Acid Base Balance

with resp acidosis the kidneys are compensating with _______ and ________ -the body must excrete ________ then the body will retain _______

bicarb and hydrogen hydrogen bicarb

what chemicals do the kidneys deal with

bicard hydrogen

how does the body retain CO2

by hypovent

if resp acidosis is caused by pneumothorax we want to do what to treat it

chest tube

what chemicals do they lungs deal with

co2

in metabolic acidosis the pH will ________

decrease less than 7.35

if co2 levels are increased the LOC is

decreased

alkalotic person acts

excitable - seizure like stimulation

s/s of resp acidosis

first HA then confused then sleepy then coma

tx for metabolic alkalosis

give K+

kidneys take how long to do their job

hours to days but they are efficent

metabolic alkalosis too little ________ and too much ______

hydrogen bicarb

metabolic acidosis= ________kalemia metabolic alkalosis = _________ kalemia

hyper hypo

with resp alkalosis are we hypervent or hypovent

hyperventilating (blowing off too much co2)

in respiratory acidosis is the pt hypoventilating or hyper?

hypo-ventilating bc they are retaining CO2

increase in CO2 and decrease in O2 is

hypoxia

test taking strategy when restless think

hypoxia

with metabolic acidosis the RR will ______ to get rid of acid

increase

with metabolic alkalosis pH will be ______

increased, greater than 7.45

acidotic person acts

lethargic

if resp acidosis is caused by pneumonia we want to do what to treat it

liquefy and mobilize secretions with postural drainage, percussion, TCDB, suctioning, fluids, elevate HOB, incentive spirometry

hyperventilation does what with CO2

lose CO2, helps decrease the level and makes us more alkalosis

what causes metabolic alkalosis

loss of upper GI contents too many antacids

with resp acidosis the pH is low or high

low- bc more acidic. below 7.35

how long does it take the lungs to compensate

quickly but not as good as the kidneys

hypoventilation does what with CO2

retains CO2, leads to an increase in CO2/acid

in resp alkalosis the pH is

too high OR above 7.45

serum K+ levels go _______ in metabolic acidosis adn go _______ in metabolic alkalosis WHY?

up down K+ goes up in acidosis due to the cells starving, K+ move from cells to plasma in exchange for hydrogen ions

What causes metabolic acidosis?

- DKA and Starvation: cells are starving bc glucose is not available. the body will breakdown fat for energy. as a result of fat breakdown, ketones are produced and causes acidosis - renal failure: due to not being able to filter the acid and bases - severe diarreha

s/s of resp alkalosis

- lightheadedness -faint feeling -perioral numbness -numbness and tingling in fingers and toes

reasons why a pt would hypoventilate

- mid abd incision (wont want to breathe deeply - narcotics -collapsed lung - pneumonia - pneumothorax

aspirin over dose and resp alkalosis

-acute aspirin overdose (stimulates the resp center and increases RR)

resp alkalosis causes

-hyperventilation due to hysterical situation -the pt is breathing too fast and removing CO2

A client who had a cerebral vascular accident (CVA) is now having Cheyne-Stokes respirations ranging from 12-30 breaths/minute. BP 158/108, HR 46. Based on this assessment, which acid/base imbalance does the nurse anticipate that this client will develop? Choose One 1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis

1. Correct: Causes of respiratory acidosis include any causes of decreased respiratory drive, such as drugs (narcotics) or central nervous system disorders. With a massive cerebral vascular accident (CVA or stroke), the respiratory center in the brain is impaired and affects oxygenation. Cheyne-Stokes respirations are characterized by progressively deeper and sometimes faster respirations followed by periods of apnea. This leads to acidosis and often times respiratory arrest.

A client, admitted to the surgical unit post left thoracotomy, is drowsy. Vital signs on admit are T 99.8ºF (37.6ºC), HR 94, R 16/shallow, BP 100/68. ABGs are pH 7.33, PCO2 48, HCO3 24. What action should the nurse initiate? Choose One 1. Have client take deep breaths .2. Administer naloxone. 3. Tell the client to breathe faster. 4. Medicate for pain.

1. Correct: This client had chest surgery and the pCO2 is high. What are you worried about? Hypoventilation. Yes, the client is probably hurting due to the incision and does not want to take deep breaths. In order to get rid of the excess CO2 the client needs to turn, cough, and deep breathe. Incentive spirometry can be provided to assist the client with this effort. 3. Incorrect: Breathing faster will only work for a few minutes. The problem is the client needs to breathe deeper to get more oxygen to the tissue and more CO2 out of the lungs. Hyperventilating will lead to respiratory alkalosis.

