The nurse is caring for a client who has postoperative vomiting. Arterial blood gas results are: pH 7.47, pCO2 40, HCO3 33, pO2 84. Which of the following interventions should the nurse include in the plan of care to restore acid?base balance?

Question

1. Administer an antiemetic agent
2. Administer naloxone to antagonize narcotic analgesic
3. Encourage the patient to use an incentive spirometer
4. Administer oxygen at 2 liters by nasal cannula

Answer 1

Administer an antiemetic agent

Rationale: The first step is to interpret the pH, which reflects alkalosis because it is greater than 7.45. The next rule is to interpret the pCO2 which is normal and therefore not a cause of acid?base imbalance. The metabolic component, HCO3, is alkaline—greater than 26 meQ/L. Vomiting results in metabolic alkalosis, the disturbance reflected in the blood gas in the scenario; therefore an antiemetic agent will help resolve the problem. Administering naloxone will antagonize narcotic analgesics, which cause respiratory acidosis. Incentive spirometry would improve ventilation; the client has a normal pCO2. There is no indication the client has hypoxemia requiring supplemental oxygen.