Acid-Base balance

Question 1

Respiratory status

Answer 1

• In acidosis, respirations and depth increase in attempt to exhale acids
• In alkalosis, respirations and depth decrease to retain CO2 to neutralize excess bicarb

Question 2

Respiratory Acidosis

Answer 2

• Caused by primary defects in the function of the lungs or changes in normal respiratory pattern
• Any condition that causes an obstruction of the airway or depresses respiratory rate can cause respiratory acidosis
• Manifestations
  
  • Drowsiness, disorientation, HA, coma
  • Decreased BP
  • Warm, flushed skin
  • Seizures
  • Hypoventilation with hypoxia
• Interventions
  
  • semi-fowler’s position
  • Encourage hydration to thin secretions
  • pts w/ history of emphysema or COPD usually aren’t given oxygen greater than 2 liters to reduce risk of C)2 retention and resp. acidosis

Question 3

Respiratory Alkalosis

Answer 3

• Causes
  
  • overstimulation of the respiratory system
    
    • Fever, hyperventilation, hypoxia, hysteria, pain, overventilation by mechanical ventilator
• Manifestations
  
  • Lethary, lightheadedness, confusion
  • Tachycardia
  • N/V, epigastric pain
  • Tetany, numbness, hyperreflexia, seizures
  • Hyperventilation
• Interventions
  
  • Encourage voluntary holding of breath
  • Provide rebreather mask as prescribed
  • Provide CO2 breaths as prescribed (paper bag)
  • Monitor electrolytes (esp. potassium and calcium)

Question 4

Metabolic Acidosis

Answer 4

• Causes
  
  • DM
  • Excessive ingestion of acetylsalicylic acid
  • High-fat diet
  • Insufficient metabolism of carbohydrates
  • Malnutrition
  • Renal insufficiency, AKI, CKD
  • Severe diarrhea
• Manifestations
  
  • Drowsiness, Confusion, HA, coma
  • Decreased BP
  • Warm, flushed skin
  • N/V/D, abdominal pain
  • Deep, rapid respirations (kussmaul’s respirations)
• Interventions
  
  • monitor potassium levels closely
  • A diet low in protein and high in calories decreases the amount of protein waste products, which lessens the acidosis

Question 5

Metabolic Alkalosis

Answer 5

• Causes
  
  • Dysfunction of metabolism
    
    • Diuretics, excessive vomiting or GI suctioning
    • Hyperaldosteronism
    • Ingestion or infusion of excess sodium bicarbonate
    • Massive transfusion of whole blood
• Manifestions
  
  • Drowsiness, dizziness, nervousness, confusion
  • Tachycardia
  • Anorexia, N/V
  • Tremors, muscle cramps, tetany, hypertonic muscles
  • tingling of extremities
  • seizures
  • Hypoventilation