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Zorluk: OrtaPhysiological Adaptation

A client recovering from an orthopedic procedure is receiving intravenous morphine via a patient-controlled analgesia (PCA) device. Upon entering the room, the nurse observes that the client is somnolent, difficult to awaken, and has shallow respirations at a rate of 8 breaths per minute. Which of the following arterial blood gas (ABG) values and clinical manifestations should the nurse anticipate? Select all that apply.

  1. pH of 7.27Cevap
  2. PaCO2PaCO_2 of 62 mm HgCevap
  3. C
    HCO3−HCO_3^- of 36 mEq/L
  4. D
    Tingling in the fingers and toes
  5. Lethargy and dull headacheCevap
  6. F
    Hyperactive deep tendon reflexes

Cevap

The expected findings are a pH of 7.27, a PaCO2PaCO_2 of 62 mm Hg, and lethargy with a dull headache.
The client's hypoventilation (8 breaths/min) caused by opiate administration results in acute carbon dioxide retention. This creates uncompensated respiratory acidosis, characterized by a low pH, an elevated PaCO2PaCO_2, and normal bicarbonate levels. Systemically, hypercapnia causes cerebral vasodilation, which presents as lethargy and headaches.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client is somnolent with a respiratory rate of 8 breaths/min due to morphine administration.
Identifying severe hypoventilation is the critical first step to determining the resulting acid-base imbalance.
2
Determine the primary acid-base disturbance.
Hypoventilation directly leads to acute respiratory acidosis.
A decreased respiratory rate causes carbon dioxide to be retained in the blood rather than exhaled.
3
Predict the corresponding ABG values.
Expect a decreased pH (< 7.35), elevated PaCO2PaCO_2 (> 45 mm Hg), and normal HCO3−HCO_3^- (22-26 mEq/L).
Acute retention of CO2CO_2 drops the pH immediately, while the kidneys have not yet had time (48-72 hours) to initiate metabolic compensation by retaining bicarbonate.
4
Identify the physiological manifestations of the imbalance.
Expect lethargy and headache.
Excess CO2CO_2 acts as a potent cerebral vasodilator, increasing intracranial blood volume and causing neurological depression.

Anahtar Kavram

Uncompensated Acute Respiratory Acidosis
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Konular

Physiological Adaptation

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