Acid-Base Balance & Ventilators PDF

1. Acid Base Principles Rule of the B’s.. If the pH & the bicarb are both in the same direction = Metabolic If they are in different directions = Respiratory Values: PaO2 → 80-100 mmHg; SaO2 → 95-100% Example: You are providing care to a client with the following blood gas results: pH 7.32, CO2...

1. Acid Base Principles Rule of the B’s.. If the pH & the bicarb are both in the same direction = Metabolic If they are in different directions = Respiratory Values: PaO2 → 80-100 mmHg; SaO2 → 95-100% Example: You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3 29, PaO2 80 & SaO2 90%. Based on the results, the client is experiencing: ↓ = acidosis, ↑ = respiratory **NCLEX TIP: Don’t memorize lists, know the principle. Will test the knowledge of a principle by having you generate lists. Example: In general, what do opioid pain meds do? They sedate you, CNS depressant. Symptoms you should pick will be options that are down (lethargy, hyporeflexia, obtunded, etc) -Opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc).. **Principle: acid base signs/symptoms.. As the pH goes... so goes my patient!!! When pH goes up; patient goes up.. (everything gets irritable!) When pH goes down; patient goes down! (systems in your body shut down) … Except with potassium: when pH goes up; potassium goes down... when pH goes down; potassium goes up!  pH UP ↑ K ↓ [ALKALOSIS] pH Down ↓ K ↑ [ACIDOSIS] Tachycardia Tachypnea Bradycardia Bradypnea Diarrhea Tremors Hypotension ↓ Lucidity Seizure Hyperreflexia (+3/+4) Anorexia Coma Agitated Borborygmi (↑Bowel Sounds) Lethargy Cardiac arrest Hypertension Palpitations Suppressed, decreased, falling Tetany Anxiety/Panic Respiratory arrest > ambu bag Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure... MAC Kussmaul!! M: metabolic AC: acidosis Example: Pt has respiratory acidosis... (select all that apply).. +1 reflexes, diarrhea, adynamic ileus , spasm, urinary retention, tachycardia, 2 nd degree mobitz type 2 heart block, hypokalemia **NCLEX TIP: SATA questions : *never only 1... never all of them* (New change 2017: can be one answer, some answers, or all of them). Main reason that people miss SATA questions is they select one more answer choice then they should. If you don’t know if it applies, don’t pick the answer. *Causes of acid-base imbalance: ○ First ask, “Is it a lung problem?” > YES → Respiratory ○ i. Over ventilating > over normal > alkalosis (PaCO2 < 35) Then, ask yourself, “Are ii. Under ventilating > under normal > acidosis (PaCO2 > 45) they over ventilating or under ventilating?” iii. Ventilating doesn’t mean respiratory rate, it deal with gas exchange. Look at SaO2 value. ○ If it is not a lung problem > Metabolic i. Prolonged gastric vomiting or suctioning > pick metabolic alkalosis because you are losing acid and becoming more basic ii. Everything else > metabolic acidosis ○ If you don’t know an acid-base imbalance based on a condition > pick metabolic acidosis **NCLEX TIP: If you want to get a question right, pay attention to the modifying phrase than the original noun. A person with obsessive compulsive disorder is now psychotic, you pay more attention to psychotic than the obsessive compulsive disorder.  If prolonged vomiting cause dehydration > you worry more about the dehydration now then the vomiting Ventilators High pressure alarms are triggered by an increased resistance to air flow (machine is pushing too hard to get air into the lungs). It can be caused by obstructions: Kinked Tube ○ Nursing action > unkink it Water in tubing (caused by condensation) ○ Nursing action > empty it/remove H20 Mucus in airway ○ Nursing action: turn, cough, deep breathe; only use suction if TCDB doesn’t work (last resort) Low pressure alarms are triggered by a decreased resistance to air flow and can be caused by disconnections of the: Tubing ○ Nursing action > pay attention to where tubing is…(contamination) If tubing is on the floor, change it out If tubing is on chest, clean with alcohol then put it back on *Respiratory alkalosis ⇒ OVERVENTILATION ventilator setting may be too high. *Respiratory acidosis = UNDERVENTILATION = ventilator setting may be too low. What does “wean” mean? gradually decrease with the goal of getting off altogether ex: Doc says wean off vent in AM... 6am ABG’s show resp. acidosis... a) follow order b) call respiratory c) hold order.. call doc d) begin to decrease the settings