Acid-Base Nursing Exam 2 PDF

COLLEGE NURS 1250 NURSING CARE OF ADULTS II EXAM 2 CONCEPT OF ACID-BASE BALANCE ROWENA A. BAUTISTA, MSN, RN, CMSRN  OVERVIEW OF ACID-BASE Produces H+ Acid Base Accepts H+ Raises pH Lowers...

COLLEGE NURS 1250 NURSING CARE OF ADULTS II EXAM 2 CONCEPT OF ACID-BASE BALANCE ROWENA A. BAUTISTA, MSN, RN, CMSRN  OVERVIEW OF ACID-BASE Produces H+ Acid Base Accepts H+ Raises pH Lowers Na+ K+ Ca++ Electrons Mg++ HCO3- Cl- pH Protons COMMON ACIDS AND BASES  WHAT IS THE JOB OF ACIDS AND BASES?  Maintains pH level  Maintain a stable concentration of H+  Provides a neutral environment  Compensates for specific imbalances  WHY BALANCE IS IMPORTANT?  Necessary for homeostasis — essential for all cellular metabolism  HYDROGEN IONS  Homeostasis of H+ concentration in body fluids ↑ H+ acid ↓ H+ alkaline  Hydrogen ion concentration is expressed as pH ↑ H+ ↓ pH ↓ H+ ↑ pH  HOW DO ACIDS AND BASES FORM? H2CO3 → forms when CO2 dissolves in H2O. It dissociates to release H+ and HCO3-. It can form acids & bases through dissociation reactions IS IT ACIDOSIS OR ALKALOSIS? 7  ARTERIAL BLOOD GAS VALUES NORMAL ACIDOSI ALKALOS ABG VALUES S IS 7.35 – pH < 7.35 > 7.45 7.45 PaCO2 35-45 > 45 < 35 HCO3- 22-26 < 22 > 26 PaO2 80-100 < 80 = Hypoxemia  IMPORTANCE OF ABG VALUES  Provide valuable information about: — Body’s ability to regulate pH. — Patient’s acid-base status. — Underlying cause of imbalance. — Patient’s overall oxygen status.  HOW ARE IMBALANCES DETECTED?  H+ and HCO3- are retained or excreted from the kidneys  CO2 is retained or expelled from the lungs REGULATORY SYSTEM 17  WHAT IS COMPENSATION?  When one system jumps in to help because the primary system is “impaired”.  To regain acid-base balance: — Lungs may respond to a metabolic disorder. — Kidneys may respond to a respiratory disorder.  Partial Compensation – pH remains abnormal.  Complete Compensation – pH returns to normal.  ACID-BASE DISORDERS  When the body’s pH varies from the normal range  Acid-base disorders are influenced by H+ ↓ H+ - ↑ pH - alkaline ↑ H+ - ↓ pH - acidic  Classifications: — Respiratory Acidosis — Respiratory Alkalosis — Metabolic Acidosis — Metabolic Alkalosis  RESPIRATORY ACIDOSIS  Decreased Ventilation: Hypoventilation —↑ PaCO2 (hypercapnia) —↑ H2CO3 (carbonic acid) → reaction of CO 2 dissolved in H2O — Free H+ and HCO3- are released thereby ↓ pH pH ↓ PaCO2 ↑ HCO3-  RESPIRATORY ACIDOSIS Renal Respiratory Compensation Depression ↑ absorption of Obstruction Chronic HCO3- ↑ excretion of Respiratory Problem H+ in urine Etiology RESPIRATORY ACIDOSIS  RECOGNIZE CUES Respiratory —rapid & shallow respirations → shallow & Respiratory depressed Neurologic —dizziness, disorientation, headache, coma Acidosis Cardiovascular —arrhythmias, hypotension Neuromuscular —muscle twitching → seizures  TAKE ACTIONS Maintain patent airway Administer oxygen cautiously Respiratory Monitor vital signs; respiratory rate Acidosis & depth Monitor ABG levels Monitor serum potassium level Administer sedative cautiously Reinforced patient teachings  RESPIRATORY ALKALOSIS  Increased Ventilation: Hyperventilation —↓ PaCO2 (hypocapnia) —↓ H2CO3 (carbonic acid) —↓ CO2 concentration causes ↑ arterial pH levels pH ↑ PaCO2 ↓ HCO3- RESPIRATORY ALKALOSIS Renal Compensatio Any factor that n contributes to ↑ absorption of hyperventilatio n H+ ↑ excretion of HCO3- in urine Etiology RESPIRATORY ALKALOSIS  RECOGNIZE CUES Respiratory —periods of apnea and hyperventilation