Medical Surgical ABGs & Acid Base Imbalances #4

Question

A nurse is caring for a postoperative hemicolectomy client undergoing continuous suction for postoperative ileus. Which information from the client’s medical history should the nurse question?

Answers

  1. The client is taking lisinopril/hydrochlorothiazide for hypertension.
    • Rationale:

      This answer is correct because hydrochlorothiazide is a diuretic, which depletes potassium. The client is undergoing continuous suction which puts the client at risk for metabolic alkalosis. With metabolic alkalosis, potassium is shifted into the cells causing hypokalemia. These two factors put the client at higher risk for metabolic alkalosis.

  2. The client has a past medical history of exacerbation of COPD.
    • Rationale:

      This answer is not correct because it is not relevant to how the client is being treated at this time. COPD is associated with respiratory acidosis due to hypoventilation and hypercapnia.

  3. The client is a diabetic on sliding scale insulin.
    • Rationale:

      This answer is not correct since it is not pertinent to the client’s treatment. A client with diabetes is only at risk for an acid-base disorder if they are noncompliant with treatment therapy and go into ketoacidosis or renal failure.

  4. The client is a diabetic on hemodialysis therapy.
    • Rationale:

      This answer is not correct because the client on dialysis would be at risk for metabolic acidosis. Maintenance dialysis cannot always completely correct a base deficit.

Overview

A client undergoing continuous suction will be at risk for metabolic alkalosis. If the client is taking a diuretic, this will further increase the client’s risk.

Explanation

Learning Outcomes

Metabolic alkalosis is an acid-base disorder which occurs from the body becoming overly alkaline. Diuretic use, gastrointestinal suctioning, vomiting or overuse of antacids cause the body to have an excess of alkaline. In addition, anything that causes hypokalemia (such as a diuretic), will place the client at risk for metabolic alkalosis. The shifting of potassium into cells, causes hypokalemia. COPD is associated with respiratory acidosis due to hypoventilation and hypercapnia. Clients with diabetes are at risk for an acid-base disorder, if they are noncompliant with treatment therapy and go into ketoacidosis or have renal insufficiency. Dialysis also can cause an acid-base imbalance.

Test Taking Tip

Understand potassium’s role with acid-base balance.

Video Rationale