VCE Quiz Acid Base Inbalance w7

Acid-Base Imbalance w7
Exercise 2 - Virtual Hospital Activity
 Sign in to work at Pacific View Regional Hospital for Period of Care 1. (Note: If you are
already in the virtual hospital from a previous exercise, click on Leave the Floor and
then on Restart the Program to get to the sign-in window.)
 From the Patient List, select Jacquline Catanazaro (Room 402).
 Click on Go to Nurses’ Station.
 Click on Chart and then on 402.
 Click on History and Physical.
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Exercise 2 - Question 1
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Is there anything in Jacquline Catanazaro’s history that would put her at risk for an acid-base
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imbalance?
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Your Answer:
Her asthma
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History of asthma; has not been taking the medication as prescribed

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Question 2
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 Click on Return to Nurses’ Station.

 Click on 402 at the bottom of your screen.
 Click on Patient Care and then on Nurse-Client Interactions.
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 Select and view the video titled 0730: Intervention—Airway. (Note: Check the virtual
clock to see whether enough time has elapsed. You can use the fast-forward feature to
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advance the time by 2-minute intervals if the video is not yet available. Then click again
on Patient Care and Nurse-Client Interactions to refresh the screen.)
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Based on Jacquline Catanazaro’s history, what would the nurse expect to be causing her
respiratory distress?
Your Answer:
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Shortness of breath
Asthma exacerbation
Question 3
Why is the nurse waiting until after the arterial blood gases (ABGs) are drawn to give the patient
a nebulizer treatment?
Your Answer:
to know blood gas levels
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To get a true picture of Jacquline Catanazaro’s acid-base balance while the patient is exhibiting
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respiratory distress
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Question 4 rs e
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 Click on Laboratory Reports.

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Document the results of Jacquline Catanazaro’s ABG on Monday at 1030.

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 pH
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 PaO2
 PaCO2
 O2 sat
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 Bicarb
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Your Answer:
ph 7.33
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PaO2 80
PaCO2 48
O2 sat 85
Bicarb 23
pH: 7.33
PaO2: 80
PaCO2: 48
O2 sat: 85%
Bicarb: 23
Question 5
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Document the results of Jacquline Catanazaro’s ABG on Wednesday at 0730.
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pH

 PaO2 rs e
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 PaCO2
 O2 sat
 Bicarb
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Your Answer:
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pH 7.35
PaO2 80
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PaCO2 50
O2sat 85
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Bicarb 24
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pH: 7.35
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PaO2: 80
PaCO2: 50
O2 sat: 85%
Bicarb: 24
Question 6
How would you interpret the results documented in questions 4 and 5? Is the acid-base
imbalance compensated or uncompensated (fully or partially)? Explain your answer.
Your Answer:
Metabolic acidosis fully compensate
Monday: Partially compensated respiratory acidosis. The pH is lower than normal (7.35-7.45),
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denoting acidosis. The PaCO2 is slightly above normal (35-45), also denoting acidosis. The
bicarb is within normal limits (21-28); it takes 24-48 hours for the renal system to begin to
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compensate for acidosis.
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Wednesday: Fully compensated respiratory acidosis. The pH is at the lower limit of normal, but
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the PaCO2 is increased with the bicarb remaining within normal limits. It is fully compensated
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because the pH is within normal limits.
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Question 7
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Based on the acute aspect of Jacquline Catanazaro’s respiratory difficulties, what lines of defense
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would you expect to be working to compensate for her respiratory acidosis?

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Your Answer:
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Bronchodilator medicines and corticosteroids to reverse some types of airway obstruction.

Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or a breathing
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machine, if needed. Oxygen if the blood oxygen level is low.
Because this is an acute respiratory problem, the chemical/protein buffer system (first line of
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defense) should be responding to bind to the extra hydrogen ions and increase the serum pH. The
third line of defense, the renal system, will take 24-48 hours to respond to and begin
compensation for the acidosis.
Question 8
If the patient’s electrolyte results were available, what might you expect her potassium levels to
be? Provide a rationale for your answer.
The potassium may be elevated. In acidosis, the extracellular hydrogen ion content increases, and
the hydrogen ions move into the intracellular fluid. To keep the intracellular fluid electrically
neutral, an equal number of potassium ions leave the cell, creating a relative hyperkalemia. If the
acidosis is chronic, the kidneys have time to compensate for the excess hydrogen and
hyperkalemia does not occur.
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Question 9
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Based on Jacquline Catanazaro’s medical diagnosis, what is the underlying pathophysiologic
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problem leading to the respiratory acidosis?
Your Answer:
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Common causes include impaired respiratory drive, and airflow obstruction due to asthma,
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COPD .
Airway obstruction—the asthma is causing bronchoconstriction and therefore decreased air

movement in and out of the lungs. This decreases gas exchange and causes CO2 retention as well
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as hypoxia.
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Question 10
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 Click on Return to Room 402.

