If the pH is normal, what should be assessed next?

When assessing a patient with a normal pH, the next logical step is to evaluate bicarbonate levels. The pH of blood is maintained within a very narrow range, primarily through the balance of carbonic acid and bicarbonate. A normal pH indicates that the acid-base balance is stable, but it is crucial to assess the bicarbonate levels to ensure that the buffering system is functioning properly and to evaluate for any potential metabolic issues.

Assessing bicarbonate levels allows healthcare providers to further understand the body's metabolic state. For example, if there are disturbances in bicarbonate, it may signal metabolic acidosis or alkalosis, even when the pH appears normal. Thus, by focusing on bicarbonate, nurses can gather more context on the patient's respiratory and metabolic status and guide further clinical decisions.

While carbon dioxide levels, electrolyte levels, and hemoglobin levels are all important in a comprehensive metabolic assessment, they do not provide as direct a relationship to the immediate acid-base balance when the pH is already considered normal.