Chapter 41: Acid Base Balance

Normal HCO3-

22-26 mEq/L

Normal PaCO2

35-45 mmHg

Normal Blood pH

7.35-7.45

Respiratory Acidosis

A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. pH = goes down PaCO2 = goes up

Full Compensation

BLOOD PH IS NORMAL

HCO3-

Bicarbonate (Kidneys)

Symptoms of Metabolic Acidosis

Coma Kussmaul Breathing Warm, Dry, Flushed Skin CNS DEPRESSION: Dysrhythmias, Coma, Cardiac Arrest

Causes of Metabolic Acidosis

Diarrhea Parenteral Nutrition Renal Failure Excess intake of Acids Starvational Ketoacidosis

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, with a random blood glucose reading of 575 mg/dL (31.91 mmol/L), vomiting, and shortness of breath. This client has experienced which phenomenon? Morbidity Risk factor Infection Exacerbation

Exacerbation

Causes of Metabolic Alkalosis

HCL, K loss = Excess prolong VOMIT/NG SUCTION K Wasting Diuretics Licorice, Chewing Tobacco

Causes of Respiratory Alkalosis

HYPERventilation Heart + Liver Failure Sepsis Hypoxia Hypocapnia

A nurse on the respiratory unit is interpreting ABGs for several patients. The patient with which problem will the nurse suspect may have developed respiratory alkalosis? Hypoxia Atelectasis Chronic respiratory illness Sedative overdose

Hypoxia

Long Process, 1-3 days, Long Term Results

Kidneys

A nurse is caring for a patient in the intensive care unit. How will the nurse interpret the patient's arterial blood gas values: pH, 7.30; PaCO2, 36 mm Hg; HCO3-, 14 mEq/L? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic Acidosis

Symptoms of Metabolic Alkalosis

SHALLOW RESPIRATIONS MUSCLE TWITCHING PARESTHESIA TETANY Seizures Confusion

Metabolic Acidosis

decreased pH in blood and body tissues as a result of an upset in metabolism pH = goes down HCO3- = goes down

Metabolic Alkalosis

elevation of HCO3- usually caused by an excessive loss of metabolic acids pH = goes up HCO3- = goes up

Non Compensation

pH is abnormal PaCO2 OR HCO3 abnormal (Only one of them is normal)

Partial Compensation

pH, CO2, and HCO3 are ALL off

PaCO2

partial pressure of carbon dioxide (Lungs)

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse? Begin CPR Place the client in the supine position Administration of 0.4 mg of naloxone Administer a lower dose of the analgesic for the next dose

Administration of 0.4 mg of naloxone

The nurse is preparing to flush a client's peripheral venous access device. Which observable intervention best assures continued effective venous access at this location? Wearing gloves when preforming the intervention Anchoring extension tubing near entry site with tape Aspirating to determine positive blood return Using a 10 ml syringe to introduce the flushing solution

Anchoring extension tubing near entry site with tape

Respiratory Alkalosis

Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. pH = goes up PaCO2 = goes down

The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation? Hematocrit values Arterial blood gas Pulmonary function Hemoglobin levels

Arterial Blood Gas

The nurse is reviewing the results of a client's arterial blood gas and pH analysis. Which findings indicate to the nurse that intervention is not required? Select all that apply. HCO3 30 mEq/L Base excess or deficit +2 mmol/L PO2 70 mm Hg pH 7.45 PCO2 40 mm Hg

Base excess or deficit +2 mmol/L pH 7.45 PCO2 40 mm Hg

Symptoms of Respiratory Acidosis

Confusion Ashen Color Dyspnea with rapid, shallow respirations Tachycardia/<BP Dysrhythmias Hyperkalemia

pH = 7.50 PaO2 = 105 mmHg PaCO2 = 29 mmHg SaO2 = 99% HCO3 = 29 mEq/L The nurse has received the arterial blood gas (ABG) results. The ABG was drawn on a client who has been receiving oxygen via partial rebreather mask. Which assessment findings should the nurse act upon after reviewing the ABG? Select all that apply. tachycardia nasal flaring fatigue sore throat headache

Fatigue Sore Throat Fatigue

A nurse is obtaining an arterial blood specimen from a client to assess acid-base status. Which value is expected for a client with normal status? HCO3: 25 mEq/L (25 mmol/L) pH: 6.45 SaO2: 89% PaCO2: 48 mm Hg (6.38 kPa)

HCO3: 25 mEq/L (25 mmol/L)

Causes of Respiratory Acidosis

HYPOventilation Atelectasis COPD Pulmonary Edema Narcotics, Anesthesia, Head Trauma Airway Obstructions

A nurse carefully assesses the acid-base balance of a patient whose bicarbonate (HCO3-) level is decreased on the ABG results. This typically occurs in patients with damage to which organ? Kidneys Lungs Adrenal glands Brain

Kidneys

Arterial Blood Gases (ABGs)

Lab test that monitors acid base balance

Symptoms of Respiratory Alkalosis

Lightheaded Confusion Blurred Vision Dry Mouth PARESTHESIA SPASMS OF EXTREMITIES TETANY Hypokalemia

Short, Mins-Hrs, Short Term Results

Lungs

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? Respiratory acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis

Metabolic Alkalosis

An adult client has developed gastric esophageal reflux disease and is treating it with frequent doses of antacids. The nurse will assess for what acid-base disorder? Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Respiratory acidosis

Metabolic Alkalosis

The student nurse asks the instructor how buffer systems work in the body to maintain the pH of the blood. The instructor explains the buffer systems to the students. Which buffer systems will be discussed by the instructor? Select all that apply. Protein buffer system Respiratory buffer system Potassium buffer system Phosphate buffer system Carbonic acid-sodium bicarbonate buffer system

Protein buffer system Phosphate buffer system Carbonic acid-sodium bicarbonate buffer system

The nurse is caring for a client with metabolic acidosis whose breathing rate is 28 breaths per minute. Which arterial blood gas data does the nurse anticipate finding? pH less than 7.35; HCO3 high; PaCO2 high pH greater than 7.45; HCO3 low; PaCO2 low; hyperventilation pH greater than 7.45; HCO3 high; PaCO2 high pH less than 7.35; HCO3 low; PaCO2 low

pH less than 7.35; HCO3 low; PaCO2 low

The nurse is caring for a client with metabolic alkalosis whose breathing rate is 8 breaths/min. Which arterial blood gas data does the nurse anticipate finding?

pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l)

The nurse is caring for a client with metabolic alkalosis whose breathing rate is 8 breaths/min. Which arterial blood gas data does the nurse anticipate finding? pH: 7.28; PaCO2: 52 mm Hg (6.92 kPa); HCO3: 32 mEq/l (32 mmol/l) pH: 7.32; PaCO2: 28 mm Hg (3.72kPa); HCO3: 24 mEq/l (24 mmol/l) pH: 7.32; PaCO2: 26 mm Hg (3.46 kPa); HCO3: 18 mEq/l (18 mmol/l) pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l)

pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l)