Question

The client is admitted with chronic obstructive pulmonary disease. Blood gases reveal pH 7.36, \(\mathrm{CO}_2 45, \mathrm{O}_2 84, \mathrm{HCO3} 28\). The nurse would assess the client to be in: A. Uncompensated acidosis B. Compensated alkalosis C. Compensated respiratory acidosis D. Uncompensated metabolic acidosis

Short answer

A. Uncompensated respiratory acidosis B. Uncompensated respiratory alkalosis C. Compensated respiratory acidosis D. Compensated respiratory alkalosis Answer: C. Compensated respiratory acidosis

Step-by-step solution

Identify the normal range for each blood gas level

The normal ranges for the blood gases are: - pH: 7.35 - 7.45 - \(\mathrm{CO}_2\): 35 - 45 mmHg - \(\mathrm{O}_2\): 80 - 100 mmHg - \(\mathrm{HCO3}\): 22 - 26 mEq/L

Compare the given blood gas levels to the normal ranges

The client's given blood gas levels are: - pH: 7.36 (within normal range) - \(\mathrm{CO}_2\): 45 mmHg (at the upper limit of normal range) - \(\mathrm{O}_2\): 84 mmHg (within normal range) - \(\mathrm{HCO3}\): 28 mEq/L (above normal range)

Determine the primary imbalance

The pH is on the low side of the normal range, which suggests acidosis. The \(\mathrm{CO}_2\) level is at the upper limit of the normal range, indicating the respiratory system's contribution to the acidity. The \(\mathrm{HCO3}\) level is above the normal range, which means the kidneys are compensating by retaining more bicarbonate to combat the acidosis.

Choose the correct option based on the analysis

Given the primary imbalance (acidosis) and the compensatory mechanism by the kidneys, the correct answer is: C. Compensated respiratory acidosis

Key concepts

Blood Gas Analysis

Blood gas analysis is an essential test used to assess the effectiveness of the lungs in oxygenating the blood and removing carbon dioxide. It also evaluates how well the kidneys are maintaining the acid-base balance by regulating bicarbonate levels.
In medical practice, these tests help diagnose and monitor conditions affecting respiratory or metabolic systems.
Key blood gas components include:

• pH: Indicates the acidity or alkalinity of the blood. A normal range is 7.35 to 7.45.
• \(\mathrm{CO}_2\): Represents the partial pressure of carbon dioxide in arterial blood. It reflects respiratory function, with a normal range of 35 to 45 mmHg.
• \(\mathrm{HCO3}\): Bicarbonate levels, which are indicative of metabolic activity, normally range from 22 to 26 mEq/L.
• \(\mathrm{O}_2\): Partial pressure of oxygen reveals oxygen status and typically should be between 80 to 100 mmHg.

By analyzing these parameters, healthcare providers can deduce whether a patient is experiencing acidosis or alkalosis, which system is primarily involved, and if there is any compensatory response.

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a persistent lung condition that obstructs airflow, making it difficult to breathe.
It includes diseases such as emphysema and chronic bronchitis.
These conditions lead to long-term respiratory impairment and a decrease in air exchange efficiency. Characteristics of COPD:

• Symptoms: Chronic cough, excessive mucus production, breathlessness especially during physical activity.
• Causes: Mainly smoking, but also long-term exposure to irritating gases or particulate matter.
• Progression: Persistent and usually progressive unless adequately managed with lifestyle changes and medications.

Chronic conditions like COPD often lead to alterations in blood gas levels because of impaired breathing. Patients with COPD frequently experience respiratory acidosis, as their compromised lung function hinders adequate removal of carbon dioxide.

Acid-Base Balance

Acid-base balance refers to the homeostasis of the body's pH levels, which are vital for proper cellular function.
The body utilizes various mechanisms to maintain a balanced pH, primarily through respiratory and renal compensations.
The role of each system includes:

• Respiratory System: Modulates the levels of carbon dioxide by altering the respiratory rate. Increased breathing expels more \(\mathrm{CO}_2\), lowering acidity.
• Renal System: Manages bicarbonate levels. It can increase reabsorption of \(\mathrm{HCO3}\) during acidosis to neutralize acidity or excrete more during alkalosis.

When disruptions occur, such as in COPD, the body attempts to compensate to stabilize pH. For example, in chronic respiratory acidosis, the kidneys gradually retain more bicarbonate to balance the low pH caused by excess \(\mathrm{CO}_2\). Understanding this interplay is crucial for diagnosing conditions accurately.

Nursing Assessment

Nursing assessment plays a critical role in the management and evaluation of patients with imbalances in the respiratory system.
Nurses are often the first to review blood gas analyses and assess patients for signs of respiratory distress.
A comprehensive assessment includes:

• Review of blood gas results to evaluate pH, \(\mathrm{CO}_2\), and \(\mathrm{HCO3}\) levels.
• Observation of patient symptoms, such as changes in breathing patterns, use of accessory muscles, and cyanosis.
• Evaluation of risk factors relevant to respiratory issues, including smoking history or exposure to pollutants.

Additionally, timely nursing interventions can help manage symptoms and prevent complications. Educating patients about disease management, medication adherence, and lifestyle modifications, such as smoking cessation, are essential components of this healthcare role.