Nursing Care of At Risk Adult Clients with Acid-Base Balance PDF

Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems in Acid-Base Balance UNIT 6: (Acid-Base Problem) Lesson 1: The Acid-Base Balance, Imbalances and  Weak acids, such as carbonic acid, dissociate their Interpretations Using Arterial Blood Gases...

Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems in Acid-Base Balance UNIT 6: (Acid-Base Problem) Lesson 1: The Acid-Base Balance, Imbalances and  Weak acids, such as carbonic acid, dissociate their Interpretations Using Arterial Blood Gases only partially (ABG) 2. Bases are proton (H+) acceptors Blood pH  Strong bases dissociate easily in water and tie  pH – potential of hydrogen up H+ (completely) o available hydrogen on ions  Weak bases, such as bicarbonate ion and  Must remain between 7.35 and 7.45 to maintain ammonia, are slower to accept H+ (doesn’t give homeostasis hydrogen and bind to free hydrogen)  Alkalosis—pH above 7.45  Acidosis—pH below 7.35 Maintaining acid-base balance in blood 3. Molecules react to prevent dramatic changes in 1. Most ions (cations & anions) originate as by-products hydrogen ion (H+) concentrations of cellular metabolism  Bind to H+ when pH drops (acidotic) 2. Acids produced by the body  Release H+ when pH rises  Phosphoric acid (changes inside the cell about 4. Three major chemical buffer systems phosphoric acid  Bicarbonate buffer system o Lactic acid – by product of anaerobic  Phosphate buffer system – PO₄ balances metabolism (caused acidity in our body) intracellular fluids pH o Fatty acids – by product of ketosis  Protein buffer system – protein such as  Carbon dioxide forms carbonic acid hemoglobin and plasma protein binds to acid to  Ammonia – ―based‖ regulate pH 3. Most Acid-base balance is maintained by the kidneys B. Respiratory System Controls of Acid-Base Balance 4. Other Acid-base controlling systems  Carbon dioxide in the blood is converted to  Blood buffers – blood has component to help in carbonic acid when combined with water which acid base balance dissociates to hydrogen ions and bicarbonate  Respiration - precursor of carbonic acid ions and is then transported in the plasma 3 Control Mechanisms of Acid-base Balance  Increase in hydrogen ion concentration produces  Blood/Chemical Buffers more carbonic acid  Kidneys  Excess hydrogen ion can be blown off with the  Lungs release of carbon dioxide from the lungs  Respiratory rate can rise and fall depending on changing blood pH C. Renal Mechanisms of Acid-Base Balance  Excrete bicarbonate ions if needed (in alkalosis)  Conserve (reabsorb) or generate new bicarbonate ions if needed (in acidosis) A. Blood Buffers When blood pH rises (in alkalosis) 1. Acids are Proton (H+) donors  Strong acids dissociate (strong acid) completely  Bicarbonate ions are excreted (excrete alkaline) and liberate all of their H+ in water  Hydrogen ions are retained by kidney tubules (conserve acid) 1 KEANA WIN Y. ACENAS SN. | BSN 2E | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems in Acid-Base Balance UNIT 6: (Acid-Base Problem) When blood pH falls (in acidosis) 4 GENERAL CLASSES OF A-B DISORDERS  Bicarbonate ions are reabsorbed (conserve Metabolic Acidosis alkaline)  Decreased plasma bicarbonate level secondary  Hydrogen ions are secreted (excrete acid) to an increase in acid component with corresponding decrease in pH Urine pH varies from 4.5 to 8.0 Metabolic Alkalosis  depends on your state ACID-BASE BALANCE DISORDERS  Increased bicarbonate level secondary to acid Primary Disorder loss or base retention, resulting in