Acid Base Unit 5
CO2 is a ___
Acid
You are making rounds on your clients. You find one of your clients struggling to breathe, appears confused, has tachycardia, and the skin appears dusky. What should you do to restore normal pH if ventilation efforts are not very successful?
Administer sodium bicarbonate IV.
sodium bicarbonate is ___
Alka-Seltzer
Numbness/Tingling is a S/S of respiratory/metabolic ___?
Alkalosis
HCO3 is a ___
Bicarbonate/Base
Albuterol and salmeterol are ____ (Class)
Bronchodilators (terol= bronchodilator)
The less you breath out, the more ___ is retained
CO2
Tiotropium treats ___
COPD
Define Hypercapnia
Excess CO2
Monitor for ___ with sodium bicarbonate
Diarrhea
Tiotropium is not for people with ___ problems
Eye
Which medication can cause dryness ___
Ipratropium Bromide
Eliminate excessive chloride intake with ___
Metabolic Acidosis
Increased BP is a S/S of ___
Metabolic Acidosis
Giving bicarbonate cautiously is a treatment for ___
Metabolic Acidosis Cautiously to not turn them into alkalosis
Dialysis is a treatment for which condition?
Metabolic acidosis (Due to RF)
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur?
Metabolic alkalosis
Bronchodilators and Anticholinergics can help treat ___
Respiratory Acidosis
What happens in respiratory alkalosis? The renal excretion of bicarbonate decreases and hydrogen ions are excreted. or The renal excretion of bicarbonate increases and hydrogen ions are retained.
The renal excretion of bicarbonate increases and hydrogen ions are retained.
pH 7.48 PaCO2 42 HCO3 35 metabolic acidosis (no compensation) metabolic alkalosis (no compensation)
metabolic alkalosis (no compensation)
What do bronchodilators do?
open narrowed airways
What is the normal HCO3 (bicarbonate) in the blood?
22-26
What is the normal PaCO2 in the blood?
35-45
What is the normal range for the pH level in the blood?
7.35-7.45
___ is used to determine blood pH
ABG
Hydrogen is a ___
Acid
Alcohol can lead to respiratory ___
Acidosis
Bronchodilators improve respiratory ___
Acidosis
Cold/Clammy skin is a S/S of metabolic ___
Acidosis
Emphysema can cause respiratory ___
Acidosis
Head injuries can cause respiratory ___
Acidosis
Impaired gas exchange/Respiratory distress can lead to respiratory ___
Acidosis
Low respiratory rate can lead to? Respiratory Acidosis or Respiratory Alkalosis
Acidosis
Opioids and Benzodiazepines can cause respiratory ___
Acidosis
Sleep apnea can cause respiratory ___
Acidosis
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first?
Administer oxygen by nasal cannula as ordered. (PaO2 is at 60)
Ipratropium Bromide and Tiotropium are what class?
Anticholinergics
Substance which minimizes or prevents large changes in pH when an acid or base is too high or too low. This helps the body to get back in midline range. Buffer or Base
Buffer
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. ___, ___, ___
Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.
theophylline is ___ and no longer ___
Dangerous and No longer first choice in bronchodilators
In hypoventilation there is CO2___ Loss or Excess
Excess When client is HYPOventilating, there is an increase in acid as the client is unable to blow off CO2. If a client were to HYPERventilate, then they would be blowing off CO2 and there would be a loss.
To correct acidosis, the kidneys excrete ___ out of the body through urination and conserve ___
H+ HCO3
Metabolic acidosis causes the kidneys excrete ___ and hold ___
HCO3 (base) H+
The lower the H+ the ___ the pH
Higher
In metabolic acidosis, the respiratory rate will increase or decrease to try to compensate?
Increase
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increases arterial pH
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Instruct the client to breathe into a paper bag.
A client has received too much morphine in the postsurgical recovery room and ABGs reveal the client has developed respiratory acidosis. Which assessment findings correlate with acute primary respiratory acidosis? Select all that apply. ___, ___, ___
Irritability Muscle twitching Respiratory depression (Inhaling acid (respiratory) will make you irritable bc that not how your supposed to ingest it)
sodium bicarbonate treats what condition?
