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Questions and Answers
Which condition would most likely lead to respiratory alkalosis?
What nursing action should be taken if the ventilator triggers a high pressure alarm due to a kinked tube?
In which situation would you likely select metabolic acidosis as the correct answer?
Which of the following actions is appropriate for a low pressure alarm caused by disconnected tubing?
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Which factor could indicate that a patient is under-ventilating?
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What does 'wean' refer to in the context of ventilator management?
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If a patient is experiencing respiratory acidosis, what is likely true about their ventilation settings?
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Which of the following is a common cause of metabolic alkalosis?
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What should be assessed to determine if a patient's ventilator is too high?
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What type of acid-base imbalance results from excessive loss of bicarbonate?
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What does it indicate when both pH and bicarbonate levels are in the same direction?
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What will occur to potassium levels when the pH rises?
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Which of the following symptoms is NOT typically associated with acidosis?
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What breathing pattern is associated with severe metabolic acidosis?
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In a patient with respiratory acidosis, which sign or symptom is least likely to be present?
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How does a decrease in pH affect the body’s systemic functions?
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Which factor is indicative of metabolic acidosis based on the rule of the B's?
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Which symptom is likely to occur with respiratory alkalosis?
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What is the normal range for PaO2 levels?
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Which of the following features would not align with symptoms of metabolic alkalosis?
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Study Notes
Acid Base Principles
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Rule of B's: If pH and bicarbonate (HCO3) are both in the same direction, it's metabolic. If they are in different directions, it's respiratory.
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Normal values: PaO2 (partial pressure of oxygen in arterial blood) - 80-100 mmHg; SaO2 (oxygen saturation) - 95-100%
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Acidosis: pH down; causes the body to slow down (e.g., bradycardia, lethargy, coma)
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Alkalosis: pH up; causes the body to speed up (e.g., tachycardia, tremors, hyperreflexia)
Potassium Levels
- Acidosis: Potassium levels ↑ (up)
- Alkalosis: Potassium levels ↓ (down)
Kussmaul Breathing:
- Deep and labored breathing pattern, often associated with metabolic acidosis, especially diabetic ketoacidosis (DKA) and kidney failure.
Ventilators
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High Pressure Alarms: Triggered by increased resistance to airflow.
- Causes: kinked tubing, water in tubing, mucus in airway.
- Nursing actions: Unkink the tubing, empty the water, encourage the patient to turn, cough, and deep breathe (TCDB); suction only if TCDB is ineffective.
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Low Pressure Alarms: Triggered by decreased resistance to airflow.
- Causes: Disconnection of tubing.
- Nursing actions: Check where the tubing is (contamination risk). If the tubing is on the floor, replace it; If the tubing is on the patient’s chest, clean with alcohol wipes and re-attach.
Ventilator Settings
- Respiratory alkalosis: Overventilation, ventilator settings may be too high.
- Respiratory acidosis: Underventilating, ventilator settings may be too low.
Weaning
- The process of gradually decreasing ventilator support to allow the patient to breathe independently.
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