increase pH  Metabolic Acidosis Respiratory Alkalosis  Metabolic Alkalosis  Decreased carbonic acid which raises the pH  Respiratory Acidosis secondary to increased respiratory rate and depth  Respiratory Alkalosis which results when normal alveolar air exchange is insufficient to meet the metabolic demands of Compensatory Process the body  Hyperventilation Respiratory Acidosis  Hypoventilation  Increased carbonic acid with corresponding  Renal bicarbonate retention decrease in pH which results when the patient is  Renal bicarbonate excretion unable to provide enough muscular mechanical COMPENSATED VS UNCOMPENSATED work to move sufficient amount of demands of A. Uncompensated or Acute the body such that O2 – CO2 exchange is  Presence of a normal value when 2 indices inadequate are abnormal A. METABOLIC ACIDOSIS  pH is one of the abnormal result  Produce by a gain of hydrogen ions or a loss of pH pCO2 HCO3 bicarbonate Abnormal Abnormal Normal Underlying cause: Abnormal Normal Abnormal  Loss of bicarbonate secondary to diarrhea, renal B. Compensated or chronic failure COMPENSATION o Pancreas - release bicarbonate to  The body brings back the pH to normal by neutralize acidic nature that came from altering the component not primarily affected stomach PARTIAL COMPENSATION  Addition of non-volatile acid (e.g. Ketoacidosis  one system compensates for the imbalance but (by product that the body used as source of the pH is still abnormal energy), lactic acidosis (by product of anaerobic FULL / COMPLETE COMPENSATION metabolism)  one system compensates for the imbalance  Hyperkalemia – not all the time which results to near normal pH Causes: NORMAL VALUES  Condition that increase loss of base (alkaline) of  pH 7.35 – 7.45 body fluids:  pO2 85 -100 mm Hg (partial pressure of o Renal Failure - Dialysis oxygen) o Starvation ketoacidosis o Chronic Diarrhea - Dialysis  pCO2 35–45mmHg o Anaerobic Metabolism  HCO3 22- 26mEqs/L  BE/BD -2 to +2mEqs/L (base deficit/excess) Signs and Symptoms: o Based deficit – (-2) – acidotic  Headache o Based excess – (2) - alkalosis  Confusion, drowsiness  SaO2 95 – 100%  Kussmaul’s respiration – to blow off excess CO2  CO2 Content 24 – 26mEqs/L – not common  Hyperkalemia  Nausea and Vomiting 2 KEANA WIN Y. ACENAS SN. | BSN 2E | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems in Acid-Base Balance UNIT 6: (Acid-Base Problem) Management Underlying cause:  Treat the underlying cause  Emotions (e.g. anxiety, anger, hysteria)  Give Insulin in Diabetes  Pain  Dialysis  Hypoxia (e.g. CHF)  Give NaHCO3 (alkaline solution or sodium  Brain Trauma bicarbonate)  Fever  Mechanical ventilation Collaborative Management: Causes:  Treat underlying causes  Extreme anxiety  Na Bicarbonate/ IV  Hypoxemia B. METABOLIC ALKALOSIS  Pneumonia  Results from H+ ion loss or gain bicarbonate  ASA poisoning Underlying cause: Signs and Symptoms:  H+ loss (e.g. vomiting, NG Suction)  Lightheadedness  Hypokalemia secondary to diuretics and  Numbness or tingling of finger and toes diarrhea  Tinnitus  Addition of base or bicarbonate  Loss of consciousness  Massive use of steroids  Hypokalemia Causes: Management  Condition that causes loss of acid loss or gain of  Treat underlying cause bases:  Sedation o Vomiting  Pain meds as ordered o Gastric suction  Emotional support (panic attack) o Intestinal fistula – ―bituka‖  Voluntary breath holding Signs and Symptoms:  Oxygen  Hypoventilation  Adjust ventilator  Mental Confusion  Breath in closed system (brown bag)  Dizziness Collaborative Management:  Tingling of finger and toes  Treat