ACID/BASE Flashcards

Question

_Metabolic Acidosis Manifestions_

Answer 1

General manifestations: weakness, fatigue, headache, malaise **GI** manifestations → N&V **Neurological** manifestations → Decreased LOC **Cardiac** manifestations → ↑HR, ↓BP, dysrhythmias **Integumentary** manifestations→ Warm & flush **Kussmaul respiration** →Deep and rapid

Answer 2

Focus on treating primary disorder Diagnostic tests Pharmacologic therapy

Answer 3

Nursing interventions may include the following tasks: Monitor cardiac status Monitor for potential excess fluid volume

Answer 4

* Characterized by high pH (\>7.45) * High bicarbonate (\>26 mEq/L) * May be caused by loss of acid or excess bicarbonate in body * Respiratory system attempts to compensate• PaCO₂ increases (\>45 mmHg)

Answer 5

Result of decreased calcium •Numbness/tingling around mouth, fingers, toes• Dizziness• Trousseau sign• Muscle spasms• Respirations depressed• Respiratory failure with hypoxemia• Respiratory acidosis

Answer 6

* Teach risks of using sodium bicarbonate * Availability of other antacid preparations * Seek medical evaluations for persistent gastric symptoms

Answer 7

* Respiratory à retention of CO₂, increasing carbonic acid * *Respiratory acidosis* * Retention of carbon dioxide * Increase CO2•*Respiratory alkalosis* * Excess loss of carbon dioxide * Decrease CO2 Taylor Fundamentals 1566-1567 Honan Adult Health 88-90 Respiratory is OPPOSITE pH and PaCO2 will be opposite!!

Answer 8

Risk factors Acute respiratory disease Pulmonary edema Aspiration of a foreign body Atelectasis Overdose of sedative or anesthetic Cardiac arrest Chronic respiratory disease Emphysema Bronchial asthma Cystic fibrosis Inadequate mechanical ventilation CNS depression Neuromuscular disease Assesment Acute respiratory acidosis Mental cloudiness Dizziness Muscular twitching Unconsciousness ABGs pH \<7.35 PaCO₂ \>45 mm Hg (primary) HCO₃⁻ normal or only slightly elevated Chronic respiratory acidosis Weakness Dull headache ABGs pH \<7.35 or low N PaCO₂ \>45 mm Hg (primary) HCO₃⁻ \>26 mEq/L (compensatory) Nursing interventions Treatment is directed at improving ventilation Pharmacologic measures Pulmonary hygiene measures Adequate hydration Supplemental oxygen Mechanical ventilation may be necessary to correct disorder but must be used cautiously to decrease PaCO₂ slowly.

Answer 9

Risk factors Hyperventilation Extreme anxiety (most common cause) Hypoxemia High fever Early sepsis Excessive ventilation by mechanical ventilator CNS lesion involving the respiratory center Assessment Lightheadedness Inability to concentrate Hyperventilation syndrome Tinnitus Palpitations Sweating Dry mouth Tremulousness Convulsions and loss of consciousness ABGs pH \>7.45 PaCO₂ \<35 mm Hg (primary) HCO₃⁻ \<22 mEq/L (compensatory) Nursing Interventions If anxiety is the cause, encourage the patient to breathe more slowly (causes accumulation of CO₂) or breathe into a closed system (paper bag). Sedative may also be necessary in extreme anxiety. Treatment of other causes is directed at correcting the underlying problem.

Answer 10

* Caused by excess of carbonic acid * Characterized by a pH \< 7.35 * PaCO₂ \> 45 mmHg * May be acute or chronic * Kidneys compensate by retaining bicarbonate

Answer 11

* Results from sudden failure of ventilation * Acute pneumonia * Overdose of sedatives or narcotics * Trauma * Aspiration * PaCO₂ rises rapidly * pH falls markedly * pH of 7 or lower can occur

Answer 12

* Associated with chronic respiratory (Cystic Fibrosis) or neuromuscular conditions (ALS, Guillain Barre) * Affects alveolar ventilation * Majority have COPD à bronchitis, emphysema * PaCO₂ increases over time, remains high * Kidneys retain bicarbonate * pH often close to normal * Hypercapnia * Carbon dioxide narcosis

Answer 13

Carefully monitor the neurological and respiratory status in clients with chronic respiratory acidosis who are receiving oxygen therapy. Immediately report a decrease in LOC or depressed respirations.