 Click on Patient Care and then Physical Assessment.
 Complete a physical assessment for Jacquline Catanazaro by clicking on the body system
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categories (yellow buttons) and subcategories (green buttons).
Record the findings of your physical assessment below.
 Mental status
 Musculoskeletal
 Cardiovascular
 Respiratory
 Integumentary
Your Answer:
Respiratory rate between 36-40. Pulse oximeter reading 82%-86% oxygenation. Use of
accessory muscles is visible, has sternal retractions. Patient unable to lay flat. Percussion:
Hyperresonant in all lobes. Auscultation: Bilateral inspiratory and expiratory wheezes present,
prolonged expiratory phase. Crackles present in right lower lobe.
Mental status: Alert and oriented x 3. Perceptual ability slightly impaired. Agitated and anxious.
Musculoskeletal: Full range of movement. Moves all extremities equally. Reflexes intact.
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Cardiovascular: Apical pulse regular. No JVD. S1 and S2 normal.
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Respiratory: Labored and shallow respiratory effort. Tachypneic. Crackles in right lower lobes,
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wheezes throughout. Productive cough with white frothy sputum. Substernal retractions and use
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Integumentary: Skin warm and moist with flushed color.
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Question 11
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Are there any clinical manifestations of respiratory acidosis? If so, please describe. If not, how
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do you explain?
Your Answer:
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 sleepiness or fatigue.
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 lethargy.
 delirium or confusion.
 shortness of breath.
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 coma.
None of the identified key features of acidosis are identified in this patient. The patient is no
longer acidotic at the time of this assessment.
Question 12
 Click on Take Vital Signs.
What is the patient’s respiratory rate? How does this correlate with her respiratory acidosis?
Your Answer:
Respiratory rate between 36-40. Yes
The exact rate will vary depending on the actual time assessed, but the respiratory rate is
elevated in attempt to blow off excess CO2 and normalize pH.
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Question 13
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If Jacquline Catanazaro’s pH were 7.2, how might her physical assessment differ? Document the
expected clinical manifestations of respiratory acidosis below.
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 Neurologic
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 Musculoskeletal
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 Cardiovascular
 Respiratory
 Integumentary
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Your Answer:
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BP 140/80 in both arms, no pulses paradoxes. P 132-136 regular, strong, all peripheral pulses
palpable and symmetrical. Auscultation: No abnormal heart sounds.
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Neurologic: Lethargy, confusion, stupor, coma

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Musculoskeletal: Hyporeflexia, skeletal muscle weakness, flaccid paralysis

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Cardiovascular: Bradycardia, tall, peaked T waves; widened QRS complexes, prolonged PR

interval; heart blocks, hypotension, thready peripheral pulses
Respiratory: Variable, ineffective respirations
Integumentary: Pale to cyanotic mucous membranes
Question 14
 Click on Chart.
 Click on 402 for Jacquline Catanazaro’s chart.
 Click on Physician’s Orders.
Look at the most recent physician’s orders. What medication is ordered to treat the respiratory
acidosis? What is the medication’s underlying mechanism of action to correct the acidosis?
Your Answer:
1. Oxygen at 2L/min with continuous pulse oximetry.
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2. IV of D5W at 125 mL/hr.
3. Methylprednisolone sodium succinate 40 mg in 50 mL D5W IV every 12 hours x 1 now.
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4. Albuterol 5 mg and Ipratropium bromide 0.5 mg by nebulizer x 1 now. If wheezing
remains, repeat dose x 1.
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5. Labs STAT: ABG, CBC, Sputum culture, and U/A.
6. Chest x-ray STAT. rs e
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Albuterol 5 mg via nebulizer x 1 STAT—this is a bronchodilator, which will relieve the airway
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obstruction caused by the asthma. Dilating the bronchi will increase air movement and gas
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exchange at the alveolar level, thus increasing CO2 excretion and raising the patient’s pH to
normal.
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Question 15
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 Click on Return to Room 402.

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 Click on Leave the Floor.

 Click on Restart the Program.
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 Sign in to work at Pacific View Regional Hospital for Period of Care 2.

 From the Patient List, select Jacquline Catanazaro (Room 402).
 Click on Go to Nurses’ Station.
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 Click on Laboratory Reports. Scroll down to review the results for Wed 1000.
Look at the ABGs drawn at 1000. Interpret the ABGs. Was the treatment effective?
Your Answer:
PaO2 92
O2SATURATION 99
PaCO2 40
pH 7.40
yes
The ABGs are now normal with a pH of 7.40 and a PaCO2 of 40. The medication was effective in
increasing air movement and gas exchange. Oxygenation is also improved as demonstrated by an
increase in the PaO2 and the oxygen saturation.
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Acid-Base Imbalance w7

Exercise 2 - Virtual Hospital Activity

History of asthma; has not been taking the medication as prescribed

 Click on Return to Nurses’ Station.

to know blood gas levels

 Click on Chart and then on 402.

 Click on Laboratory Reports.

Document the results of Jacquline Catanazaro’s ABG on Monday at 1030.

Metabolic acidosis fully compensate

Not yet graded / 1 pts

would you expect to be working to compensate for her respiratory acidosis?

Bronchodilator medicines and corticosteroids to reverse some types of airway obstruction.

machine, if needed. Oxygen if the blood oxygen level is low.

Airway obstruction—the asthma is causing bronchoconstriction and therefore decreased air

Not yet graded / 1 pts

 Click on Return to Room 402.

categories (yellow buttons) and subcategories (green buttons).

Record the findings of your physical assessment below.

Not yet graded / 1 pts

 Click on Take Vital Signs.

Respiratory rate between 36-40. Yes

Neurologic: Lethargy, confusion, stupor, coma

Musculoskeletal: Hyporeflexia, skeletal muscle weakness, flaccid paralysis

Cardiovascular: Bradycardia, tall, peaked T waves; widened QRS complexes, prolonged PR

Respiratory: Variable, ineffective respirations

Integumentary: Pale to cyanotic mucous membranes

1. Oxygen at 2L/min with continuous pulse oximetry.

Not yet graded / 1 pts

 Click on Return to Room 402.

 Click on Leave the Floor.

 Sign in to work at Pacific View Regional Hospital for Period of Care 2.

 Click on Chart and then on 402.

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