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Acid Base Balancing


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Normal Acid-base balance is
Imbalances are classified as being ____________ or ____________.
respiratory or metabolic
Respiratory imbalances affect _________ _________ concentrations.
carbonic acid
Metabolic imbalances affet the base ____________.
Normal valuses for pH
Normal valuses for pCO2
35-45 mmHg
Normal valuses for HCO3
Normal valuses for pO2
80-100 mmHg
Normal valuses for O2 saturation is
common cause of Respiratory acidosis
*abnormalities in pulmonary ventilation leading to CO2 retention.
*Halted or hindered gas exchange
*Obsructions preventing exhalation of CO2
*Impaired neuromuscular function or integerity of chest wall
*Depressed Respiratory center in medullat
Etiology of Respiratory acidosis
ARDS, Pneumonia, Atelectasis, COPD, emphysema, asthma, bronchial burns, chest trauma, Guillain-Barre, MS, Mysathenia gravi, Drug overdoses, anesthesia, acute alcoholism.
Compensatory mechanisms that take place within 24 hours of Respiratory Acidosis
Kidneys conserve HCO3 and excrete more hydrogen ions into urine
Urine becomes more acidotic
Clinical manisfestations or signs of respiratory acidosis
Drowsiness, unconsciousness, disorientation, rapid, shallow respirations, tachycardia, dizziness, decreased BP, headache, Tachycardia, seizures
Interventions for Respiratory acidosis
Improve respiratory function, correct acidosis, assess for iatrogenic complications of interventions
How can we improve respiratory function?
antibiotics for infection, postural drainage, bronchodilators, inhalation therapy, breathing exercises, mechanical ventilation, oxygen therapy.
What is the 2nd intervention in correcting respiratory acidosis? and how do we correct that?
Correct Acidosis
through treating hyperkalemia if present and IV sodium bicarbonate
What is the 3rd intervention in correcting respiratory acidosis? and what are some of them?
assess for iatrogenic complications of interventions---tetany, CO2 narcosis, rebound respiratory alkalosis, metabolic acidosis.
What results from excreting too much CO2?
respiratory alkalosis
Respiratory alkalosis is almost always a result of _________?
Hyperventilation can be caused by 1._____________ 2.____________ 3.____________
anxiety, aftermath of severe exercise and hypoxia at high altitudes
Compensatory Mechanisms of Respiratory alkalosis
*Respirations decrease or even cease until CO2 levels rise enough to stimulate increase in respirations.
*Kidneys slow absorption of HCO3 and increase release of hydrogen ions causing alkaline urine
clinical manisfestations or signs of respiratory alkalosis are
increased neuromuscular irritability, hyperreflexia, muscular twitching, seizures, lightheadedness,numbness and tingling in toes and fingers, tachycardia, dysrhythmias.
What should the nurse do for a respiratory alkalosis pt.?
Eliminate cause of hyperventilation, help person breathe more slowly and deeply (paper bag), if neurological problems is the cause, treat the primary problem.
Most common cause of metabolic acidosis?
overproduction of metabolically produced acids found in diabetes mellitus,
Infections with high fever,
trauma, and major surgery.
other causes of Metabolic acidosis
excessive ingestion of acid (aspirin, ferrous sulfate), Renal diseases( kidneys lose ability to secrete acids), abnormal loses of alkali (acute vomiting, loss of pancreatic, biliary and lower intestinal fluids
clinical manisfestations of Metabolic acidosis
drowsiness, coma, dehydration, n/v, diarrhea, headache,MOST COMMON is muscular twitching and deep rapid respirations (Kussmaul's breathing)
Nursing interventions for metabolic acidosis
restore blood volume and osmolarity
Correct HCO3 deficit
assess for and prevent electrolyte imbalances (Hyperkalemia) and protect from injury.
Common causes of metabolic alkalosis
excessive loss of hydrogen ions from body through vomiting and gastric suction w/o replacement of alkali
Compensatory mechanisms of metabolic alkalosis
hypoventilation (to keep some of the CO2), hydrogen ions are conserved and large amounts of sodium and potassium are excreted by the kidneys
clinical manisfestations of metabolic alkalosis
belligerence, irritable, disorientated, lethargy, shallow slow respirations, periods of apnea, tachycardia, dysrhythmias, n/v, hypertonic muscles, tingling of fingers and toes, seizures
Nursing intervention for metabolic alkalosis
treat primary condition, correct alkalosis, correct water sodium, chloride and potassium deficits.
Metabolic Acidosis
pH < 7.35
pH indicates the number of
Hydrogen Ions H+
Metabolic acidosis cause
excess acids
Normal range for pH
7.35 - 7.45
The acid base imbalance of a client with diabetic ketoacidosis is called?
Metabolic acidosis
condition in which acid accumulates in the body
Common Causes
Acute respiratory conditions (pulmonary edema, pneumonia, acute asthma), opiate OD, foreign body aspiratio0n, chest trauma
Your COPD patient has an acute exacerbation of the disease-- the acid base imbalance is?
