Understanding Acid-Base Imbalances: Critical Thinking Guide
School
Keiser University, Miami**We aren't endorsed by this school
Course
FUN 1022
Subject
Nursing
Date
Dec 11, 2024
Pages
7
Uploaded by nancynicolas7nn
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking WorksheetConcept: Acid-BaseCritical Thinking WorksheetComplete the following normal ranges:pH: ____7.35-7.45___PaO2: __80-100 mm Hg_____SaO2: _____94-100 %_______PaCO2: _____22-26_________HCO3: ________35-45_______ROME METHODROMEWhat Does EachLetter Stand For?pH valuePCO2HCO3RRespiratory ↓↑nOOppositeMMetabolic↑n↑EEqualPlace your pH values on the arrow to help you rememberpH PaCO2 HCO37.35 – 7.45 35 – 45 21 – 28 Respiratory Acidosis↓ ↑normalRespiratory Alkalosis↑ ↓normalMetabolic Acidosis↓ normal↓Metabolic Alkalosis↑ normal↑CO2=_Lungs___ and supports _______________________________HCO3=_Kidney_ and supports _______________________________Define the below:•Uncompensated or not compensated = CO2 & HCO3 abnormal in same direction. Partial = pH Abnormal•Full or Compensated = pH in range
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking WorksheetTreatment for hyperventilation addresses the underlying disorder. The person may breathe through a rebreather mask temporarily, mixing the excessively exhaled carbon dioxide with oxygen so that carbon dioxide is inhaled. If the underlying cause of respiratory alkalosis is panic,treatment is aimed at preventing further hyperventilation and helping the patient reestablish a normal level of carbon dioxide in the blood. Sedatives may be given to calm the patient. To aid in the retention of carbon dioxide, the patient may be instructed to hold the breath or breathe into a paper sack and then rebreathe the carbon dioxide exhaled. This recycling of carbon dioxide can eventually restore normal carbonic acid levels in the blood.Interventions1. Monitor for signs of respiratory distress.2. Provide emotional support and reassurance to the client.3. Assist with breathing techniques and breathing aids as prescribed.a. Voluntary holding of the breath if appropriateb. Use of a rebreathing mask as prescribedc. Carbon dioxide breaths as prescribed (rebreathing into a paper bag)4. Monitor ventilator clients to be sure that they are not forced to take breaths too deeply or rapidly.5. Monitor electrolyte values, particularly potassium and calcium levels.Respiratory AlkalosisExpected Lab Values:_pH>45; CO2<35;K; ↓Ca; Treatment: __Prevent further loss of hydrogen, Potassium, calcium, chloride ions. Restore fluid balance. Monitor changes, provide safety Modify or DC Gastric suctioning, AntiemeticsAdjust/DC drugs that promote hydrogen ion excretion, Nutritional support, Provide Safety / Prevention of complicationsCauses: hyperventilation, fear, anxiety, mechanical ventilation, salicilate toxicity, high altitidues, early stage acute respiratory problems. Signs & Symptoms: CNS - increased activity, anxiety, irritability, tetany, seizures, parasthesias, NV – hyperreflexia, muscle cramping, twitching, weaknessCV- increased HR, normal or low BP, increased digixin toxicity Resp – hyperventilation
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking Worksheet6. Calcium gluconate may be prescribed for tetany; assist with administration.Diet: Foods high in nutrients and potassium can help combat electrolyte deficiencies. Nutrients and potassium are primarily found in fruits and vegetables, as well as some other foods, such as: carrots; bananas; milk; beans; spinach; bran. Food ↑KNursing priorities – preventing complications Monitoring breathing status hourly and intervening when changes occur. Auscultation of lungs, monitor for retractions, accessory muscle use, audible grunt or wheeze (without stethoscope) Cyanosis in nail beds and circumoral. The treatment for respiratory acidosis is establishment or maintenance of an airway. Use of noninvasive positive 49pressure ventilation or the insertion of an endotracheal tube may be necessary. Oxygen administration may be needed, and the assistance of a mechanical ventilatormay be required. Conservative treatment includes deep-breathing exercises with use of an incentive spirometer, bronchodilators, and antibiotics if indicated. Care must be taken when Respiratory AcidosisExpected Lab Values:_Elevated K as body attempts to maintain electroneutrality during bufferingpH below 7.35, PaO2 <90mm Hg, PaCo2 >50 and can even be >100 mm Hg, bicarb 21-28mEq/L or higherTreatment: Drug therapy (bronocodilators, anti-inflammatories, mucolytics), oxygen, pulmonary hygeine, (positioning DBC) ventilation Causes: __Anesthetics, drugs (especially opiods) Electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block__267___ Signs & Symptoms: _CV - Brady/<3 block, tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulsesCNS – Lethargy, confusion, stupor, comaNM – Hyporeflexia, SM weakness, flaccid paralysis -269
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking Worksheetadministering certain drugs that depress the respiratory center, including narcotics, hypnotics, and tranquilizers.The patient must be watched closely for respiratory and cardiac arrest. Should either occur, it will be necessary to maintain respiration and circulation artificially through cardiopulmonary resuscitation.Clinical CuesIn patients with COPD, the respiratory drive mechanism is altered, and oxygen can act as a respiratory depressant. Oxygen should be administered with great care to these patients (no more than 2 to 3 L/min) because it can cause respiratory arrest.If a patient's history is unknown, oxygen is begun at a rate of 2 to 3 L/min until it is determined that a higher flow rate can be tolerated.Interventions1. Monitor for signs of respiratory distress.2. Administer oxygen as prescribed.3. Place the client in a semi-Fowler’s position.4. Encourage and assist the client to turn, cough, and deep-breathe.5. Encourage hydration to thin secretions.6. Reduce restlessness by improving ventilation rather than by administering tranquilizers, sedatives, or opioids because these medications further depress respirations.7. Prepare to assist to administer respiratory treatments as prescribed.8. Suction the client’s airway, if necessary.9. Monitor electrolyte values, particularly the potassium level.10. Assist to administer antibiotics for respiratory infection or other medications as prescribed.11. Prepare to assist with endotracheal intubation and mechanical ventilation (these measures may be instituted if CO2 levels rise above 50 mm Hg and if signs of acute respiratory distress are present).Diet:COPD: Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of protein at least twice a day to help maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat, fish, poultry, nuts and driedbeans or peas.