Answer 14

Acute respiratory acidosis •PaCO₂ levels rise rapidly•Cause manifestations of hypercapnia•Cerebral vasodilation•LOC progressively decreases•Rapid changes in ABGs•Skin warm, flushed•Pulse elevated

Answer 15

Nursing interventions may include the following tasks: Monitor cardiac status Monitor respiratory status

Answer 16

* Always caused by hyperventilation, leading to carbon dioxide deficit * Characterized by a pH \> 7.45 * PaCO₂ \< 35 mmHg

Answer 17

Light-headedness The feeling of panic and difficulty concentrating Circumoral and distal extremity paresthesias Tremors Positive Chvostek sign Trousseau sign

Answer 18

Management focuses on correcting the imbalance and treating the underlying cause. Create calm environmental Quiet, low stimulation Reduce anxiety or panic ABGs prior to meds or O₂therapy

Answer 19

**Goal of treatment**: Restore or maintain normal body balance * Identify the underlying cause * Collaborative care Health history Daily weight Monitoring of intake and output Assessing respiratory and renal function Maintenance of patent airway Oxygen saturation monitoring

Answer 20

1. Is it a ***respiratory*** or a ***metabolic*** problem? 2. Is this ***alkalosis*** or ***acidosis?*** 3. Is this ***uncompensated or compensated?***

Answer 21

1 Look at pH 2. Look at PaCO₂ 3. Look at HCO₃^- 4. Look at the PaCO₂ or the HCO₃^- and match either with the pH. 5. Look at the total picture and determine if compensated. 6. Look at PaO2 and SaO2

Answer 22

* **Respiratory Acidosis**•pH ↓•PaCO2 ↑•HCO3: WNL * **Respiratory Alkalosis**•pH ↑•PaCO2↓•HCO3: WNL * **Metabolic Acidosis**•pH ↓•PaCO2: WNL•HCO3 ↓ * **Metabolic Alkalosis**•pH ↑•PaCO2: WNL•HCO3 ↑

Answer 23

**_5. Look at the total picture and determine whether compensation has occurred._** Determine whether the body is compensating for the pH change. Complete compensation occurs when the body’s ability to compensate is so effective that the pH falls within the normal range. Partial compensation occurs when the pH remains outside the normal range. Compensation involves opposites: for example, in primary metabolic acidosis, compensation involves respiratory alkalosis; in primary respiratory acidosis, compensation involves metabolic alkalosis. Determine which level more closely corresponds with the pH, indicating the primary cause of the problem. The other level reflects the compensation. Example: pH ↓7.29 PaCO2 ↓17 mm Hg HC ↓19 mEq/L The low pH indicates acidosis; the PaCO2 is low, which normally leads to alkalosis, and the bicarbonate level is low, which normally leads to acidosis. In this example, the bicarbonate level more closely corresponds with the pH, making the primary cause of the problem metabolic. The resultant decrease in PaCO2 reflects partial respiratory compensation—metabolic acidosis with partial respiratory compensation (Willis, 2015). When compensation occurs, the PaCO2 and the HCO3− will always point in the same direction.

