Acid-Base Balance Flashcards
caused by an excess of dissolved carbon dioxide, or carbonic acid
Respiratory Acidosis
Respiratory Acidosis
pH less than 7.35 and a PaCO2 greater than 45 mmHg
Chronic respiratory acidosis
bicarbonate level is higher than 28 mEq/L, as kidneys compensate by retaining bicarbonate
Respiratory acidosis
results from carbon dioxide retention caused by alveolar hypoventilation
Hypoxemia (decreased oxygen)
frequently accompanies respiratory acidosis
Acute respiratory acidosis
results from sudden failure of ventilation
Acute respiratory acidosis
Chest trauma, aspiration of foreign body, acute pneumonia, overdoses of narcotic or sedative meds
Acute respiratory acidosis
serum bicarbonate level initially unchanged b/c the compensatory response of kidneys continues over hours to days
Acute respiratory acidosis
Hypercapnia (increased carbon dioxide levels) affects neurologic function and the cardiovascular system
Chronic Respiratory Acidosis
most patients have COPD, with chronic bronchitis and emphysema
Primary risk factor for respiratory acidosis
chronic lung diseases: pneumonia, COPD// or trauma
Respiratory Acidosis Etiology
Diseases of the airway such as asthma, COPD
Disease of the chest
Drugs that suppress breathing such as opioids or alcohol
Obstructive sleep apnea
Acute respiratory acidosis
headache, warm flushed skin, elevated pulse, blurred vision, irritability or AMS, decreasing LOC, cardiac dysrhythmias, cardiac arrest
Chronic respiratory acidosis
weakness, dull headache, sleep disturbances with daytime sleepiness, impaired memory, personality changes
Respiratory acidosis
use continuous positive airway pressure CPAP
Chronic respiratory acidosis
encourage pursed lip breathing
Chronic respiratory acidosis
serum electrolytes may show hypochloremia
Respiratory acidosis pharmacologic therapies
bronchodilator to open airways, ABT for resp infect
Respiratory acidosis
tx focuses on improving alveolar ventilation and gas exchange
Respiratory alkalosis
pH greater than 7.45 and PaCO2 of less than 35 mmHg
Respiratory alkalosis
always caused by hyperventilation, leading to carbon dioxide deficit
Respiratory alkalosis
high fever, hypoxia, gram-negative bacteremia, thyrotoxicosis, early salicylate intoxication, encephalitis, high progesterone levels
Respiratory alkalosis
light-headedness, a feeling of panic and difficulty concentrating, circumoral and distal extremity paresthesias, tremors, and postive chvostek sign, and trousseau sign, tinnitus, chest tightness, palpitations
Acids
release hydrogen ions in solution
Bases
accept hydrogen ions in solution
solution = more acidic
as hydrogen ion concentration increases, the pH falls
solution = more alkaline
as hydrogen ion concentration falls, pH rises
7.35-7.45
normal pH of body fluids
acids
metabolic processes produce
24-28 mEq/L
normal serum bicarbonate level
1.2 mEq/L
normal serum carbonic acid
alkalosis
depresses respiratory center, decreasing rate and depth of respirations
acidosis
kidneys excrete H+ and retain bicarbonate
alkalosis
kidneys retain H+ and excrete bicarbonate
metabolic acidosis
n/v, weakness, fatigue, headache, decreased LOC, hyperventalation
metabolic alkalosis
confusion, decreased LOC, hypotension, tetany, seizures, respiratory failure
The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder?
Metabolic alkalosis
Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.
A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding?
An increased pH with an increased HCO3
Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3 to increase. Symptoms experienced by the client would include hypoventilation and tachycardia.
The nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder?
Metabolic acidosis
Clinical manifestations of respiratory alkalosis include
lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.
The nurse plans care for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-base imbalance?
Respiratory acidosis is most often caused by hypoventilation in a client with COPD.
A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder?
When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The client also experiences headache; restlessness; mental status changes, such as drowsiness and confusion; visual disturbances; diaphoresis; cyanosis as the hypoxia becomes more acute; hyperkalemia; rapid, irregular pulse; and dysrhythmias.
An anxious preoperative client is at risk for developing respiratory alkalosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder?
Clinical manifestations of respiratory alkalosis include a decrease in the respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesias such as tingling of the fingers and toes, hypokalemia, hypocalcemia, tetany, and convulsions.
A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse should develop a plan of care because the client is at risk for the development of which type of acid-base imbalance?
Metabolic acidosis
The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse assesses this client for which signs/symptoms that are characteristic of this disorder?
Headache, restlessness, and confusion
A nurse is admitting a client with a diagnosis of Guillain-Barré syndrome to the hospital. The nurse knows that if the disease is severe enough, the client will be at risk for which acid-base imbalance?
Respiratory acidosis
A nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse should expect to note which findings associated with an anticipated acid-base disturbance?
If metabolic acidosis occurs, the client is likely to exhibit drowsiness, headache, and tachypnea.
A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse should monitor this client, expecting to note which signs/symptoms?
A client with metabolic alkalosis is likely to exhibit decreased respiratory rate and depth as a compensatory mechanism.