underlying cause  Muscle twitching, Tetany  Breathe in paper bag  Convulsions D. RESPIRATORY ACIDOSIS  Hypokalemia  Respiratory system fails to remove CO2 from Management body fluids as it is produced by the tissues  Replace fluids and electrolytes Underlying cause  Observe level of consciousness  Hypoventilation (e.g. COPD,  Give acidifying substances Neuromuscular disease. Trauma, over Collaborative Management: sedation, drug overdose, anesthesia)  Treat underlying cause  Airway obstruction  NaCl fluids  Cardio respiratory arrest  Potassium supplements Causes:  Carbonic anhydrase inhibitor (e.g. Diamox)  Condition that hinder pulmonary  Monitor I & O removal/exhalation of CO2 C. RESPIRATORY ALKALOSIS  Pulmonary edema, airway obstruction,  Resulting from hyperventilation which ―blows atelectasis, ARDS, neuromuscular disorders off‖ CO2, which decreases carbonic acid concentration Signs and Symptoms:  ↑ PR and RR 3 KEANA WIN Y. ACENAS SN. | BSN 2E | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY| Nursing Care of At Risk and Sick Adult Clients with Alterations/ Problems in Acid-Base Balance UNIT 6: (Acid-Base Problem)  ↑ Visual Disturbances II. ASSESSMENT:  Headaches or ―fullness‖ in the head  ↑ RR  ↑ ICP  Dyspnea  Hyperkalemia  Retractions Management  Central cyanosis  Treat underlying cause  Dry cough  Provide patient airway (CPT)  Fine crackles  Endotracheal intubation  Fever  Monitor neurologic status  Alteration in LOC ABG’s ↓ PaO2 ↑ PCO2 Collaborative Management III. NURSING INTERVENTION DURING ABG  Correct the cause of hypoventilation TAKING  Pulmonary hygiene 1. Performed to assess ventilation And Acid-base  Mech Vent balance  Semi- fowlers position (lung expansion) 2. Radial artery is the common site for withdrawal VIII. STEPS IN ABG ANALYSIS of blood specimens. 1. Classify the pH 3. Perform Allen’s test to assess for adequacy of 2. Identify the system involved: respiratory or collateral circulation of the hand metabolic 4. 10 ml pre-heparinized syringe to prevent clotting Assess pCO2 & HCO3 of specimen 3. Identify the primary disorder 5. Container with ice to prevent hemolysis of the 4. Determine presence and classify degree of specimen compensation NURSING INTERVENTIONS for PEEP 5. Determine status of oxygenation If on PEEP (Positive End Expiratory Pressure) Final analysis  Keep collapsed alveoli open a) Degree of compensation  Monitor the following: b) Primary Disorder o PEEP Ventilation c) Status of oxygenation o PAP (Pulmonary Artery Pressure) IX. EVALUATION OF OXYGENATION  Pain medications Based on pO2  Promote comfort  > 100 More than adequate oxygenation  85-100 adequate oxygenation Nursing Management  78-84 mild hypoxemia A. Physical Management  60-77 moderate hypoxemia a) Ensure adequate ventilation and oxygenation  40-59 severe hypoxemia through the use of mechanical ventilation or  < 40 very severe hypoxemia CPAP b) Provide adequate humidity Acute Respiratory Distress Syndrome (ARDS) c) Use aseptic technique when entering the I. CAUSES: artificial airway  Shock d) Frequently assess the patients need for ventilator  Aspiration assistance  Inhalation of toxic agents e) Elevate the patient to semi-fowlers or sitting  O2 toxicity position.  Near drowning  Trauma B. Psychological care  Infection a) Recognized that patient is usually apprehensive  Disseminated Intravascular Coagulation (DIC) b) Explain the function of the equipment carefully  Fat emboli c) Inform the patient and his family that he will not be able to speak 4 KEANA WIN Y. ACENAS SN. | BSN 2E | BULSUCON BATCH 2026 | BULACAN STATE UNIVERSITY|