Nursing Care Plan | NCP Metabolic Alkalosis

1. Monitor BP.
Rationale: Arteriolar dilation or decreased cardiac contractility (such as occurs with sepsis), and hypovolemia occur, resulting in systemic shock, evidenced by hypotension and tissue hypoxia.

2. Assess level of consciousness (LOC) and note progressive changes in neuromuscular status—strength, tone, and movement.
Rationale: Decreased mental function, confusion, seizures, weakness, and flaccid paralysis can occur because of hypoxia, hyperkalemia, and decreased pH of cerebrospinal and interstitial fluids (Felver, 2005).

3. Provide seizure and coma precautions—bed in low position, use of padded side rails, and frequent observation.
Rationale: Protects client from injury resulting from decreased mentation and convulsions.

4. Monitor heart rate and rhythm.
Rationale: Acidemia may be manifested by changes in ECG configuration and presence of bradydysrhythmias as well as increased ventricular irritability such as fibrillation—signs of hyperkalemia. Life-threatening cardiovascular collapse may also occur because of vasodilation and decreased cardiac contractility. Note: Hypokalemia can occur as acidosis is corrected, resulting in premature ventricular contractions (PVCs) or ventricular tachycardia.

5. Observe for altered respiratory excursion, rate, and depth.
Rationale: Hyperventilation, or Kussmaul’s respiration, may be noted as a compensatory mechanism to eliminate excess acid; however, as potassium shifts out of cells in an attempt to correct acidosis, respiration may become depressed. Transient respiratory depression may be the result of overcorrection of metabolic acidosis with sodium bicarbonate.

6. Assess skin temperature, color, and capillary refill.
Rationale: Evaluates circulatory status, tissue perfusion, and effects of hypotension.

7. Auscultate bowel sounds; measure abdominal girth, as indicated.
Rationale: In the presence of coexisting hyperkalemia, GI distress, including abdominal distention, diarrhea, and colicky pain, may be present.

8. Monitor intake and output (I&O) closely and weigh regularly.
Rationale: Marked dehydration may be present because of GI losses. Therapy needs are based on underlying cause and fluid balance.

9. Monitor urine pH.
Rationale: Kidneys attempt to compensate for acidosis by excreting excess hydrogen in the form of weak acids and ammonia. Maximum urine acidity is pH of 4.

10. Provide oral hygiene with sodium bicarbonate washes and lemon and glycerin swabs.
Rationale: Neutralizes mouth acids and provides protective lubrication.