Metabolic acidosis
The 2 buffer systems to help maintain homeostasis in the body are the lungs and the ___
Kidneys
Where is H+ and HCO3 found?
Kidneys
In metabolic acidosis, is there is a ___ Low pH and a low bicarbonate concentration or high pH and a high bicarbonate concentration
Low pH and a low bicarbonate concentration
The greater the concentration of H+ the _________the pH. Higher or Lower
Lower
Where is HCO3 and CO2 found?
Lungs
Which organ can correct faster Lungs or Kidneys
Lungs
A nurse carefully assesses the acid-base balance of a patient whose carbonic acid level is decreased. This is most likely a patient with damage to the: Lungs Kidneys Adrenal Glands Blood Vessels
Lungs The lungs are the primary controller of the body's carbonic acid supply and thus, if damaged, can affect acid-base balance. The kidneys are the primary controller of the body's bicarbonate supply. The adrenal glands secrete catecholamines and steroid hormones. The blood vessels act only as a transport system.
Kussmal Respirations are a S/S of?
Metabolic Acidosis Rapid breathing to excrete CO2 (Acid)
Monitor clients neuro status with ___
Metabolic Acidosis (Eating (metabolic) acid will make you crazy)
Confusion/LOC Muscle twitching Drowsy Are S/S of ___
Metabolic Acidosis (Eating (stomach/metabolic) acid will make you dizzy and confused to the point that you LOC)
Increased RR due to body trying to compensate for?
Metabolic Acidosis (The kidneys compensate for your lungs and vice versa)
Check gi volume loss with NGT can help dx ___
Metabolic Alkalosis
Cystic Fibrosis can cause ___
Metabolic Alkalosis
Maintain chloride levels with ___
Metabolic Alkalosis
Pyloric Stenosis can cause ___
Metabolic Alkalosis
Vomiting, NGT, and Drains can cause ___
Metabolic Alkalosis
Excessive adrenocorticoid hormones like Hyperaldonsteronism and Cushing's can cause ___
Metabolic Alkalosis H+ loss due to kidneys
Isotonic IV fluid can help treat ___
Metabolic Alkalosis (I just remember this as alkaLOsis means you're low on electrolytes and isotonics have all the electrolytes)
Antacids can cause ___ because they have ___ in them
Metabolic Alkalosis because they have bicarbonate in them
Decreased cardiac output is a S/S of ___
Metabolic acidosis
Diarrhea and renal failure and s/s of?
Metabolic acidosis
Shock and Coma are S/S of ___
Metabolic acidosis
Which acid-base imbalance would the nurse suspect after assessing the following 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 A low pH indicates acidosis. This, coupled with a low bicarbonate, indicates metabolic acidosis. The pH and bicarbonate would be elevated with metabolic alkalosis. Decreased PaCO2 in conjunction with a low pH indicates respiratory acidosis; increased PaCO2 in conjunction with an elevated pH indicates respiratory alkalosis.
The emergency-room nurse is caring for a trauma client. Your client has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 20 mEq/L. How should the nurse interpret these results? Uncompensated respiratory acidosis. Fully compensated metabolic acidosis Metabolic acidosis with partial compensation Metabolic alkalosis with partial compensation
Metabolic acidosis with partial compensation The client is experiencing metabolic acidosis with partial compensation. The pH matches the HCO3 when doing the tic-tac-toe method. Then there is a PaCO2 that is on the alkalotic side. It is trying to help it's friend to get the pH and HCO3 back to normal. It is partially compensated because nothing is back to normal YET. Full compensation is only seen when the pH is in the normal range!!!
What can occur with long term diuretic therapy? Metabolic alkalosis Metabolic acidosis Hyperkalemia Respiratory acidosis
Metabolic alkalosis There can be a loss in potassium related to long term diuretic therapy. Hypokalemia can result in Alkalosis.
What drug class for theophylline
Methylxanthine (Theo likes meth)
ipratropium bromide does what ___ (action) and if for clients that ___
Opens the airway and is for clients that can not tolerate other drugs
Respiratory Alkalosis is caused by breathing ___
Out too much CO2
Define atelectasis
Partial or complete lung collapse
Increased cardiac output is seen in ___
Respiratory acidosis
ipratropium and tiotropium treat
Respiratory acidosis
A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? Respiratory acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis
Respiratory acidosis The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, it is a respiratory acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21 indicates an acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range, ruling out metabolic acidosis.
