Nursing Process - Acid/Base Balance: Lec 9

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Assessing

Acute and chronic illness, trauma and certain therapeutic interventions may place a patient at risk for acid-base imbalances These can seriously compromise the patient's health status and may prove life threatening

What is being measured by these numbers?

Alveolar ventilation (by pCO2) Hypoxia (by pO2 and O2 Sat) Acid base status (by pH)

Conditions Respiratory Acidosis

COPD, pulmonary edema, pneumothorax, overdose, severe pneumonia, ARDS, resp. failure, post anesthesia; over sedation

3rd step

Determine whether body is compensating for the pH change Problem - respiratory the renal system assists in compensation either by increasing or decreasing HCO³ Problem - metabolic the respiratory system assists by regulating CO² Compensation PaCO² and HCO³ - point in same direction

Nursing Process - Evaluating

Evaluation must be ongoing with acid-base imbalances Evaluate and readjust plans and interventions throughout nursing care Effectiveness of the plan should result in the client being able to practice self-care behaviors to maintain acid-base balance

Nursing Process - Outcome Identification and Planning

Exhibit signs and symptoms of restored balance or homeostasis after initiation of treatment Practice self-care behaviors to promote acid-base balance and respond appropriately to the body's signals of impending acid-base imbalance

2nd step

If a change in pH is present, determine if it is respiratory (PaCO² ) or metabolic (HCO³)

Nursing Process - Diagnosing

Ineffective Breathing Pattern related to compensatory mechanism of lungs (hypoventilation or hyperventilation) Anxiety related to hyperventilation

1st step Interpreting ABGs

Is to determine whether the pH is normal, alkalotic or acidotic Normal 7.35 -7.45 Acidotic < 7.35 Alkalotic > 7.45

Arterial Blood Gases (ABGs)

Laboratory tests commonly used to determine the adequacy of oxygenation and ventilation, as well as in the assessment and treatment of acid-base imbalances Findings are obtained through analysis of an arterial blood sample pH of blood indicates balance or impending acidosis or alkalosis The blood's oxygenation and carbon dioxide gas values are also reported Provides information regarding the effectiveness of the respiratory system

4th step

Look at the total picture and determine whether compensation has occurred Absent if: pH abnormal, one component abnormal, one normal Partial if: pH abnormal, one component abnormal, one beginning to change Complete if: pH abnormal, one component abnormal, second changed to move pH within normal range

What does the ABG tell you about your patient?

Obtains baseline information about pt. Assesses extent of lung disease Acid - base balance Determines if O2 therapy (or mechanical ventilation) is successful.

Corrective actions involve medical and nursing interventions to promote a return to homeostasis

Pharmacologic agents Mechanical ventilation Monitor intake/output

The partial pressures are indicated by "P", the "a" indicates an arterial specimen

The partial pressure of carbon dioxide is abbreviated PaCO² The partial pressure of oxygen is abbreviated PaO²

Additional ABG Values

The partial pressure of oxygen - PaO² and Oxygen saturation - SaO² Directly reflect the adequacy of oxygenation and ventilation

Nursing Process - Implementing

Treatment is directed at improving ventilation possibly through mechanical assistance Correction of underlying problem is the mainstay of interventions for acid-base imbalances

Assessment related to acid-base imbalance should include

a nursing history, physical assessment, fluid intake and output, daily weight, and laboratory studies, specifically the arterial blood gases

Conditions Respiratory Alkalosis

anxiety bacteremia fever hypoxemia pain pulmonary embolism

The PaCO² low

carbonic acid leaves the body in excessive amounts

Assessment Metabolic Acidosis

confusion drowsiness headache nausea/ vomiting resp. rate

Assessment Respiratory Acidosis

confusion lethargy nausea restlessness seizures shallow resp.

Treatment Metabolic Alkalosis

correct the cause restore fluid volume

Treatment Metabolic Acidosis

correct the defect may administer NaHCO3

Although compensation is the body's natural attempt to restore balance

correction may also be required

Conditions Metabolic Acidosis

diarrhea diabetic ketoacidosis renal insufficiency salicylate poisoning

Conditions Metabolic Alkalosis

diuretics gastric suction vomiting steroids

Causes Metabolic Alkalosis

gain of HCO3 or loss of H+

Causes Respiratory Alkalosis

hyperventilation

Causes Respiratory Acidosis

hypoventilation

The nursing assessment is directed toward the following:

identifying those at risk for acid-base imbalance Determine the specific imbalance through defining characteristics and assessment findings Determining plan of care, appropriate nursing diagnosis, followed by specific outcomes and associated interventions Evaluate the effectiveness of the plan of care

Assessment Respiratory Alkalosis

inability to concentrate lightheadedness loss of consciousness numbness and tingling resp. rate (increased)

Causes Metabolic Acidosis

loss of HCO3 or gain of H+

The kidneys are involved in either

reabsorbing bicarbonate or excreting bicarbonate, depending on what is needed to maintain the delicate acid-base balance

The PaCO² influenced by

respiratory activity

The bicarbonate level (HCO³ ) reflects

the bicarbonate level of the body

When the PaO² is low,

the hemoglobin carries less than normal amounts of oxygen

When the PaO² is high,

the hemoglobin carries more oxygen

Oxygen saturation readings (SaO² ) reveal

the percentage of oxygen in the blood that combines with hemoglobin

The PaCO² high

there are excessive amounts of carbonic acid in the body

Assessment Metabolic Alkalosis

tingling of fingers and toes neuromuscular irritability dizziness

Treatment Respiratory Alkalosis

treat cause rebreathe CO2: paper bag

Treatment Respiratory Acidosis

treat cause of hypoventilation


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