A nurse on a medical surgical unit is admitting a client from a provider's office.

Exhibits

Click to highlight the information in the Nurse's Notes and Vital Signs that should be reported to the provider.

1500:                         

• Temperature: 39 degrees Celcius (102.2 F)
• Heart rate: 122/min
• Respiratory rate: 24/min
• BP: 106/54 mmHg
• Oxygen saturation: 95% on room air

1530:

• Client lethargic, reporting abdominal cramping, experiencing projectile vomiting.
• Voiding dark, concentrated urine.
• Client requesting water

Rationale:

A. This occurs when there is hypoventilation, leading to elevated PaCO2 and decreased pH. In this case, the PaCO2 is low (32 mm Hg) and the pH is high (7.48), so this is not consistent with respiratory acidosis.

B. The high pH (7.48) indicates alkalosis, and the low PaCO2 (32 mm Hg) shows that the alkalosis is caused by excessive exhalation of CO2, characteristic of respiratory alkalosis. The HCO3 is normal, indicating the kidneys have not yet compensated.

C. Metabolic acidosis is characterized by a low pH and low HCO3. Here, the pH is elevated and HCO3 is normal, so this is not consistent with metabolic acidosis.

D. Metabolic alkalosis would present with high pH and elevated HCO3, often due to vomiting or diuretic use. In this scenario, HCO3 is normal, indicating the alkalosis is not metabolic in origin.

Rationale:
A. RBC count is not typically affected by acute pancreatitis unless there is bleeding, which is uncommon.

B. Serum amylase is elevated in acute pancreatitis because pancreatic inflammation leads to the release of digestive enzymes into the bloodstream. Amylase levels usually rise within 6–12 hours of symptom onset and remain elevated for 3–5 days.

C. Calcium levels often decrease in acute pancreatitis due to fat saponification, not increase.

D. Magnesium levels are usually normal or decreased, but elevation is not a typical finding in pancreatitis.