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Zorluk: OrtaPhysiological Adaptation

A clinical team is monitoring a client who has been undergoing continuous nasogastric decompression for three days due to a severe small bowel obstruction. The nurse should identify which of the following findings as evidence that the client is developing metabolic alkalosis? (Select all that apply)

  1. Shallow respirations at a rate of 10 breaths per minuteCevap
  2. B
    Arterial blood gas results showing a pH of 7.50 and a PaCO2 of 30 mm Hg
  3. Involuntary facial muscle twitching when the facial nerve is tappedCevap
  4. D
    A progressively narrowing pulse pressure with cool, clammy extremities
  5. Arterial blood gas results showing a pH of 7.48 and a bicarbonate level of 32 mEq/LCevap
  6. F
    Deep, rapid breathing pattern accompanied by a fruity breath odor

Cevap

The correct findings are shallow respirations at a rate of 10 breaths per minute, involuntary facial muscle twitching when the facial nerve is tapped, and arterial blood gas results showing a pH of 7.48 and a bicarbonate level of 32 mEq/L.
The correct options represent the primary laboratory criteria for metabolic alkalosis (elevated pH and elevated bicarbonate), the respiratory system's compensatory mechanism (hypoventilation to retain carbon dioxide), and the secondary clinical manifestation of decreased ionized calcium (positive Chvostek's sign) that reliably occurs in alkalemic states due to increased calcium binding to albumin.

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1
Analyze the physiological impact of the prescribed therapy.
Continuous nasogastric decompression removes hydrochloric acid (HCl) from the stomach.
Loss of gastric acid directly predisposes the client to a primary increase in serum bicarbonate, resulting in metabolic alkalosis.
2
Identify the direct laboratory evidence for this specific imbalance.
Metabolic alkalosis is confirmed by an elevated pH (greater than 7.45) and an elevated bicarbonate level (HCO3- greater than 28 mEq/L).
These ABG values confirm the primary metabolic disturbance.
3
Determine the expected physiological compensatory mechanism.
The body compensates by hypoventilating (shallow, slow breathing).
Hypoventilation retains carbon dioxide (an acid) to help lower the elevated blood pH back toward a normal range.
4
Identify secondary electrolyte shifts and their associated clinical manifestations.
The client may exhibit a positive Chvostek's sign (facial muscle twitching).
Alkalosis decreases the proportion of ionized calcium in the blood by increasing calcium binding to albumin, leading to neuromuscular excitability.

Anahtar Kavram

Physiological adaptation to metabolic alkalosis involves respiratory compensation (hypoventilation) and secondary electrolyte shifts (decreased ionized calcium).
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Physiological Adaptation

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