Respiratory acidosis
A pt. is in pain and is anxious from an accident. The acid base imbalance is?
Respiratory alkalosis
condition in which base substances accumulate in the body
A client has been taking extra lasix for “bloating”. The acid base imbalance is?
Metabolic alkalosis
Metabolic acidosis compensation
rate and depth of respirations increase, eliminating additional CO2
pH Up
Interpret the ABG: ph 7.25, pCo2 54, HCO3 24, pO2 84
Respiratory acidosis
pH down
Respiratory Acidosis
pH < 7.35
1st step to blood gas interpretation
look at pH and determin a/b status
Interpret the ABG: ph 7.50, pCo2 28, HCO3 24, pO2 70
Respiratory Alkalosis
Metabolic Alkalosis
pH > 7.45
2nd step to blood gas interpretation
look at respiratory component to see if the imbalance is due to a respiratory reason
Interpret the ABG: ph 7.19, pCo2 35, HCO3 26, pO2 85
Metabolic alkalosis cause
bicarb excess
3rd step to blood gas interpretation
look at metabolic component to determine if imbalance is due to a metabolic reason
Interpret the ABG: ph 7.50, pCo2 40, HCO3 30, pO2 90
Metabolic Alkalosis
Metabolic acidosis effect on ABGs
decrease pH
Interpret the ABG: ph 7.35, pCo2 50, HCO3 30, pO2 60
Respiratory Alkalosis
pH 7.45
What is the normal ratio of base to acid?
Interpret the ABG: ph 7.38, pCo2 30, HCO3 18, pO2 75
Measures the pressure exerted by CO2 dissolved in the blood
Metabolic alkalosis compensation
rate and depth of respirations decrease, retaining CO2
Respiratory component of blood gases
Metabolic alkalosis effect on ABGs
increase pH
PCO2 normal values
35 - 45 mmHg
Measures the amount of bicarbonate (base) in blood
Respiratory acidosis cause
retained CO2
The system most critically affected ( can cause death) by severe abnormalities in potassium balance is?
The cardiovascular system
Acidosis that results from respiratory dysfunction is called?
Respiratory acidosis
Metabolic component of blood gases
Respiratory acidosis compensation
Kidneys conserve bicarb to resore carbonic acid:bicarb ration of 1:20
Chronic obstructive lung disease is a primary cause of?
Respiratory acidosis
HCO3 normal values
22 - 26 mEq/L
measures the patial pressure of O2 dissolved in blood
Respiratory acidosis effect on ABGs
decrease pH
Diabetes mellitus is a primary cause of?
Metabolic acidosis
indicates the ability of the lungs to allow Oxygen to diffuse into bloodstream
Respiratory alkalosis cause
loss of CO2
Normal range of PO2
80 - 100 mm Hg
Respiratory alkalosis compensation
Kidneys excrete bicarb and conserve H+ to restore carbonic acid: bicarb ratio
Percentage of hemoglobin that is saturated w/ oxygen
O2 saturation
Respiratory alkalosis effect on ABGs
increase pH
each molecule of hemoglobin can carry how many molecules of oxygen?
Normal value for O2 saturation
95 - 100%
measures all the bases inteh blood that are available to help buffer
Base Excess (BE)
Normal value for base excess
-2 to +2
provides a more complete picture of body's ability to buffer
Base Excess (BE)
3 causes of respiratory acidosis
1. primary lung function problem
what condition is caused by increases in CO2 in blood causing an increase in H+
respiratory acidosis
in what condition does K+ move out of cells so H+ move into cells creating high serum potassium levels
in what condition do cells release H+ into the blood and K+ move into cells from blood serum causing low K+ levels
in what condition does CO2 increase and HCO3 decrease?
in what condition does CO2 decrease and HCO3 increase?
if pH is abnormal and both CO2 and HCO3 are abnormal, what is the compensation level?
partially compensated
if pH is abnormal and either, but not both, CO2 or HCO3 is abnormal, what is the compensation level?
if pH is normal and both CO2 and HCO3 is abnormal, what is compensation level?
what are some possible reasons for metabolic acidosis? (handout from class)
Diabetic ketoacidosis, shock, kidney failure
what are some reasons for respiratory acidosis (handout from class)
sedation, shock, severe pneumonia
what are some reasons for metabolic alkalosis
vomiting, fever, tachypnea
what are some reasons for respiratory alkalosis?
hyper ventilation, pain, anxiety
what acid/base condition is it and what may have caused it?
part. compensated metabolic acidosis; Diabetic ketoacidosis
HCO3: 28
partially compensated resp. acidosis; asthma
PCO3: 20
partially compensated respiratory alkalosis; hyperventilation or pain
PCO3: 32
partially compensated metabolic alkalosis; vomiting
HCO3: 34
metabolic alkalosis, compensated; sedation

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