A patient's ABG reports showing pH 7.30, PaCO2 50, bicarbonate level is 24, than what intervention is appropr… - AIIMS Delhi NO - 2017

AIIMS Delhi NO - 2017

Medical Surgical Nursing

Hard

Appeared in: AIIMS Delhi NO - 2017

Explanation

The patient's ABG values (pH < 7.35, PaCO₂ > 45 mmHg, and normal HCO₃⁻) are classic signs of uncompensated respiratory acidosis.
Respiratory acidosis is caused by hypoventilation, which is the failure of the lungs to eliminate enough carbon dioxide (CO₂), leading to its accumulation in the blood (hypercapnia).
The definitive treatment is to improve alveolar ventilation to help the patient 'blow off' the excess CO₂.
Assisting ventilation, whether through non-invasive methods or mechanical ventilation, directly addresses the root cause of the acid-base imbalance.

Option B: Calcium gluconate is not used to treat respiratory acidosis. Its primary indications are severe hyperkalemia (to stabilize cardiac membranes) and symptomatic hypocalcemia.
Option C: Administering oxygen treats hypoxemia (low blood oxygen) but does not correct hypercapnia (high CO₂), which is the cause of respiratory acidosis. In some patients with chronic CO₂ retention (like COPD), high-flow oxygen can suppress their respiratory drive and worsen the acidosis.
Option D: Sodium bicarbonate is an alkaline agent used to correct metabolic acidosis. Administering it in respiratory acidosis is inappropriate because it does not fix the underlying ventilation problem and can worsen the condition by increasing the body's CO₂ load.

Clinical Relevance

Nursing practice connection: Knowing ABG Interpretation and Intervention for Respiratory Acidosis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to rapidly interpret ABG results to identify and respond to life-threatening conditions like acute respiratory acidosis.
The priority nursing action for a patient with respiratory acidosis is to perform a thorough respiratory assessment (rate, depth, effort, lung sounds) and intervene to improve ventilation.
Patient safety is critical. Inappropriately administering high-flow oxygen to a patient with chronic CO₂ retention can lead to respiratory arrest.

How to Approach the Question

Step 1: Analyze the pH. A value of 7.30 is below the normal range of 7.35-7.45, which signifies acidosis.
Step 2: Analyze the PaCO₂. A value of 50 mmHg is above the normal range of 35-45 mmHg. This indicates an accumulation of acid (CO₂).
Step 3: Use the ROME mnemonic (Respiratory Opposite, Metabolic Equal). The pH is low and the PaCO₂ is high (moving in opposite directions), which points to a respiratory cause.
Step 4: Analyze the HCO₃⁻. A value of 24 mEq/L is within the normal range of 22-26 mEq/L. This means the metabolic system has not yet compensated.
Step 5: Synthesize the findings to diagnose uncompensated respiratory acidosis.
Step 6: Evaluate the interventions based on the diagnosis. Since the problem is CO₂ retention due to hypoventilation, the correct action is to improve ventilation.

Concept Tested & Keywords

QapOG_iGIyzv0dpj8tQie-

E6 Nursing Fundamentals Taylor p. 785-787

E6 Medicine Harrison 22e Part 1 p. 416-418

E6 Medicine Harrison 22e Part 2 p. 211-213