A nurse is caring for a patient receiving IV therapy in the left forearm and notices that the site is red, swollen, and warm.
What action should the nurse take first?

Choice A rationale:

Metabolic alkalosis is characterized by a high pH (above 7.45), high bicarbonate (HCO3-) levels, and normal or low PaCO2. The patient's ABGs show a low pH (7.26), low bicarbonate (14 mEq/L), and low PaCO2 (30 mm Hg), which are not consistent with metabolic alkalosis.

Choice C rationale:

Respiratory alkalosis is characterized by a high pH (above 7.45), low PaCO2, and normal or slightly elevated bicarbonate levels. The patient's ABGs do show a low PaCO2, but the pH is low (acidic) and the bicarbonate is low, which are not consistent with respiratory alkalosis.

Choice D rationale:

Respiratory acidosis is characterized by a low pH (below 7.35), high PaCO2, and normal or slightly elevated bicarbonate levels. The patient's ABGs do show a low pH, but the PaCO2 is also low, which is not consistent with respiratory acidosis.

Rationale for the correct answer, B:

Metabolic acidosis is characterized by a low pH (below 7.35), low bicarbonate levels, and normal or low PaCO2. The patient's ABGs are consistent with metabolic acidosis because they show a low pH (7.26), low bicarbonate (14 mEq/L), and low PaCO2 (30 mm Hg).

Acute kidney injury is a common cause of metabolic acidosis. The kidneys play a vital role in regulating acid-base balance by excreting acids and reabsorbing bicarbonate. When the kidneys are damaged, they are unable to excrete acids effectively, leading to an accumulation of acids in the blood and a decrease in bicarbonate levels.

Additional Information:

It's important to note that the patient's low PaCO2 is likely a compensatory mechanism for the metabolic acidosis. In response to acidosis, the respiratory system tries to increase ventilation to blow off more carbon dioxide, which helps to raise the pH. However, this compensatory mechanism is often not enough to fully correct the acidosis.

Choice A rationale:

Malnutrition is a risk factor for HAIs, but it is not a common cause. Malnutrition weakens the immune system, making it less able to fight off infection. However, malnutrition is not directly responsible for the introduction of pathogens into the body, which is a necessary step for the development of an HAI.

Choice C rationale:

Multiple caregivers can contribute to the spread of pathogens, but it is not a common cause of HAIs. When multiple caregivers are involved in a patient's care, there is a greater chance that one of them may be carrying a pathogen and transmit it to the patient. However, this is not the most common way that HAIs are spread.

Choice D rationale:

Chlorhexidine washes are actually used to prevent HAIs, not cause them. Chlorhexidine is an antiseptic that kills bacteria and other pathogens. It is often used to clean the skin before surgery or other invasive procedures.

Choice B rationale:

Urinary catheterization is a common cause of HAIs. A urinary catheter is a tube that is inserted into the bladder to drain urine. Catheters can introduce bacteria into the bladder, which can lead to urinary tract infections (UTIs). UTIs are the most common type of HAI.

Here are some of the reasons why urinary catheterization is a common cause of HAIs:

Catheters can introduce bacteria into the bladder. The catheter itself can act as a conduit for bacteria to enter the bladder. Bacteria can also enter the bladder around the catheter, where the catheter enters the urethra.

Catheters can irritate the bladder. This can make the bladder more susceptible to infection. Catheters can obstruct the flow of urine. This can allow bacteria to grow in the bladder.

Catheters can be difficult to keep clean. This can increase the risk of bacteria growing on the catheter and being introduced into the bladder.