Author Question: A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low ... (Read 70 times)

NguyenJ · **on:** Jul 22, 2018

A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days. The patient's respiratory rate has decreased to 12 breaths per minute.

The nurse would expect the patient to have which of the following arterial blood gas values? a. pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L
b. pH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L
c. pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L
d. pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L

Question 2

Which of the following patients is at greatest risk for serious complications when using the Valsalva manoeuvre to expel feces?

a. A 25-year-old pregnant patient
b. A 66-year-old male patient with hypertrophied prostate disease
c. A 44-year-old male patient with glaucoma
d. A 53-year-old female patient with stomach cancer

cadimas · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

B
Compensated metabolic alkalosis should show alkalosis pH and HCO3 (metabolic) values, with a slightly acidic CO2 (compensatory respiratory acidosis). In this case, pH 7.52 is alkaline (normal = 7.35 to 7.45), PaCO2 is acidic (normal 35 to 45 mm Hg), and HCO3 is elevated (normal = 22 to 26 mEq/L). A result of pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L is uncompensated metabolic alkalosis. pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L is within normal limits. pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L is compensated respiratory acidosis.

Answer to Question 2

C

Feedback
A Although use of the Valsalva manoeuvre may contribute to hemorrhoids in pregnancy, this is not as serious as increasing the intraocular pressure of a patient with glaucoma.
B The Valsalva manoeuvre is not contraindicated in a patient with hypertrophied prostate disease.
C Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greatest risk of serious complications (such as cardiac irregularities and elevated blood pressure) with this manoeuvre, and need to avoid straining to pass the stool.
D The Valsalva manoeuvre is not contraindicated in a patient with stomach cancer.