A nurse is evaluating a client who has been receiving continuous nasogastric (NG) suctioning for 3 days due to a paralytic ileus. The client reports new-onset severe muscle cramping and palpitations. The cardiac monitor displays frequent premature ventricular contractions (PVCs). The client's respiratory rate is 10 breaths/min and shallow. Arterial blood gas (ABG) results are: pH 7.54, PaCO2 49 mm Hg, PaO2 88 mm Hg, and HCO3 35 mEq/L. To reduce the risk of impending physiological decompensation, which action is the nurse's priority?
- Initiate a prescribed intravenous potassium chloride protocol.Cevap
- BCoach the client to perform deep, rapid breathing exercises.
- CLower the head of the bed to a flat, supine position.
- DImmediately discontinue the nasogastric suctioning.
Cevap
The correct action is to initiate a prescribed intravenous potassium chloride protocol.
The client is experiencing metabolic alkalosis resulting from the loss of gastric acid via prolonged nasogastric suctioning. Gastric secretions are rich in both hydrogen and potassium ions; therefore, significant depletion leads to severe hypokalemia. The client's symptoms of muscle cramping, palpitations, and frequent premature ventricular contractions (PVCs) are classic signs of hypokalemia and represent an immediate, life-threatening risk for lethal ventricular dysrhythmias. The priority action is to stabilize the myocardium by initiating a prescribed potassium chloride replacement protocol. The client's decreased respiratory rate and elevated PaCO2 represent an expected and necessary compensatory mechanism to retain acid and lower the blood pH.
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Anahtar Kavram
Identifying and managing fluid, electrolyte, and acid-base imbalances associated with therapeutic procedures to prevent life-threatening cardiac complications.
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