How would the nurse interpret this client's Arterial Blood Gas (ABG) results? pH 7.30 PaCO2 55 mm Hg Bicarb 25 mEq/liter 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

1., & 5. Correct. Now will a pH of 7.30 make the patient have acidosis or alkalosis? Well it's less than 7.35 so that's a low pH, and you know that a low pH is acidosis. So now we know acidosis, but we still must figure out if it is respiratory or metabolic. Look at the PaCO2, it is 55. That's a lot of CO2, and it's greater than the normal range of 35-45, so the PaCO2 must be acidosis. Now the Bicarb is 25, and a Bicarb of 25 is within the normal range of 22-26. To determine whether this is respiratory or metabolic acidosis, we need to match the pH with either the PaCO2 or the HCO3. The pH that we're trying to match is acidosis, so keep in mind you're trying to match the word acidosis with one of the chemicals. Well look at our problem, the CO2 is also acidosis. So, since these two match and they are both acidosis, we can say this is clearly Respiratory Acidosis because the "respiratory" chemical (CO2) is the one that matches the pH. Now, look at the Bicarb level. The bicarb is normal and doesn't match our pH which is acidosis, so, we can just mark it out. There you have it; this is Respiratory Acidosis. So, is there any compensation going on? No, not yet. The bicarb is still within normal limits. These values indicate uncompensated respiratory acidosis.

normal HCO3/bicarb

22-26 mEq/L

How would the nurse interpret this client's Arterial Blood Gas (ABG) results? pH 7.35 PaCO2 30 mm Hg Bicarb 19 mEq/liter

3., & 7. Correct. These ABG values indicate metabolic acidosis. The pH is normal, but it is on the acidosis side of normal at 7.35. Now, which other chemical says acidosis? Look at the bicarb; the bicarb is low, indicating acidosis so there's your match! The bicarb matches the pH. What chemical problem does the bicarb relate to - respiratory or metabolic? It's metabolic. Metabolic acidosis. Has compensation begun? Yes. The lungs are compensating for the metabolic acidosis by getting rid of CO2, which is an acid. Therefore, the PaCO2 is below the normal range of 35-45. Since the pH is normal, full compensation has occurred.

normal PaCO2

35-45 mmHg

A client arrives at the clinic with reports of persistent vomiting, weakness and leg cramps. The nurse notes that the client is irritable. BP 102/58, HR 108, RR 14. Based on this data, what acid/base imbalance does the nurse expect? Incorrect Choose One1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis

4. Correct: Symptoms of alkalosis are often due to associated potassium loss and may include irritability, weakness, and cramping. Excessive vomiting eliminates gastric acid and potassium, leading to metabolic alkalosis.

Which initial arterial blood gas (ABG) results would the nurse likely see in a client who has overdosed on acetylsalicylic acid (ASA)? Choose One 1. pH 7.50, PaCO2 42, PaO2 63, SaO2 91, HCO3 28 2. pH 7.32, PaCO2 36, PaO2 83, SaO2 95, HCO3 19 3. pH 7.28, PaCO2 28, PaO2 72, SaO2 90, HCO3 16 4. pH 7.48, PaCO2 30, PaO2 88, SaO2 92, HCO3 24

4. Correct: This ABG result indicates respiratory alkalosis. Initially, acetylsalicylic acid stimulates the respiratory center and causes an increase in respiratory rate and depth. This causes respiratory alkalosis by blowing off CO2 and causing the pH to increase. Losing CO2 (acid) makes the client more alkalotic, which is reflected with an increased pH, decreased PaCO?2 and normal HCO?3.

pH 7.44 PaCO2 51 mm Hg Bicarb 31 mEq/liter 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

4., & 7. Correct. The pH is on the alkalosis side of normal (7.35-7.45). Anything above 7.0 is on the alkalotic side of normal. Look at the CO2. The CO2 is high, which indicates acidosis, so this does not match the alkalotic pH, does it? No. Look at the Bicarb. The bicarb is high, indicating alkalosis, so there is your match. The bicarb is higher than 26, so there is a lot of base in the body. So, this is metabolic alkalosis. Has compensation begun? Yes. The PaCO2 is high. The lungs are attempting to compensate by holding on to carbon dioxide, an acid, to make the pH normal. Since the pH is normal, full compensation has occurred.

normal pH

7.35-7.45

normal PaO2

80-100 mmHg

treatment for resp alkalosis

may have to sedate to bring down RR

resp acidosis what chemical is causing the prob

CO2 increase

s/s of metabolic acidosis

Hyperkalemia increased RR-kussmaul resp - DKA pt

Metabolic Acidosis signs and symptoms include

Metabolic Acidosis signs and symptoms include headache, confusion, increased respiratory rate and depth, drowsiness, and nausea and vomiting. This can occur in cases of diarrhea, when more bicarb is lost through the lower GI tract.

Repiratory Alkalosis signs and symptoms include

Repiratory Alkalosis signs and symptoms include an inability to concentrate, light-headedness, numbness and tingling, tinnitus and loss of consciousness. The loss of CO2 from the lungs would be the problem with respiratory alkalosis, but the problem described in the question is metabolic.