Respiratory Neurologic —lightheadedness, confusion, lethargy Alkalosis Cardiovascular —tachycardia, arrhythmias Neuromuscular —tingling of extremities, hyperreflexia, tetany, seizures Gastrointestinal —epigastric pain, nausea, vomiting  TAKE ACTIONS Instruct patient to breathe slowly & less deeply Monitor vital signs; respiratory rate Respiratory & rhythm Alkalosis Monitor ABG levels Monitor serum potassium level Administer sedatives cautiously Reinforced patient teachings  TAKE ACTIONS Pursed-Lip Breathing Techniques Respiratory Alkalosis  TAKE ACTIONS Take 6–12 natural breaths with a paper bag held over the mouth & nose. Then remove the bag, and Respiratory take easy, natural breaths. Alkalosis  METABOLIC ACIDOSIS  Gain and/or inability to excrete acid  HCO - deficit 3  pH ↓ due to excess H+ pH ↓ PaCO2 HCO3- ↓  METABOLIC ACIDOSIS Respiratory Compensatio DKA n Renal Failure ↑ elimination Diarrhea of CO2 to raise Salicylate pH Poisoning Starvation Etiology METABOLIC ACIDOSIS  RECOGNIZE CUES Respiratory Metabolic Acidosis —Kussmaul breathing, fruity-breath with DKA Neurologic —dull headache, lethargy, confusion, coma Cardiovascular —arrhythmias, hypotension Neuromuscular —tingling and numbness in extremities Gastrointestinal —abdominal pain, anorexia, nausea, vomiting  TAKE ACTIONS Monitor neurologic status Metabolic Acidosis Monitor vital signs; respiratory rate & depth Position patient to facilitate breathing Administer O2 to correct lactic acidosis Monitor ABG levels Monitor HCO3- and K+ levels  TAKE ACTIONS Administer IVF containing lactate as Metabolic Acidosis ordered Administer insulin and NS to correct hyperglycemia Administer NaHCO3 cautiously Institute cardiac monitoring for patients with ↑K+ Reinforced patient teachings  METABOLIC ALKALOSIS  Loss of strong acid  HCO - excess 3  pH ↑ due to decrease in H+ pH ↑ PaCO2 HCO3- ↑  METABOLIC ALKALOSIS Respiratory Compensatio Nasogastric n Suction ↓ ventilation to Diuretic Therapy retain CO2 Prolonged Vomiting Etiology METABOLIC ALKALOSIS  RECOGNIZE CUES Respiratory —slow, shallow Neurologic Metabolic Alkalosis —irritability, disorientation, belligerence Cardiovascular —dysrhythmias Neuromuscular —tingling, muscle cramps, tetany Gastrointestinal —anorexia, nausea, vomiting  TAKE ACTIONS Monitor vital signs Assess neurological status Metabolic Alkalosis Monitor ABG values IVF and electrolytes supplements as ordered Monitor patients at risk for metabolic alkalosis Reinforced patient teachings  ACID-BASE PNEUMONIC (ROME) RESPIRATORY – OPPOSITE METABOLIC – EQUAL ABG pH PaCO2 HCO3- ↓ ↑ Normal ↑ ↓ Normal ↓ Normal ↓ ↑ Normal ↑ PULMONARY AND RENAL COMPENSATION Respiratory Acidosis Eliminate excess CO2 Respiratory Alkalosis Retain CO2 Metabolic Acidosis Conserve HCO3- Eliminate excess H+ Metabolic Alkalosis Conserve H+ Eliminate excess HCO3-  BASIS FOR COMPENSATION Compensato PaCO2 pH ry Status HCO3- Uncompensate Abnormal No change d Partially Abnormal Compensated Follows the primary shift Compensated Normal  COMPENSATION → PH TELLS THE TALE PaCO HCO3 ABG pH 2 - 7.33 46 27 7.43 30 20 7.37 28 18 7.48 47 30 ACID-BASE TIC TAC TOE Acid Normal Base  RESPIRATORY pH & PCO2 in the same column Acid Normal Base pH = 7.33 PaCO2 = 46 HCO3- = 27 Partially Compensated Respiratory Acidosis  METABOLIC pH & HCO3- in the same column Acid Normal Base pH = 7.48 PaCO2 = 47 HCO3- = 30 Partially Compensated Metabolic Alkalosis THE BATTLE FOR HOMEOSTASIS  Assess  Intervene  Stay curious  Think critically