Nursing: A Concept-Based Approach to Learning, Volume 1, 3rd Ed. | Registered Nurse (RN) School Study Aid
pH - Blood and Urine Lab Value
- Blood
- 7.35 - 7.45
- Urine
- 4.0 - 8.0
Blood Acid-Base Control
- In a State of Acidemia
- Medullary Chemoreceptors Control Ventilation Rate
- Expulsion of CO2 through Lungs Increases pH
- Bicarbonate Reabsorption from the Kidney Increases pH
- Kidney Excretion of H+ Increases pH
How to Interpret Acid Base Disorders
- pH, pCO2, HCO3 (Bicarbonate)
- pH
- Acidosis
- Alkalosis
- pCO2
- Opposite Direction As pH
- Respiratory Acidosis
- Respiratory Alkalosis
- HCO3 (Bicarbonate)
- Same Direction As pH
- Metabolic Acidosis
- Metabolic Alkalosis
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
Respiratory Acidosis Interventions
- Improve Respiration
- Bronchodilators
- Respiratory Stimulants
- Drug Antagonists
- Oxygen
- Assisted Ventilation
- Prevent Complications
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
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
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
Metabolic Acidosis Interventions
- Raise Plasma pH > 7.20
- Treat Underlying Cause
- Sodium Bicarbonate
- Follow ABGs
- Continuously Monitor Patient
Metabolic Alkalosis Assessment
- Increased pH > 7.45
- Increased HCO3 > 26
- Excitable State
- Arrhythmias
- Paresthesias
- Muscle Cramps
- Muscle Weakness
- Decreased Respiratory Effort
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
Oxygen Delivery Methods
- Nasal Cannula
- Simple Face Mask
- Non-Rebreather Mask
- Venturi-Mask
- Oxygen In Use Sign
- No Electrical Sparks
- Six Feet Away from Open Flames
- Dry Nasal and Upper Airway Mucosa
- Skin Irritation
- Home Education