A patient's ABG shows: pH 7.32. PaCO2 50 mmHg. HCO3 24 mEq/L. What is the correct diagnosis?
Metabolic acidosis
Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
The Correct Answer is B
A. Metabolic acidosis would be indicated by a low pH and a low HCO3, which is not present in this case since HCO3 is normal.
B. The pH of 7.32 indicates acidemia, and a PaCO2 of 50 mmHg suggests respiratory acidosis as the body is retaining carbon dioxide, contributing to the low pH. The HCO3 is normal, indicating that there is no metabolic compensation occurring.
C. Respiratory alkalosis would show a high pH and low PaCO2, which is not the case here.
D. Metabolic alkalosis would present with a high pH and elevated HCO3, which is also not present in these ABG results.
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Correct Answer is D
Explanation
A. Encouraging oral intake may not be effective due to the patient's likely need for more rapid rehydration given his low blood pressure and heart rate.
B. A potassium-sparing diuretic is inappropriate in this situation, as the patient is already experiencing fluid loss and requires rehydration, not diuresis.
C. Restricting fluid intake would be contraindicated as the patient is in a state of dehydration and hypotension.
D. Administering an IV bolus of normal saline is the priority intervention to quickly restore fluid volume and improve blood pressure and hydration status.
Correct Answer is C
Explanation
A. Mottled skin is more indicative of the progressive or refractory stages of shock, where perfusion to the skin is severely compromised.
B. A heart rate of 160/min indicates tachycardia, which is common in shock but is not the most characteristic finding of the compensatory stage.
C. During the compensatory stage of shock, the body attempts to maintain blood pressure and perfusion, and a blood pressure of 115/68 mmHg suggests that compensatory mechanisms are still functioning adequately.
D. Hypokalemia is not a typical finding in the compensatory stage; rather, the body may exhibit signs of hyperkalemia due to tissue breakdown and acidosis.