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Fundamentals of Nursing, 10 Ed., Potter, Perry, Stockert & Hall, 2020 | Registered Nurse (RN) School Study Aid

How to Interpret Acid Base Disorders

pH, pCO₂, HCO₃ (Bicarbonate)

Acidosis

Alkalosis

pCO₂

Opposite Direction as pH

Respiratory Acidosis

Respiratory Alkalosis

HCO₃ (Bicarbonate)

Same Direction as pH

Metabolic Acidosis

Metabolic Alkalosis

3 mins

Respiratory Acidosis Assessment

Decreased pH < 7.35

Increased PaCO2 > 45

Reduced Respirations

Anxiety

Change in LOC

Tachycardia

Cyanosis

Increased Electrolytes

ECG Changes

Muscle Weakness

Hyporeflexia

2 mins

Respiratory Acidosis Interventions

Improve Respiration

Bronchodilators

Respiratory Stimulants

Drug Antagonists

Oxygen

Assisted Ventilation

Prevent Complications

1 min

Respiratory Alkalosis Assessment

Increased pH > 7.45

Decreased PaCO2 < 35 mmHg

Hyperventilation

Brainstem Stimulation

Head Injury

Shock

Lightheadedness

Tingling Lips or Fingers

Trousseau's

Chvostek's Sign

Anxiety

2 mins

Respiratory Alkalosis Interventions

Treat Underlying Cause

Decrease Tidal Volume and/or Respiratory Rate

Give Adequate Pain Control and Sedation

Sedatives

Antidepressants

Compensatory Drop in Serum Bicarbonate

Calming Breathing Exercises

Correct CO2 Slowly

2 mins

Metabolic Acidosis Assessment

Decreased pH < 7.35

Decreased HCO3 < 22

Abdominal Pain

CNS Depression

Coma

Hypotension

Arrhythmias

Increased Respirations

Kussmaul Respirations

Flushed, Warm, Dry Skin

Muscle Weakness

2 mins

Metabolic Acidosis Interventions

Raise Plasma pH > 7.20

Treat Underlying Cause

Sodium Bicarbonate

Follow ABGs

Continuously Monitor Patient

2 mins

Metabolic Alkalosis Assessment

Increased pH > 7.45

Increased HCO3 > 26

Excitable State

Arrhythmias

Paresthesias

Muscle Cramps

Muscle Weakness

Decreased Respiratory Effort

1 min

Metabolic Alkalosis Interventions

Treat Underlying Cause

Stop Potassium (K+) Wasting Diuretics

Spironolactone

Acetazolamide

IV Fluids

Sodium Chloride

Replace Potassium (K+)

Monitor Respiratory Rate

Monitor Heart Rate

Seizure Precautions

2 mins

Hypercalcemia Causes

Two CHIMPANZEES Acronym

Thyroid Disorders

Calcium Supplements

Hyperparathyroidism

Iatrogenic (Drugs, immobility)

Milk-Alkali Syndrome

Paget's Disease of Bone

Acromegaly or Addison's Disease

Neoplasms

Zollinger-Ellison Syndrome

Excessive Vitamin A

Excessive Vitamin D

Sarcoidosis

2 mins

Hypercalcemia

> 10.5 mg/dL Ca²⁺

Pathologic Fractures

Lethargy

Hypercoagulation

Constipation

ECG Changes

QT Shortening

No Calcium Intake

Chelating Drugs

Calcitonin

Bisphosphonates

Loop Diuretics instead of Thiazide Diuretics

Increased Risk for Renal Calculi

Increase Fluids

3 mins

Hypercalcemia Treatments

Treat Underlying Disorder

Hydration

Dialysis

Calcium Restriction

Bisphosphonates

Calcitonin

Cinacalcet

Glucocorticosteroids

Denosumab

2 mins

Hypocalcemia Causes

Hypoalbuminemia

Hypomagnesemia (Less Common Hypermagnesemia)