Answer 24

* PaO2 \< 80% - hypoxemia * SaO2 \< 95% - hypoxemia * Hypoxemia – low O2 in blood * Hypoxia – low O2 to tissues * Low Saturation – less O2 on hemoglobin SaO2 is that there are some things that will affect its accuracy or reliability. Because of these things, you may see a high SpO2 but actually the patient is not oxygenating well at all. Remember that the SaO2 measures the saturation of hemoglobin. 1.Oxygenation Values on an ABG1.PaO2 – Partial Pressure of Oxygen1.Amount of oxygen dissolved in arterial blood2.How well the lungs are working to get O2 INTO the arterial blood2.SaO2 – Arterial Oxygen Saturation1.Percentage of hemoglobin molecules fully saturated with oxygen in arterial blood2.How well is the blood carrying/transporting O2 to the tissues2.Pulse Oximetry1.An indirect, peripheral measurement of oxygen saturation2.Affected by peripheral perfusion and temperature Nursing Points General 1.Normal Values1.PaO2 → 80-100 mmHg1.On Room Air (21% FiO2)2.SaO2 → 95-100%2.Oxyhemoglobin Dissociation Curve1.Patient conditions affect ‘affinity’ of Hgb for O22.Same SaO2, different PaO2 Assessment 1.Low PaO2 or SaO21.Cyanosis2.Dyspnea3.Tachypnea4.Cool skin2.Low PaO2 but high SaO21.Limitations of SaO21.Anemias2.Carbon Monoxide poisoning1.Headache, dizziness, dyspnea, no cyanosis3.P/F Ratio1.Normal PaO2, but on supplemental oxygen = something’s still wrong2.PaO2 ÷ FiO2 → Normal is \>4003.Example1.PaO2 1202.FiO2 60%3.P/F Ratio = 120 / 0.60 = 2001.Indicates moderate to severe ARDS Therapeutic Management 1.Give supplemental O22.Blood transfusions as needed3.May require mechanical ventilation if respiratory effort is not sufficient Nursing Concepts 1.Oxygenation2.Gas Exchange Patient Education 1.May need to help family understand the numbers, if they are anxious

Answer 25

1 Determine the PH 2. Look at the PaCO2. Remember, carbon dioxide is produced by cellular metabolism and is excreted by the lungs through exhalation. It represents the respiratory component of the blood gas. Normal levels range from 35 to 45 mm Hg. Changes in the PaCO2 reflect lung function. A PaCO2 level below 35 mm Hg can be caused by hyperventilation, resulting in alkalosis. When the patient retains CO2, as a result of hypoventilation, for example, the PaCO2 level rises above 45 mm Hg, resulting in acidosis. 3. Look at the HCO3−. Remember, bicarbonate is produced by the kidneys. It represents the metabolic component of the blood gas. Normal levels range from 22 to 26 mEq/L. Changes in the HCO3− reflect kidney function. A HCO3−level below 22 mEq/L indicates acidosis and above 26 mEq/L indicates alkalosis. **_4. Look at the PaCO2 or the HCO3- and match either with the pH._** If the pH is low and the PaCO2 is high, the patient has respiratory acidosis. If the pH is high and the PaCO2 is low, the patient has respiratory alkalosis. If the pH and HCO3−are high but the PaCO2 is normal, the patient has metabolic alkalosis. The patient has metabolic acidosis if the pH and HCO3−are low and the PaCO2 is normal (Woodruff, 2006). **_5. Look at the total picture and determine whether compensation has occurred._** Determine whether the body is compensating for the pH change. Complete compensation occurs when the body’s ability to compensate is so effective that the pH falls within the normal range. Partial compensation occurs when the pH remains outside the normal range. Compensation involves opposites: for example, in primary metabolic acidosis, compensation involves respiratory alkalosis; in primary respiratory acidosis, compensation involves metabolic alkalosis. Determine which level more closely corresponds with the pH, indicating the primary cause of the problem. The other level reflects the compensation. Example: pH ↓7.29 PaCO2 ↓17 mm Hg HC ↓19 mEq/L The low pH indicates acidosis; the PaCO2 is low, which normally leads to alkalosis, and the bicarbonate level is low, which normally leads to acidosis. In this example, the bicarbonate level more closely corresponds with the pH, making the primary cause of the problem metabolic. The resultant decrease in PaCO2 reflects partial respiratory compensation—metabolic acidosis with partial respiratory compensation (Willis, 2015). When compensation occurs, the PaCO2 and the HCO3− will always point in the same direction.

Answer 26

Lung / respiratory

Answer 27

Kidneys / metabolic

ACID/BASE Flashcards

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