Inadequate excretion of CO2 can result in? Respiratory acidosis or Respiratory alkalosis
Respiratory acidosis There is an over accumulation of acid in the lungs.
Breathing into a bag treats?
Respiratory alkalosis
Dry mouth and Tinnitus are s/s of
Respiratory alkalosis
Sedatives treat?
Respiratory alkalosis
Trousseau's sign is a sign of ___
Respiratory alkalosis
A client has a diagnosis of generalized anxiety. What should the nurse see in this client who develops light headedness and is hyperventilating? Respiratory acidosis or Respiratory alkalosis
Respiratory alkalosis The client is blowing off CO2 related to hyperventilating. They should slow the rate and breathe in a closed system like a paper bag.
Hypokalemia and Hypocalcemia can be a S/S of ___ and ___
Respiratory and Metabolic Alkalosis (Hypo means low so alkaLOsis means low)
Hyperkalemia can be a S/S of ___ and ___
Respiratory and Metabolic acidosis (Hyper means high, high reminds me of acid)
ipratropium bromide is a nasal spray that treats ___
Seasonal allergies
Position to improve respiratory acidosis
Semi high fowlers
Which medication needs its own IV line ___
Theophylline (It doesn't mix well with other drugs)
Left over powder is ok with the medication ___
Tiotropium
In respiratory alkalosis , the kidneys will retain hydrogen ions and excrete bicarbonate ions. T/F?
True
The nurse is caring for a client diagnosed with Emphysema. The nurse learns that the client's PaCO2 has been between 56 and 64 mm Hg for several months. Why should the nurse be cautious administering oxygen? Oxygen may cause the client to hyperventilate and become acidotic. Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. Oxygen will increase the client's intracranial pressure and create confusion. The client's calcium will rise dramatically due to pituitary stimulation.
Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. No information indicates the client's calcium will rise dramatically due to pituitary stimulation. No feedback system that oxygen stimulates would create an increase in the client's intracranial pressure and create confusion. Increasing the oxygen would not stimulate the client to hyperventilate and become acidotic; rather, it would cause hypoventilation and acidosis.
With respiratory acidosis you need to improve ___
Ventilation
Potassium promotes ___
acid-base balance
A client with emphysema is at a greater risk for developing which acid-base imbalance?
chronic respiratory acidosis
Caution for hypersensitivity with ___
ipratropium bromide
Define Hypoxemia
low oxygen in the blood
pH 7.25 PaCO2 45 HCO3 21 metabolic acidosis respiratory acidosis
metabolic acidosis
pH 7.25 PaCO2 33 HCO3 21 metabolic acidosis with partial compensation metabolic acidosis with full compensation respiratory acidosis with full compensation respiratory alkalosis with partial compensation
metabolic acidosis with partial compensation
A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?
metabolic alkalosis
A client is on a mechanical ventilator. Blood gases are pH 7.5 and PCO2 30. Which lab would be most likely noted in this condition? phosphorus level of 4 potassium level of 3 sodium level of 145 magnesium level of 2
potassium level of 3 The client is experiencing respiratory alkalosis. A low potassium can be seen with alkalosis. There is a deficit of acid and an accumulation of base. This occurs in conditions that cause over-stimulation of the respiratory system. (The nurse will need to change the settings on the ventilator.)
pH 7.23 PaCO2 53 HCO3 28 metabolic acidosis with full compensation respiratory acidosis with partial compensation metabolic alkalosis with partial compensation respiratory acidosis with full compensation
respiratory acidosis with partial compensation
pH 7.53 PaCO2 23 HCO3 22 respiratory alkalosis (uncompensated) respiratory acidosis (uncompensated)
respiratory alkalosis (uncompensated)
pH 7.53 PaCO2 30 HCO3 21 respiratory alkalosis with full compensation respiratory alkalosis with partial compensation metabolic acidosis with partial compensation metabolic alkalosis with full compensation
respiratory alkalosis with partial compensation