Nursing Prioritization Delegation Assignment Q 57


A group of nursing students is assigned to care for a client with a nasogastric tube connected to a wall suction. One student asks why the client’s respiratory rate has decreased. Choose the best response.
  
     A. "Whenever a client develops a respiratory acid-base problem, decreasing the respiratory rate helps fix the problem."
     B. "The client is hypoventilating because of anxiety, and we will have to stay observant for the development of respiratory acidosis."
     C. "It's common for clients with uncomfortable equipment such as nasogastric tubes to have a lower rate of breathing."
     D. "The client may have a metabolic alkalosis due to the nasogastric suctioning, and the decreased respiratory rate is a compensatory mechanism."
    
    

Correct Answer: D. “The client may have a metabolic alkalosis due to the nasogastric suctioning, and the decreased respiratory rate is a compensatory mechanism.”
Nasogastric suctioning can result in a decrease in acid components and a metabolic alkalosis. The client’s decrease in rate and depth of ventilation is an attempt to compensate by retaining carbon dioxide. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space.
Option A: Metabolic alkalosis causes hypoventilation, which may cause hypoxemia, especially in patients with poor respiratory reserve, and it may impair weaning from mechanical ventilation.
Option B: Hypoventilation develops because of inhibition of the respiratory center in the medulla. Symptoms of hypocalcemia (eg, jitteriness, perioral tingling, muscle spasms) may be present.
Option C: This response may be right, but it does not discuss all the components of the question. As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension (PaCO2), which diminishes the change in pH that would otherwise occur.