Question

A client has the following arterial blood gases: pH 7.30, HCO3 - 17, PCO2 25 mm Hg, PO2 98 mm Hg. Which intervention by the nurse is most appropriate?

a) Administer sodium bicarbonate.
b) Administer oxygen therapy.
c) Encourage the client to breathe into a paper bag.
d) Initiate mechanical ventilation.

Answer 1

The client has metabolic acidosis with respiratory compensation, indicated by low pH and bicarbonate levels, with decreased PCO2. The most appropriate intervention is to administer sodium bicarbonate to correct acidosis since oxygen levels are normal and there's no indication for mechanical ventilation or rebreathing into a paper bag.

Step-by-step explanation:

The client's arterial blood gases indicate a pH of 7.30, which is below the normal range, pointing towards acidosis. The bicarbonate level (HCO3 -) is at 17 mM, which is lower than the normal range, suggesting that the condition is metabolic acidosis. Moreover, the PCO2 at 25 mm Hg is below the normal reference values for both males and females, indicating a compensatory respiratory response to the metabolic acidosis by hyperventilating to excrete CO2 and bring up the pH. Oxygen saturation (PO2) is normal at 98 mm Hg, indicating sufficient oxygenation.

The most appropriate intervention from the list given for this metabolic acidosis with respiratory compensation would be to administer sodium bicarbonate (a). This would help to increase the bicarbonate levels in the blood, correcting the acidosis. Oxygen therapy (b) is not indicated here as the PO2 levels are normal. Breathing into a paper bag (c) is a treatment for hyperventilation associated with respiratory alkalosis, which isn't the case here. Lastly, since the client is already compensating for the metabolic acidosis with a lowered PCO2, initiating mechanical ventilation (d) is not the primary intervention needed at this time.