Acid Base Balance

Question 1

Goal of an ABG?

Answer 1

identify acidosis or alkalosis

Question 2

Rule of the B’s

Answer 2

if pH and BICARB are BOTH in the same direction then it is METABOLIC

Question 3

If pH and bicarb are in different directions…

Answer 3

respiratory

Question 4

normal pH

Answer 4

7.35-7.45

Question 5

normal bicarb

Answer 5

22-26

Question 6

What do you see with low pH…

Answer 6

acidosis
as the pH goes, so does my patient
-low pH, low S/S

hyporeflexic, bradycardic, bradypnec, lethargy, obtunded, coma

Question 7

obtunded

Answer 7

1 step lower than lethargic

Question 8

What do you see with high pH…

Answer 8

alkalosis
as the pH goes, so does my patient
-high pH, high S/S

irritability, hyperreflexic, tachypnea, tachycardic

Question 9

what is a hyporeflexic finding?

Answer 9

0, +1

Question 10

what is a normoreflexic finding?

Answer 10

+2

Question 11

what is a hyperreflexic finding?

Answer 11

+3, +4

Question 12

paralytic ileus

Answer 12

down

Question 13

borborygmi

Answer 13

up; increased bowel sounds

Question 14

who would need a ambu bag at bedside?

Answer 14

acidosis–resp arrest, down S/S

Question 15

who would need suctioning at the bedside?

Answer 15

alkalosis–seize, up S/S

Question 16

Potassium and pH…

Answer 16

as goes my pH, so does my patient except potassium

-opposite

Question 17

acidosis…potassium is…?

Answer 17

high

Question 18

alkalosis…potassium is…?

Answer 18

low

Question 19

Kussmaul breathing

Answer 19

MacKussmaul

-metabolic acidosis

Question 20

over/under ventilate, translate…

Answer 20

overventilation= respiratory alkalosis

underventilation= respiratory acidosis

Question 21

Example: pt is overusing breathing techniques during labor

Answer 21

over ventilating= respiratory alkalosis

Question 22

Example: near drowing

Answer 22

respiratory acidosis

Question 23

Example: emphysema, air trapping

Answer 23

respiratory acidosis

Question 24

When assessing ventilation, think…

Answer 24

gas exchange at the lung level…not RR

Question 25

Example: Your patient is on a PCA pump, what acid base imbalance would indicate backing off the pump?

Answer 25

respiratory acidosis

Question 26

Prolonged gastric suction or vomitting?

Answer 26

Metabolic alkalosis

Question 27

For everything that isnt lung and isnt vomitting/suctioning?

Answer 27

metabolic acidosis

Question 28

Patient with hyperemesis who is now dehydrated?

Answer 28

metabolic acidosis

Question 29

acute renal failure…

Answer 29

metabolic acidosis

Question 30

If you don’t know it….

Answer 30

metabolic acidosis

Question 31

Compensation: if the pH is normal…

Answer 31

fully compensated

Question 32

Compensation: if the pH is out of range and only one of the others out of range….

Answer 32

uncompensated

Question 33

Compensation: all levels out of range…

Answer 33

partially compensated

“partiALLy”

Question 34

normal CO2

Answer 34

35-45