Vital Signs
Blood pressure 113/72 mmHg Heart rate 77 bpm .
Respiratory rate 17 breaths/min
Heart rate 77 bpm
I and O
1100
1200
Oral Intake
0 ml
80 ml
Intravenous intake
1000 ml
100 ml
urine output
0 ml
400 ml
Emesis
18 ml
22 ml
Review H and P, nurse’s notes, laboratory results, flow sheet, and orders.
Click to mark whether the assessment finding represents a therapeutic result of the sodium bicarbonate administered, a non-therapeutic side-effect, or an unrelated finding.
A.
Heart rate 77 bpm
B.
400 mL Urine Output
C.
Bicarbonate 22 mEq/L (22 mmol/L)
D.
Blood pressure 113/72 mmHg
E.
pH 7.35
F.
Sodium 152 mEq/L (152 mmol/L)
G.
Capillary refill 2 seconds
The Correct Answer and Explanation is:
Let’s analyze each assessment finding in the context of sodium bicarbonate administration. Sodium bicarbonate is often used to treat conditions associated with metabolic acidosis or severe acid-base imbalances. The therapeutic effects and side effects of sodium bicarbonate administration include:
A. Heart Rate 77 bpm
Assessment: This finding is likely unrelated to sodium bicarbonate administration. Sodium bicarbonate does not typically affect heart rate directly. The normal heart rate of 77 bpm suggests that the patient’s cardiovascular system is stable and not influenced by sodium bicarbonate.
B. 400 mL Urine Output
Assessment: This finding could be related to sodium bicarbonate therapy. Sodium bicarbonate can cause a diuretic effect in some patients, leading to increased urine output. Increased urine output can be a therapeutic result as the body may excrete excess bicarbonate through urine.
C. Bicarbonate 22 mEq/L (22 mmol/L)
Assessment: This finding represents a therapeutic result. Sodium bicarbonate is administered to correct low bicarbonate levels in cases of metabolic acidosis. A bicarbonate level of 22 mEq/L is within the normal range (22-28 mEq/L), indicating that the treatment may have successfully corrected the initial imbalance.
D. Blood Pressure 113/72 mmHg
Assessment: This finding is likely unrelated to sodium bicarbonate administration. Sodium bicarbonate is not typically associated with significant changes in blood pressure. The blood pressure reading of 113/72 mmHg is within the normal range and does not suggest a direct effect of sodium bicarbonate.
E. pH 7.35
Assessment: This finding indicates a non-therapeutic effect or inadequate response. Normal blood pH ranges from 7.35 to 7.45. A pH of 7.35 is on the lower end of normal, suggesting persistent acidosis, which means the sodium bicarbonate therapy might not have been fully effective or the patient’s condition is not adequately corrected.
F. Sodium 152 mEq/L (152 mmol/L)
Assessment: This finding represents a non-therapeutic side effect. Sodium bicarbonate can lead to hypernatremia (increased sodium levels) as a side effect, particularly with high or prolonged doses. A sodium level of 152 mEq/L is elevated, indicating a potential side effect of the therapy.
G. Capillary Refill 2 seconds
Assessment: This finding is likely unrelated to sodium bicarbonate administration. A capillary refill time of 2 seconds is within the normal range and reflects adequate peripheral perfusion, which is not typically influenced by sodium bicarbonate.
Summary
- Heart Rate 77 bpm – Unrelated
- 400 mL Urine Output – Possible therapeutic result
- Bicarbonate 22 mEq/L – Therapeutic result
- Blood Pressure 113/72 mmHg – Unrelated
- pH 7.35 – Non-therapeutic (possible ineffective treatment)
- Sodium 152 mEq/L – Non-therapeutic side effect
- Capillary Refill 2 seconds – Unrelated
Each finding should be evaluated in the context of the patient’s overall clinical status and the goals of sodium bicarbonate therapy.