acid base imbalance 2

8/22/2019 Acid Base Imbalance 2

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Acid-Base Imbalances

4935


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Respiratory Acidosis

Caused by: disturbances in ventilation,perfusion or diffusion that result inhypoventilation

Common causes:

Neuromuscular problems

Depression of the respiratory center in the brainLung disease

Airway obstruction


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Neuromuscular problems: Gullian-Barre syndrome, Myasthenia

Gravis, and Polio

Depression of the respiratory center in the brain: trauma, tumors,

vascular disorders, some medications, and infections

Lung disease: respiratory infections, COPD, asthma attacks, chronic

bronchitis, pulmonary edema, pneumothorax.

Airway obstruction: retained secretions, retained objects,

anaphylaxis, laryngeal spasm, and some lung diseases.


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Who is at risk?

Children

Mechanical ventilation

Post-operative patients Anyone on analgesics or sedatives


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Signs and Symptoms

Apprehension

Restless

Headache

Confusion- Coma

Depressed DTR

N&VWarm flushed skin

Dyspnea

Tachycardia

Diaphoretic

Diminished breath soundsHypoxemia, cyanosis, cardiac arrest ( In late stages)

Respirations: initially: Rapid shallow respirations (but not in all cases) In an attempt to compensate, the respiratory rate and depth increase


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Tests show what?

pH:

PaCO2:

HCO3:

Serum Electrolytes: Elevated K, because it

is moving out of the cell and there in moreof it in circulation


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Treatment

Maintain a patent airway

Bronchiodialators

O2 as needed Drug therapy to treat hyperkalemia

Antibiotics if there is an infection

Chest PT


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Monitoring

Assess vitals and respiratory status

Monitor neurological status

Report alterations in ABG, electrolytes,pulse ox.

Give O2 as ordered

Encourage coughing/ deep breathing/positional changes

Maintain Hydration: Watch I&O


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Documentation

VS/ cardiac rhythm

I&O

Notification of MD O2 therapy/ vent settings and medications

given

Character of pulmonary secreations Electrolytes and ABG results.


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Respiratory Alkalosis

Caused by: too much CO2 is being eliminated.This causes a decrease in the PaCO2 and anincrease in the pH.

Common Causes:

Hyperventilation due to pain or anxiety

Hypermetabolic states

Liver FailureConditions that affect the brains resp control center

Hypoxia


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Anxiety/Pain: May increase respiratory rate

Hypermetabolic states: Fever and sepsis

Drugs: nicotine, salicylates, chatecholamines

Conditions that affect the resp. control center of thebrain: elevated progesterone levels, stroke, trauma

Hypoxia: High altitude, pulmonary embolus, hypotension


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Signs and Symptoms

Respirations are rapid and deep: as the body tries to

compensate, the respiration rate and depth eill go down

Anxious/ restless

Headache/ lightheadedness Muscle weakness/ tingling in the fingers and toes

ECG changes/ arrhythmias/ tachycardia

Hyperreflexia/ carpopedal spasm/ tetany

Extreme cases: confusion/ alternating apnea and

hyperventilation/ siezures/coma


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Tests show what?

pH

PaCO2

Possible Hypokalemia Possible Hypocalcemia

ECG: possible arrhythmias


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Treatment/ Monitoring

Correct underlying disorder

Relaxation techniques

Watch VS Report changes in cardiac, neuro, or

neuromuscular functioning

Watch and report changes in the ABG andelectrolytes

Provide undisturbed rest periods


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Documentation

VS

I&O

IV therapy

Interventions (including those to relieve anxiety)/

response

ABG/ electrolyte results

Safety measures Any time you notify the doctor about a change


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Metabolic Acidosis

Caused by: either a loss of HCO3 fromextracellular fluids or an accumulation ofmetabolic acids, or a combination of both

Common causes:

Overproduction of ketone bodies

Impaired kidney function

GI losses

Poisoning/ drug toxicity


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Overproduction of Ketone bodies: diabetes, chronicalcoholism, malnutrition, starvation, poor intake ofcarbohydrates, hyperthyroidism, severe infection with afever

Impaired Kidney Function: renal failure and acute tubularnecrosis

GI losses: severe diarrhea, intestinal malabsorption

Poisoning/ Drug toxicity: salicylates, methanol, ethyleneglycol


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Signs and Symptoms

Kussmauls respirations: rapid and deep

Hypotension/ arrhythmias

Skin warm and dry

Weakness/ decreased DTR/ decreasedmuscle tone

A/N/V

headache

LOC deterioration


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The tests show

pH

HCO3

PaCO2 Hyperkalemia

Elevated glucose and ketones in diabetic

ketoacidosis ECG changes (sometimes)


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Treatment

Sodium bicarb IV

Abx if there is an infection

Antidiarrheal if needed

Rapid acting insulin if diabeticketoacidosis is a problem

Ventilation if needed

Dialysis in patients with renal failure

Safety and seizure precautions


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Monitoring

Watch ABGs and electrolytes

Maintain IV line and flush before and after bicarb

is given

VS, cardiac rhythm

Notify MD of changes in neuro status

Position semi-fowlers/ and turn if in a stupor

Monitor LOC Watch I&O


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Documentation

Assessment findings (including neuro)

I&O

IV therapy and response

ABG and electrolyte results

VS and cardiac rhythm

Vent or dialysis if utilized

Notification of the MD

Patient teaching


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Metabolic Alkalosis

Caused by: either a loss of acid or increase/ gainof bicarb or both

Common Causes:Hypokalemia

Acid loss from GI tract

Diuretic therapy

Kidney disease

Transfusions/ drugs


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Hypokalemia: Diuretic use

Loss from GI tract: Excessive vomiting, pyloric stenosis,

NG tube suctioning, GI surgeries

Diuretic therapy: Thiazide and loop diuretics

Kidney disease: renal artery stenosis

Drugs: corticosteroids, antacids that contain baking

soda. Sodium bicarb


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Signs and Symptoms

Respirations will be slow and shallow in anattempt to compensate until hypoxia occurs

cyanosis

Muscle twitching, weakness, and tetany

Hyperactive DTR/ parasthesia of fingers, toesand mouth

Apathy, confusion, coma

A/N/V

Polyuria

Arrhythmias/ death


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Tests show

pH

HCO3

PaCO2 Low potassium, calcium, and chloride

Possible ECG changes


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Treatment

Stop diuretics and NG suctioning

Anteimetics if underlying cause is N/V

Acetazolamide (Diamox) may be given

IV ammonium chloride in sever cases

O2

Seizure precautions if necessary

Irrigate NG with NS instead of tap water(helps with retention of electrolytes)


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Monitoring

VS/ cardiac rhythm/ respiratory status

LOC

I&O ABG and electrolytes

Assess for muscle weakness, tetany or

decreased activity Notify the MD of any changes in status


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Documentation

VS

IV therapy

Interventions and patient response

Medications given I&O

O2 therapy

Notification of the MD

Safety measures

ABG and electrolyte results

acid base imbalance 2

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