A client had arterial blood gases drawn. The results are a pH of 7.34, a partial pressure of carbon dioxide of 37 mm Hg, a partial pressure of oxygen of 89 mm Hg and a bicarbonate level of 19 mEq/L. the nurse interprets that the client is experiencing?

Appeared in: DHS 2018 shift 1st

Explanation

The diagnosis is Metabolic Acidosis because the client's pH is low (7.34), indicating an acidotic state.
The cause is identified as metabolic because the bicarbonate (HCO₃⁻) level is also low (19 mEq/L), which is the primary metabolic indicator.
The ROME (Respiratory Opposite, Metabolic Equal) mnemonic can be applied: in metabolic acidosis, the pH and HCO₃⁻ levels move in the same direction (both are low or 'equal' in direction).
The partial pressure of carbon dioxide (PaCO₂) is normal (37 mm Hg), indicating that the respiratory system has not yet compensated for the metabolic imbalance.

Option B: Metabolic alkalosis is incorrect because it is characterized by a high pH (above 7.45) and a high bicarbonate (HCO₃⁻) level (above 26 mEq/L). The client's values are the opposite.
Option C: Respiratory acidosis is incorrect. While it presents with a low pH, the primary cause is an elevated PaCO₂ (above 45 mm Hg) due to hypoventilation. The client's PaCO₂ is normal.
Option D: Respiratory alkalosis is incorrect because it involves a high pH (above 7.45) and a low PaCO₂ (below 35 mm Hg) from hyperventilation. The client's pH is low.

Clinical Relevance

Nursing practice connection: Knowing Arterial Blood Gas (ABG) Interpretation helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Prompt and accurate ABG interpretation is a critical nursing skill for managing acutely ill patients, as it guides immediate treatment decisions.
Metabolic acidosis can be caused by various conditions, including diabetic ketoacidosis (DKA), lactic acidosis, renal failure, and severe diarrhea. Identifying the underlying cause is crucial for effective treatment.
Nursing interventions for metabolic acidosis include monitoring vital signs and level of consciousness, administering IV fluids and bicarbonate as ordered, treating the underlying cause, and closely monitoring subsequent ABG results.

How to Approach the Question

First, analyze the pH to determine if the blood is acidotic (less than 7.35), alkalotic (greater than 7.45), or normal.
Next, examine the PaCO₂ (the respiratory parameter). If it moves in the opposite direction of the pH (e.g., pH is low, PaCO₂ is high), the cause is respiratory.
Then, examine the HCO₃⁻ (the metabolic parameter). If it moves in the same direction as the pH (e.g., pH is low, HCO₃⁻ is low), the cause is metabolic.
In this case, the pH is low (7.34) and the HCO₃⁻ is low (19), indicating a metabolic cause. The PaCO₂ is normal, confirming the primary problem is metabolic acidosis without respiratory compensation.
Finally, evaluate the options based on this analysis to select the correct diagnosis.

Concept Tested & Keywords

Concept Tested: Arterial Blood Gas (ABG) Interpretation
Stem keywords: arterial blood gases, pH, partial pressure of carbon dioxide, bicarbonate
Lead-in keywords: interprets
Clinical cues: pH of 7.34 (low)
Clinical cues: PaCO2 of 37 mm Hg (normal)

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 56-58

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.