acid/base imbalances

Question 1

how to determine type of acid/base imbalance

Answer 1

determine whether HCO3 goes in the same or opposite direction with pH
• Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base imbalance is metabolic … Otherwise, it is respiratory

Question 2

• pH 7.3

* HCO3 20

Answer 2

metabolic acidosis

Question 3

• pH 7.58

* HCO3 32

Answer 3

metabolic alkalosis

Question 4

• pH 7.22

* HCO3 35

Answer 4

respiratory acidosis

Question 5

As the pH goes, so goes my patient, except for….

Answer 5

Potassium … That means
• If pH is low, everything is low, except potassium
• If pH is high, everything is high, except potassium

Question 6

If pH goes over 7.45, this is…

and everything goes (up or down?)

Answer 6

Alkalosis
• Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic, diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
• However, potassium is opposite. Therefore, hypokalemia

Question 7

• What is the nursing intervention for pH >7.45?

Answer 7

o Pt need suctioning because of seizures

Question 8

If pH goes below 7.35, this is…

and everything goes (up or down?)

Answer 8

Acidosis
• Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
• However, potassium is high (hyperkalemia)

Question 9

Nursing intervention for pH <7.35?

Answer 9

o Pt needs to be ventilated with an Ambu bag—respiratory arrest

Question 10

So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause…

Answer 10

Metabolic ACidosis with Kussmaul respirations

Question 11

Cause of respiratory..

Answer 11

“Is it LUNG? … If yes, then it is respiratory

Question 12

If UNDERventilating

Answer 12

Then pick acidosis—pH is under 7.35

Question 13

If OVERventilating

Answer 13

Then it is alkalosis, pH is over 7.45

Question 14

What type of acid-base derangement is present in labor?

Answer 14

o Respiratory alkalosis … Overventilating—pH increases … Alkalosis)

Question 15

What type of acid-base derangement is present in drowning?

Answer 15

o Respiratory acidosis … Underventilating—pH decreases … Acidosis

Question 16

What type of acid-base derangement is present when pt is on PCA (patient-controlled anesthesia) pump?

Answer 16

o Ventilation is down … Respiratory acidosis

Question 17

cause of metabolic..

Answer 17

If it is not LUNG, then it is metabolic. If the patient has prolonged gastric vomiting or suction (sucking out acid), pick alkalosis
• For everything else that isn’t lung, pick metabolic acidosis