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Zorluk: OrtaPhysiological Adaptation

A nurse is assessing a client who has had a nasogastric (NG) tube connected to continuous low wall suction for the past 48 hours due to a small bowel obstruction. Which of the following clinical and laboratory findings indicate that the client is experiencing a primary acid-base imbalance associated with this therapy? Select all that apply.

  1. Arterial blood pH of 7.52Cevap
  2. Decreased respiratory rate of 10 breaths per minuteCevap
  3. C
    Serum bicarbonate of 18 mEq/L
  4. D
    Arterial partial pressure of carbon dioxide of 32 mm Hg

Cevap

The correct findings are an arterial blood pH of 7.52 and a decreased respiratory rate of 10 breaths per minute.
Continuous nasogastric suctioning depletes the stomach of hydrochloric acid, leading to a state of metabolic alkalosis. This is evidenced by an elevated arterial blood pH (greater than 7.45). To compensate for this alkalotic state, the respiratory system slows down (hypoventilation) to retain carbon dioxide, which forms carbonic acid in the blood and helps bring the pH back toward a normal range. Therefore, both the elevated pH and the decreased respiratory rate are expected findings.

Adım Adım Çözüm

1
Identify the primary physiological consequence of continuous nasogastric suctioning.
The client is losing significant amounts of gastric acid (hydrochloric acid).
Gastric secretions are highly acidic; excessive removal leads to a deficit of acid and a relative excess of base in the extracellular fluid.
2
Determine the specific acid-base imbalance caused by this loss.
The loss of stomach acid results in metabolic alkalosis.
Metabolic alkalosis is defined by a primary increase in bicarbonate or a loss of hydrogen ions, presenting with a pH greater than 7.45.
3
Identify the expected physiological compensation for this state.
The lungs will attempt to compensate by hypoventilating.
Decreasing the respiratory rate retains carbon dioxide, which acts as an acid in the blood, attempting to neutralize the alkalosis and lower the pH.
4
Evaluate the options against these findings.
An elevated pH and a decreased respiratory rate match the expected primary imbalance and compensatory response.
Options presenting acidosis (low bicarbonate) or hyperventilation (low carbon dioxide) represent misinterpretations of the imbalance and its compensation.

Anahtar Kavram

Continuous removal of gastric acid via nasogastric suctioning leads to metabolic alkalosis, characterized by an elevated pH, elevated bicarbonate, and a compensatory decrease in respiratory rate to retain carbon dioxide.
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Physiological Adaptation

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