VCE Quiz Acid Base Inbalance w7 | Correct Answers Indicated.

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 ...

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. Exercise 2 - Question 1 Is there anything in Jacquline Catanazaro’s history that would put her at risk for an acid-base imbalance? Question 2 Not yet graded / 1 pts • 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. • 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 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.) Exercise 2 - Question 2 Based on Jacquline Catanazaro’s history, what would the nurse expect to be causing her respiratory distress? Shortness of breath Asthma exacerbation Question 3 Not yet graded / 1 pts Exercise 2 - Question 3 Why is the nurse waiting until after the arterial blood gases (ABGs) are drawn to give the patient a nebulizer treatment? Question 4 Not yet graded / 1 pts • Click on Chart and then on 402. • Click on Laboratory Reports. Exercise 2 - Question 4 Document the results of Jacquline Catanazaro’s ABG on Monday at 1030. • pH • PaO2 • PaCO2 • O2 sat • Bicarb Your Answer: Not yet graded / 1 pts Exercise 2 - Question 5 Document the results of Jacquline Catanazaro’s ABG on Wednesday at 0730. Bicarb: 24 Question 6 Not yet graded / 1 pts Exercise 2 - 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. 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 compensate for acidosis. Wednesday: Fully compensated respiratory acidosis. The pH is at the lower limit of normal, but the PaCO2 is increased with the bicarb remaining within normal limits. It is fully compensated because the pH is within normal limits. Question 7 Not yet graded / 1 pts Exercise 2 - Question 7 Based on the acute aspect of Jacquline Catanazaro’s respiratory difficulties, what lines of defense would you expect to be working to compensate for her respiratory acidosis?. Question 8 Not yet graded / 1 pts Exercise 2 - 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. Question 9 Not yet graded / 1 pts Exercise 2 - Question 9 Based on Jacquline Catanazaro’s medical diagnosis, what is the underlying pathophysiologic problem leading to the respiratory acidosis? Question 10 Not yet graded / 1 pts • 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 categories (yellow buttons) and subcategories (green buttons). Exercise 2 - Question 10 Record the findings of your physical assessment below. • Mental status • Musculoskeletal • Cardiovascular • Respiratory • Integumentary 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. Cardiovascular: Apical pulse regular. No JVD. S1 and S2 normal. Respiratory: Labored and shallow respiratory effort. Tachypneic. Crackles in right lower lobes, wheezes throughout. Productive cough with white frothy sputum. Substernal retractions and use of neck muscles. Integumentary: Skin warm and moist with flushed color. Question 11 Not yet graded / 1 pts Exercise 2 - Question 11 Are there any clinical manifestations of respiratory acidosis? If so, please describe. If not, how do you explain? Question 12 Not yet graded / 1 pts • Click on Take Vital Signs. Exercise 2 - Question 12 What is the patient’s respiratory rate? How does this correlate with her respiratory acidosis? Question 13 Not yet graded / 1 pts Exercise 2 - Question 13 If Jacquline Catanazaro’s pH were 7.2, how might her physical assessment differ? Document the expected clinical manifestations of respiratory acidosis below. • Neurologic • Musculoskeletal • Cardiovascular • Respiratory • Integumentary Neurologic: Lethargy, confusion, stupor, coma Musculoskeletal: Hyporeflexia, skeletal muscle weakness, flaccid paralysis 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 Not yet graded / 1 pts • Click on Chart. • Click on 402 for Jacquline Catanazaro’s chart. • Click on Physician’s Orders. Exercise 2 - Question 14 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? Albuterol 5 mg via nebulizer x 1 STAT—this is a bronchodilator, which will relieve the airway obstruction caused by the asthma. Dilating the bronchi will increase air movement and gas exchange at the alveolar level, thus increasing CO2 excretion and raising the patient’s pH to normal. Question 15 Not yet graded / 1 pts • Click on Return to Room 402. • Click on Leave the Floor. • Click on Restart the Program. • 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. • Click on Chart and then on 402. • Click on Laboratory Reports. Scroll down to review the results for Wed 1000. Exercise 2 - Question 15 Look at the ABGs drawn at 1000. Interpret the ABGs. Was the treatment effective?