Acid-Base Balance - notes PDF

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ACID-BASE BALANCE and VENTILATORS Mark Klimek PRACTICE QUESTIONS AT THE END

ABG interpretation: Rule of the B’s: If the pH and the Bicarb Are Both in the same direction Then it is metaBolic

For example: Normal pH =7.35 to 7.45 Normal Bicarb= 22-26 CO2 35-45 a. pH 7.3 (low=acidic) HCO3=20 (low bicarb) The pH and the Bicarb are Both in the same direction=metaBolic pH below 7.35=acidotic METABOLIC ACIDOSIS b. pH 7.58 (high=basic) HCO3=32 (high) The pH and the Bicarb are Both in the same direction=metaBolic METABOLIC ALKALOSIS c. pH 7.22 (low) HCO3=30 (high) The pH and bicarb are in opposite directions therefore this is respiratory. RESPIRATORY ACIDOSIS

B. Signs and Symptoms of acid-base imbalance: “As the pH goes down, so goes my patient.” pH up (alkalosis)

pH DOWN (acidosis)

borborygmi (hyperactive bowel sounds)

bradycardia

Seizures

hypotension Lethargic Decreased level of consciousness hyporeflexia Decreased bowel sounds Cardiac arrest Respiratory distress

C. Causes of Acid-Base imbalance: First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask yourself, “Are they over ventilating or under ventilating?” If over ventilating, pick RESPIRATORY ALKALOSIS. If under ventilating, pick RESPIRATORY ACIDOSIS.

If it’s not lung, then it’s metabolic. If the patient has prolonged gastric vomiting or suction, pick METABOLIC ALKALOSIS. For everything else that isn’t lung, pick METABOLIC ACIDOSIS. When you don’t know what to pick, choose METABOLIC ACIDOSIS, very frequent problem.

VENTILATOR ALARMS: High pressure alarms are triggered by increased resistance to air flow and can be caused by obstructions: 1. 2. 3. 4.

kinks condensation/fluid mucus suctioning patient

To solve problem, do least invasive to most invasive first, suction is the last option, can irritate mucosa

Low pressure alarms are triggered by decreased resistance to air flow and can be caused by disconnections of the tubing or oxygen sensor line.

RESPIRATORY ALKALOSIS means ventilator settings may be too HIGH

RESPIRATORY ACIDOSIS means ventilator settings may be too LOW PRACTICE QUESTIONS:

1. A nurse is caring for a client with a diagnosis of COPD. The nurse monitors the client for which acid-base imbalance that most likely occurs in clients with this condition? 1. Metabolic acidosis 2.Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis 2. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis 3. The RN reviews the results of the ABG with the LPN and tells the LPN that the client is experiencing respiratory acidosis. The LPN would expect to note which of the following on the laboratory result form? 1. pH 7.50, PCO2 52 mm Hg 2. pH 7.35, PCO2 40 mm Hg 3. pH 7.25, PCO2 50 mm Hg 4. pH 7.50, PCO2 30 mm Hg 4. The nurse is told that the blood gas results indicate a pH of 7.55 and a PCO2 of 30 mm Hg. The nurse determines that these results indicate: 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis 5. A client has the following lab values: a pH of 7.55, an HCO3- of 22 mm Hg, and a PCO2 of 30 mm Hg. What should the nurse do? 1. Perform Allen's test 2. Prepare the client for dialysis 3. Administer insulin as ordered 4. Encourage the client to slow down breathing

6. A pt's blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following? 1. respiratory acidosis 2. metabolic acidosis 3. respiratory alkalosis 4. metabolic alkalosis

1. 2. 3. 4. 5. 6.

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