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking WorksheetTreatment is directed at correcting the underlying cause and attempting to restore the body fluids to a less alkaline state. Fluids and electrolytes are replaced orally and parenterally as needed. Emergency measures include the administration of an acidifying solution, such as ammonium chloride. Interventions1. Monitor for signs of respiratory distress.2. Monitor potassium and calcium levels.3. Institute safety precautions.4. Medications and intravenous fluids to promote the kidney excretion of bicarbonate may be prescribed.5. Prepare to assist with potassium replacement as prescribed.6. The underlying cause of the alkalosis needs to be treated.Metabolic AlkalosisExpected Lab Values:↓K_overdose NaTreatment: __Prevent further loss of hydrogen, Potassium, calcium, chloride ions. Restore fluid balance. Monitor changes, provide safety Modify or DC Gastric suctioning, AntiemeticsAdjust/DC drugs that promote hydrogen ion excretion, Nutritional support, Provide Safety / Prevention of complicationsCauses: Antacids, blood transfusions, sodium bicarbonate TPN, prolonged vomiting, NG suction, hypercortisolism, hyperaldosteronism, loop and thiazide diuretics Signs & Symptoms: CNS - increased activity, anxiety, irritability, tetany, seizures, parasthesias, NV – hyperreflexia, muscle cramping, twitching, weaknessCV- increased HR, normal or low BP, increased digixin toxicity Resp – decreased respiratory effort
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking WorksheetNursing focus – continuously monitor the client for indications of response. Is the condition improving or worsening? CV and skeletal muscle symptoms are sensitive to acidosis and are the priority. Interpreting ABGs results. Acidodis s/s CV - Brady/<3 block, tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulsesCNS – Lethargy, confusion, stupor, comaNM – Hyporeflexia, SM weakness, flaccid paralysis Interventions1. Monitor for signs of respiratory distress.2. Check level of consciousness for central nervous system depression.3. Monitor intake and output and assist with fluid and electrolyte replacement as prescribed.4. Initiate safety and seizure precautions.5. Monitor the potassium level closely; as metabolic acidosis resolves, potassium moves back into the cells, and the potassium level decreases.Monitor the client experiencing severe diarrhea for manifestations of metabolic acidosis.E. Interventions for diabetes mellitus and diabetic ketoacidosis1. Give insulin as prescribed to hasten the movement of serum glucose into the cell, thereby decreasing the concurrent ketosis.2. When glucose is being properly metabolized, the body stops converting fats to glucose.Metabolic AcidosisExpected Lab Values:↓Na _Elevated K as body attempts to maintain electroneutrality during bufferingpH below 7.35, PaO2 80-100 mm Hg, PaCo2 35-40, bicarb 15-20 mEq/L or lowerTreatment: Hydration, drugs and treatments to control the cause, (DKA - insulin) (Dehydration - Rehydration, antidirrheals) Bicarb if levels are low and pH is less than 7.2 Causes: DKA, starvation, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol or methanol intoxication (alcohol), salicylate intoxication, kidney failure, pancreatitis, liver failure, dehydration, diarrhea -267Signs & Symptoms: CV - Brady/<3 block, tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulsesCNS – Lethargy, confusion, stupor, comaNM – Hyporeflexia, SM weakness, flaccid paralysis
Acid Base (Metabolic Alkalosis/Acidosis & Respiratory Alkalosis & Acidosis)Critical Thinking Worksheet3. Monitor for circulatory collapse caused by polyuria, which may result from the hyperglycemicstate; osmotic diuresis may lead to extracellular volume deficit and may require fluid and electrolyte replacement.