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Difficulty: MediumPhysiological Adaptation

A nurse is evaluating a client who has a severe exacerbation of chronic obstructive pulmonary disease (COPD). The client's most recent arterial blood gas (ABG) results show a pH of 7.31, PaCO2 of 62 mm Hg, and HCO3- of 34 mEq/L. Which of the following conclusions should the nurse draw regarding the client's physiological state based on these findings? (Select all that apply)

  1. The client is in a state of respiratory acidosis.Answer
  2. The kidneys are actively retaining bicarbonate to buffer the blood.Answer
  3. C
    The primary acid-base imbalance is metabolic alkalosis.
  4. D
    The client has achieved full compensation for the acid-base disorder.
  5. E
    The lungs are effectively eliminating excess carbon dioxide.

Answer

The correct conclusions are that the client is experiencing respiratory acidosis and that the kidneys are retaining bicarbonate as a compensatory mechanism.
The client's pH of 7.31 reflects an acidotic state. The elevated PaCO2 of 62 mm Hg points to a respiratory cause, defining the condition as respiratory acidosis. The kidneys are responding to this by holding onto bicarbonate, as evidenced by the elevated HCO3- of 34 mEq/L, which is the expected physiological adaptation to buffer the excess acid.

Step-by-Step Solution

1
Analyze the blood pH level.
The pH is 7.31.
A normal pH is 7.35 to 7.45. A pH less than 7.35 indicates acidemia, establishing the presence of an acidosis.
2
Analyze the PaCO2 level to determine if the cause is respiratory.
The PaCO2 is 62 mm Hg.
A normal PaCO2 is 35 to 45 mm Hg. An elevated PaCO2 in the presence of acidemia confirms that the primary disorder is respiratory acidosis.
3
Analyze the HCO3- level to identify any compensatory response.
The HCO3- is 34 mEq/L.
A normal HCO3- is 22 to 26 mEq/L. An elevated bicarbonate level demonstrates a metabolic compensatory response, where the kidneys retain base to counteract the respiratory acid.
4
Evaluate the state of compensation.
The acid-base imbalance is partially compensated.
Although the kidneys are actively retaining bicarbonate, the pH has not yet returned to the normal range.

Key Concept

Interpretation of arterial blood gas (ABG) values and recognition of physiological compensatory mechanisms in acid-base imbalances.
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Topics

Physiological Adaptation

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