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NUR 113 Acid/Base
How to Interpret Acid Base Disorders
pH, pCO2, HCO3 (Bicarbonate)
Step 1
pH
Acidosis
Alkalosis
Step 2
pCO2
Opposite Direction As pH
Respiratory Acidosis
Respiratory Alkalosis
Step 3
HCO3 (Bicarbonate)
Same Direction As pH
Metabolic Acidosis
Metabolic Alkalosis
3 mins
Respiratory Acidosis Assessment
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
Pharmacologic Interventions
Bronchodilators
Respiratory Stimulants
Drug Antagonists
Nonpharmacologic Interventions
Oxygen
Assisted Ventilation
Prevent Complications
1 min
Respiratory Alkalosis Assessment
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
Mechanically Ventilated Patients
Decrease Tidal Volume and/or Respiratory Rate
Give Adequate Pain Control and Sedation
Hyperventilation Syndrome
Sedatives
Antidepressants
Considerations
Compensatory Drop in Serum Bicarbonate
Calming Breathing Exercises
Correct CO2 Slowly
2 mins
Metabolic Acidosis Assessment
Characteristics
Decreased pH < 7.35
Decreased HCO3 < 22
Signs & Symptoms
Abdominal Pain
CNS Depression
Coma
Hypotension
Arrhythmias
Increased Respirations
Kussmaul Respirations
Flushed, Warm, Dry Skin
Muscle Weakness
2 mins
Metabolic Acidosis Interventions
Interventions
Raise Plasma pH > 7.20
Treat Underlying Cause
Sodium Bicarbonate
Considerations
Follow ABGs
Continuously Monitor Patient
2 mins
Metabolic Alkalosis Interventions
Interventions
Treat Underlying Cause
Stop Potassium (K+) Wasting Diuretics
Spironolactone
Acetazolamide
IV Fluids
Sodium Chloride
Replace Potassium (K+)
Considerations
Monitor Respiratory Rate
Monitor Heart Rate
Seizure Precautions
2 mins
Metabolic Alkalosis Assessment
Signs and Symptoms
Increased pH > 7.45
Increased HCO3 > 26
Excitable State
Arrhythmias
Paresthesias
Muscle Cramps
Muscle Weakness
Decreased Respiratory Effort
1 min
Blood Acid-Base Control
Characteristics
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
2 mins
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