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Zorluk: OrtaPhysiological Adaptation

A nurse is evaluating a client who is being managed for septic shock. The client presents with cool, pale extremities, a respiratory rate of 28 breaths/minute, and a serum lactate level of 6.2 mmol/L. Based on this clinical presentation, which arterial blood gas (ABG) result should the nurse anticipate?

  1. pH 7.28, PaCO2PaCO_2 30 mm Hg, HCO3−HCO_3^- 14 mEq/LCevap
  2. B
    pH 7.50, PaCO2PaCO_2 28 mm Hg, HCO3−HCO_3^- 22 mEq/L
  3. C
    pH 7.31, PaCO2PaCO_2 56 mm Hg, HCO3−HCO_3^- 25 mEq/L
  4. D
    pH 7.49, PaCO2PaCO_2 42 mm Hg, HCO3−HCO_3^- 32 mEq/L

Cevap

The anticipated arterial blood gas result is pH 7.28, PaCO2PaCO_2 30 mm Hg, and HCO3−HCO_3^- 14 mEq/L, representing metabolic acidosis with partial respiratory compensation.
The correct ABG result demonstrates a low pH and low bicarbonate, indicative of metabolic acidosis, along with a low PaCO2PaCO_2, reflecting partial respiratory compensation. This aligns exactly with a client in septic shock who is producing excess lactic acid (indicated by the high lactate level) and hyperventilating (28 breaths/minute) to compensate.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client has signs of poor tissue perfusion (cool, pale extremities) and an elevated serum lactate of 6.2 mmol/L.
Elevated lactate in the setting of shock indicates anaerobic metabolism and the development of lactic acidosis, a form of metabolic acidosis.
2
Determine the primary acid-base imbalance.
Metabolic acidosis, characterized by a low pH (< 7.35) and a low HCO3−HCO_3^- (< 22 mEq/L).
The accumulation of lactic acid consumes bicarbonate, leading to a direct drop in blood pH.
3
Evaluate the respiratory compensatory mechanism.
The client is tachypneic (28 breaths/minute), which blows off carbon dioxide, leading to a low PaCO2PaCO_2 (< 35 mm Hg).
The respiratory system attempts to compensate for metabolic acidosis by increasing the rate and depth of breathing to eliminate CO2CO_2, an acidic gas.

Anahtar Kavram

Acid-Base Imbalances in Shock States
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Konular

Physiological Adaptation

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