the physiological assessment findings to the toxicologic etiology.
3
Identify the priority pharmacological intervention to reverse the toxicity.
Intravenous sodium bicarbonate is selected as the primary treatment.
Sodium bicarbonate actively reverses the severe acidemia and employs 'ion trapping' in the renal tubules, drastically accelerating the elimination of the toxic salicylate molecules.

Key Concept

Management of Severe Salicylate (Aspirin) Toxicity and Compensatory Mechanisms
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Topics

Physiological Adaptation

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