Case StudiesH+ and pH ImbalancesABG

AnalysisCompensation

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H+ and pH – 10 Points

QUESTION:

•Zero is commonly referred to what on the pH scale

ANSWER:

•Acidic

H+ and pH – 20 Points

QUESTION:

•The pH is considered what if the H+ is high

ANSWER:

•Low (acidic)

H+ and pH – 30 Points

QUESTION:

•Normal arterial blood pH range

ANSWER:

•7.35 to 7.45

H+ and pH – 40 Points

QUESTION:

•There is a systemic decrease in hydrogen ion concentration or an excess of base

ANSWER:

•Alkalemia

H+ and pH – 50 Points

QUESTION:

•An ion necessary to maintain membrane integrity and the speed of enzymatic reactions

ANSWER:

•Hydrogen ion

Imbalances – 10 Points

QUESTION:

•Occurs when there is alveolar hypoventilation ANSWER:

•Respiratory Acidosis

Imbalances – 20 Points

QUESTION:

•Occurs when there is bicarbonate loss (less than 24 mEq/L) either from the extracellular fluid or cannot be regenerated by the kidneys

ANSWER:

•Metabolic Acidosis

Imbalances – 30 Points

QUESTION:•Occurs when there is alveolar hyperventilation (excessive blow-off of CO2) and decreased plasma carbon dioxide (hypocapnia)

ANSWER:

•Respiratory Alkalosis

Imbalances– 40 Points

QUESTION:

•Occurs when bicarbonate is increased (exceeds 26 mEq/L), usually caused by excessive loss of metabolic acids ANSWER:

•Metabolic Alkalosis

Imbalances– 50 Points

QUESTION:

•Carbon dioxide is retained (hypercapnia), increasing [H+] and producing acidosis

ANSWER:

•Respiratory Acidosis

ABG Analysis – 10 Points

QUESTION:

•Arterial blood gas result:

•pH: 7.38•PaCO2: 39•HCO3: 22

ANSWER:

•Normal ABG

ABG Analysis – 20 Points

QUESTION:

Arterial blood gas report:pH: 7.58PaCO2: 36HCO3: 31

ANSWER:

•Metabolic Alkalosis

ABG Analysis – 30 Points

QUESTION:

Arterial blood gas report:pH: 7.31PaCO2: 41HCO3: 16

ANSWER:

Metabolic Acidosis

ABG Analysis – 40 Points

QUESTION:

Jane Joe is a 45-year-old female admitted to the ED with a severe asthma attack. She has been experiencing increasing shortness of breath since admission three hours ago. Her arterial blood gas is as follows:pH: 7.22PaCO2: 55HCO3: 25

ANSWER:Respiratory Acidosis

ABG Analysis – 50 Points

QUESTION:

Mr. Worried is a 52-year-old widow. He is retired and living alone. He enters the ED complaining of shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies diabetes; blood sugar is normal. There are no EKG changes. He has no significant respiratory or cardiac history. He takes several antianxiety medications. He says he has had anxiety attacks before. While being worked up for chest pain an ABG is done: ABG results are:

pH= 7.48 PaCO2= 28 HCO3= 22

ANSWER:

•Respiratory Alkalosis

Compensation – 10 Points

QUESTION:

pH is within the normal range

ANSWER:

Fully compensated

Compensation – 20 Points

QUESTION:

The body is slowly trying to compensate and fix the imbalance of the pHANSWER:

Partially compensated

Compensation – 30 Points

QUESTION:

The body has not done anything to fix the problem or the imbalance and pH is below 7.35 or higher than 7.45

ANSWER:

Uncompensated

Compensation – 40 Points

QUESTION:

Jane Jones is a 54-year-old admitted to the ED for an ileus. She has been experiencing nausea and vomiting. An NG tube has been in place for the last 24 hours. Here are the last ABG results:

pH: 7.43PaCO2: 48HCO3: 36ANSWER:Fully Compensated Metabolic Alkalosis

Compensation – 50 Points

QUESTION:Mrs. Puffer is a 35-year-old single mother, just getting off the night shift. She reports to the ED in the early morning with shortness of breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks. Her temperature is 102.2, blood pressure 110/76, heart rate 108, respirations 32, rapid and shallow. Breath sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.ABG results are:

pH= 7.44 PaCO2= 28 HCO3= 24

ANSWER:Fully Compensated Respiratory Alkalosis

Case Studies – 10 Points

QUESTION:

The results from the ABGs come back from the laboratory and show:

pH = 7.37 Pa C02 = 29 mmHg HC03 = 17 mEq/L

ANSWER: Fully Compensated Metabolic Acidosis

Case Studies – 20 Points

QUESTION:Arterial blood gas values are as follows:

pH: 7.24PaCO2: 32 mmHgHCO3: 14 mEq/L

ANSWER:

Partially Compensated Metabolic Acidosis

Case Studies – 30 Points

QUESTION:

A client, 5 days post-abdominal surgery, has a nasogastric tube. The nurse notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2hours) of coffee ground secretions. The physcian orders STAT ABGs. The ABG results show:

pH = 7.52 Pa C02 = 35 mmHg HC03 = 29 mEq/L

ANSWER:Uncompensated Metabolic Alkalosis

Case Studies – 40 Points

QUESTION:

A client is admitted to the hospital and is being prepared for a craniotomy (brain surgery). The client is very anxious and scared of the impending surgery. He begins to hyperventilate and becomes very dizzy. The client looses consciousness and the STAT ABGs reveal: pH = 7.57 Pa C02 = 26 mmHg HC03 = 24 mEq/L

ANSWER:Uncompensated Respiratory Alkalosis

Case Studies – 50 Points

QUESTION:A two-year-old is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The father of the infant reports to the nurse that he has observed slight tremors and behavioral changes in his child over the past three days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are:

pH = 7.36 Pa C02 = 69 mmHg HC03 = 36 mEq/L

ANSWER:Fully Compensated Respiratory Acidosis