Hypovitaminosis D

Hypoparathyroidism

Medications

Hyperphosphatemia

Malnutrition

Acute Pancreatitis

Alkalosis

Sepsis

Chronic Kidney Disease

2 mins

Hypocalcemia

Muscle Spasms

< 8.5 mg/dL Ca2+

Decreased Bone Density

Tetany

Chvostek's Sign

Trousseau's Sign

Increased DTR

ECG Changes

QT Prolongation

Oral and IV Replacement of Ca2+

Seizure Precautions

2 mins

Hypocalcemia Treatments

Treat Underlying Disorder

IV Calcium Gluconate

Cardioprotective

Calcium Carbonate

Calcium Citrate

Vitamin D Supplements

Treat Hypomagnesemia

2 mins

Hyperkalemia

> 5.0 mEq/L K+

Abdominal Cramps

Muscle Weakness

Diarrhea

Arrhythmia

Tall, Peaked T Waves

IV Calcium

Infusion of Glucose and Insulin

Loop or Thiazide Diuretics

Kayexalate

Dialysis

Prevention Education

2 mins

Hypokalemia

< 3.5 mEq/L

Muscle Weakness

Arrhythmia

U Wave

Ileus

Hyporeflexia

IV K+ Infusion at 5-10 mEq/hr

Give Orally with Food

Monitor Respiratory Status

3 mins

Hypernatremia

> 145 mEq/L Na+

Change in LOC

Extreme Thirst

Orthostatic Hypotension

Dry Flushed Skin

Muscle Twitching

Seizures

Treat and Prevent Dehydration

Hypotonic Solutions (0.225% or 0.45% NaCl)

Sodium Restriction

Diuretics

2 mins

Hyponatremia

< 135 mEq Na+

Nausea and Vomiting

Decreased LOC

Confusion / Lethargy

Seizures

Assess Airway

Reduce Diuretic Dosage

Mannitol (Osmitrol)

Fluid Restriction

Hypertonic Solution (3% or 5% NaCl)

2 mins

Hypermagnesemia

Flushing

Lethargy

Muscle Weakness

Decreased Deep Tendon Reflexes (DTRs)

Decreased Respirations

Bradycardia

Hypotension

Dialysis

IV Calcium Gluconate

Diuretics

Avoid Antacids and Laxatives containing Mg²⁺

2 mins

Hypomagnesemia

Confusion

Increased Deep Tendon Reflexes (DTRs)

Neuromuscular Irritability

Seizures

Muscle Cramps

Tremors

Insomnia

Tachycardia

Magnesium Sulfate

Foods High in Magnesium

1 min

IV Solutions

Hypotonic (< 280 mOsm/L)

1/4 Normal Saline (0.225% NaCl)

1/2 Normal Saline (0.45% NaCl)

Isotonic (280-300 mOsm)

Normal Saline (0.9% NaCl)

Lactated Ringer's (LR)

Dextrose 5% in Water (D5W)

Hypertonic (> 300 mOsm)

3% or 5% NaCl

Dextrose 5% in 0.45% NaCl

Dextrose 10% in Water (D10W)

3 mins

Normal Electrolyte Lab Values

Potassium (K⁺)

3.5 to 5.0 mEq/L

Calcium (Ca²⁺)

8.5 to 10.5 mg/dL

Phosphate (PO₄^3–)

2.5 to 4.5 mg/dL

Magnesium (Mg²⁺)

1.5 to 2.5 mEq/L

Sodium (Na⁺)

135 to 145 mEq/L

Chloride (Cl^–)

95 to 105 mEq/L

2 mins

Magnesium (Mg2+) Lab Value

1.5 to 2.5 mEq/L

28 secs

Phosphate (PO43-) Lab Value

2.5 to 4.5 mg/dL

29 secs

Potassium (K+) Lab Value

3.5 to 5.0 mEq/L

20 secs

Calcium (Ca2+) Lab Value

8.5 to 10.5 mg/dL

26 secs

Chloride (Cl-) Lab Value

95-105 mEq/L

28 secs

Sodium (Na+) Lab Value

135-145 mEq/L

24 secs

Types of Blood Products

Whole Blood

Packed Red Blood Cells

Fresh Frozen Plasma

Immunoglobulins

Clotting Factors

Albumin

Platelets

Use within 24 Hours

Washing Removes Antibodies

Irradiation Destroys WBCs

2 mins

Blood Types and Compatibilities

No Antigens (Type O Blood)

Universal Donor

A Antigen (Type A Blood)

B Antigen (Type B Blood)

AB Antigen (Type AB Blood)

Universal Recipient

Rh (Rhesus) Antigen

Never Rh+ to Rh-

Blood Transfusion

Obstetric Patient

2 mins

Blood Transfusion Administration

Proper Patient Identification

Large Bore Needle

Y Tubing

Baseline Vital Signs

Slow IV Infusion

Monitor During First 15 Minutes or 50 mL of Blood

Monitor for Reactions

Do Not Add Anything To Same IV Line

No Dextrose or Lactated Ringers

Jehovah's Witnesses, No Transfusions

3 mins

Transfusion Reactions

Acute Hemolytic

Febrile, Non-Hemolytic

Mild Allergic

Anaphylactic

Circulatory Overload

Sepsis Reaction

Transfusion-Related Acute Lung Injury (TRALI)

Massive Blood Transfusion

2 mins

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