Respiratory Acidosis signs and symptoms include

Respiratory Acidosis signs and symptoms include decreased respiratory rate, hyportension and a decrease in level of consciousness. Remember, if it's respiratory acidosis, it traces back to the lungs. This problem describes a metabolic issue.

s/s of metabolic alkalosis

observe LOC serum K+ will go down monitor for hypoK+

early S/s of hypoxia

Restlessness, tachycardia

an increase an acid makes the LOC

decrease

hyperkalemia s/s

muscle twitching, muscle wekaness, flaccid paralysis, arrythmias

How would the nurse interpret this client's Arterial Blood Gas (ABG) results? pH 7.30 PaCO2 55 mm Hg Bicarb 25 mEq/liter Select All That Apply 1. Respiratory acidosis 2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis5. Uncompensated6. Partially compensated7. Fully compensated

1., & 5. Correct. Now will a pH of 7.30 make the patient have acidosis or alkalosis? Well it's less than 7.35 so that's a low pH, and you know that a low pH is acidosis. So now we know acidosis, but we still must figure out if it is respiratory or metabolic. Look at the PaCO2, it is 55. That's a lot of CO2, and it's greater than the normal range of 35-45, so the PaCO2 must be acidosis. Now the Bicarb is 25, and a Bicarb of 25 is within the normal range of 22-26. To determine whether this is respiratory or metabolic acidosis, we need to match the pH with either the PaCO2 or the HCO3. The pH that we're trying to match is acidosis, so keep in mind you're trying to match the word acidosis with one of the chemicals. Well look at our problem, the CO2 is also acidosis. So, since these two match and they are both acidosis, we can say this is clearly Respiratory Acidosis because the "respiratory" chemical (CO2) is the one that matches the pH. Now, look at the Bicarb level. The bicarb is normal and doesn't match our pH which is acidosis, so, we can just mark it out. There you have it; this is Respiratory Acidosis. So, is there any compensation going on? No, not yet. The bicarb is still within normal limits. These values indicate uncompensated respiratory acidosis.

The emergency department nurse is monitoring a client being admitted in diabetic ketoacidosis (DKA). Which arterial blood gas value would be expected? Select All That Apply 1. pH 7.32 2. PaCO2 32 3. HCO3 25 4. PaO2 78 5. SaO2 82

1., &2. Correct: In DKA, the client is acidotic. Normal pH is 7.35-7.45. A pH of 7.32 indicates acidosis and will be expected for a client in DKA. Normal PaCO2 is 35-45. Remember CO2 is considered an acid. The client in DKA will have an increased respiratory rate, so the PaCO2 will either be normal or low. This value of 32 is low and is an expected finding as the body is compensating for the acidosis. 3. Incorrect: Normal HCO3 is 22-26. HCO3 is a base. Initially, the acids bind to the bicarb to reduce the acid levels. Therefore, the HCO3 would be less than 22. So, in DKA, the expected initial finding is a low HCO3?. Keep in mind that with acidosis, as the body compensates later, the kidneys will retain bicarb and you will see the bicarb levels increase. 4. Incorrect: Normal PaO2 is 80-100. An expected finding in DKA will be normal or increased PaO2, not decreased.

A client who has been given steroids for a prolonged period to treat asthma, reports dizziness, tingling of the fingers, and muscle weakness. What action should the nurse take first? Choose One1. Determine current blood pressure2. Connect client to a cardiac monitor3. Administer oxygen4. Obtain arterial blood gases

2. Correct. These symptoms are indicative of hypokalemia and metabolic alkalosis. What do steroids do to the body? Steroids make you retain sodium and excrete potassium. So, you could become hypokalemic. Low potassium levels cause an increase in the reabsorption of bicarb by the kidneys. That is why you sometimes see metabolic alkalosis with Cushing's disease and prolonged steroid use. What electrolyte imbalance do we see with metabolic alkalosis? It's hypokalemia. So, if you have a client who is hypokalemic then they may have muscle weakness, hypotension and life threatening arrhythmias. And we know when the potassium is messed up, we should always think about the heart first. Connect the client to the cardiac monitor.

A client presents to the emergency department (ED) with flu symptoms, fever, and chills. The nurse notes that the vital signs are: T 102.8°F (39.3°C), P 128, RR 30, B/P 154/88. ABG results are: pH-7.5, PaCO2 32, HCO3 23. What acid/base imbalance does the nurse determine that this client has developed? Choose One1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis

2. Correct: This client has a high fever. Hyperventilation due to anxiety, pain, shock, severe infection, fever, and liver failure can lead to respiratory alkalosis. Here, the ABGs reflect respiratory alkalosis. pH > 7.45, PCO2 < 35, HCO3 normal.

Cheyne-Stokes

abnormal breathing pattern; periods of dyspnea and apnea reason for reps acidosis

co2 is an

acid

hydrogen is a

acid

kidneys remove excess _____ and ______ by excreting them through urine OR kidneys can retain _______ and _________ and return it to the blood

acid bicarb hydrogen

when you see upper GI contents, think

acid, losing acid

pH less than 7.35

acidic

pH greater than 7.45

alkalosis

bicarb is a

base

when you see lower GI tract think (diarrhea)

base, losing base

with resp alkalosis the body will excrete ______ and retain ________

bicarb hydrogen

with metabolic acidosis there is too little ________ and too much _________

bicarb hydrogen=acidosis