ACID BASE BALANCE

Question 1

what are the major chemicals you have to remember with Acid-base balance?

Answer 1

1. Bicarb (base)
2. Co2 (Acid)
3. Hydrogen (Acid)

Question 2

What are the major lung and kidney chemicals?

Answer 2

Lung = C02 (Carbonic Acid)
Kidney = Hydrogen & Bicarb
These chemicals can either make you sick or compensate. It depends in which imbalance you have.

Question 3

What does the pH tell you about the blood?

Answer 3

If it is…..Acidic, alkaline or neutral

Question 4

What is the normal range for pH?

Answer 4

7.35-7.45

Question 5

What does it mean if the pH is below 7.35?

Answer 5

Acidosis=coma/death

Question 6

What does it mean if the pH is above 7.45?

Answer 6

Alkalosis=Nervous system excites = convulsions/death

Question 7

The body is continuously adjusting C02, BiCarb, & Hydrogen to keep the pH between 7.35-7.45.

How does the body stay within normal range by utilizing compensating organs such as, kidneys & Lungs?

Answer 7

KIDNEYS
-Removes acid thru urine
-Holds on Bicarb returns to blood OR Excrete thru the
urine.
-Kidneys take hrs. or days to do their job (slow).

LUNGS

• Rids C02 thru exhale
• Hypoventilation = Retain C02
• Lungs respond FAST

Question 8

Describe the Pathophysiology of Respiratory Acidosis

Answer 8

Acute or Chronic Lung Problem caused by too much C02 = Hypo-ventilating. Therefore retains C02 (acid) therefore kidneys will compensate with Bicarb and Hydrogen.

In acidosis the body is trying to compensate b/c of less acid so… the body must excrete the acid, which means get rid of hydrogen. Therefore the body will retain bicarb b/c its a Base and pH will be low.

Question 9

Causes of Respiratory Acidosis

Answer 9

Retaining C02
Mid abdominal incision, narcotics, sleeping pills,
pneumothorax, collapsed lung, pneumonia.
* All have poor gas exchange therefore retaining C02 =
Hypoventilation=Acidosis=Coma

Narcotics & Sedatives suppress respirations causing C02 retention.

If C02 is high then O2 low so hypoxia sets in.

Question 10

S/S Respiratory Acidosis

Answer 10

1. Headache, confused, sleepy
2. If not corrected=COMA
3. Hypoxia-give O2, early signs are restlessness & tachycardia

NOTE: With Restlessness THINK HYPOXIA 1st
As acid concentration C02 increases LOC decreases

Question 11

Treatment: Respiratory Acidosis

Answer 11

Fix breathing problem first.
Tx. Pneumonia 
   - Rid secretions postural drainage
   - Percussion (vibe therapy) losens
   - Deep breathing exercises
   - Suctioning remove secretions
   - Fluids liquify secretions
   - Elevate HOB - expand lungs better.
   - Incentive Spirometry - expand lungs
   - Tx. Pneumothorax - Pt. will have chest tube.
   - Encourage post op pt. turn, cough, deep breath.
   - Prevent pneumonia = prevent respiratory acidosis

Question 12

Describe the Pathophysiology of Respiratory Alkalosis

Answer 12

Lungs are sick, so kidneys compensate
Kidneys excrete Bicarb, & Retain Hydrogen
Losing C02 (acid)
Hyperventiling
pH is high - anything over 7.45 = alkalosis

Question 13

Causes of Respiratory Alkalosis

Answer 13

Hyperventilation
Hysterical Acute Aspirin Overdose
Situation Hysterical Client
*Pt breathing to fast therefore removing C02 (acid)

Question 14

S/S Respiratory Alkalosis

Answer 14

Light headed or faint feeling
Peri-Oral numbness
Numbness & tingling in fingers & toes

Question 15

Tx. Respiratory Alkalosis

Answer 15

Do not wait for kidneys to kick in.
Breathe into a paper bag
May have to sedate Pt.
Tx. the cause
Monitor ABG's

Question 16

Describe the Pathophysiology of Metabolic Acidosis

Answer 16

Kidneys are sick-problem chemical hydrogen & Bicarb. Lungs compensate with CO2. pH is low and Respiratory rate is high.

Question 17

Causes: Metabolic Acidosis

Answer 17

DKA & STARVATION - cells are starving for glucose so body will breakdown protein & fat and produce ketones. ketones are acid.
RENAL FAILURE
SEVERE DIARRHEA - losing base from body leaving acid behind = metabolic problem.

Question 18

S&S: Metabolic Acidosis

Answer 18

Depends on the cause:

HYPERKALEMIA = muscle twitching, muscle weakness, flaccid paralysis and arrhythmia’s

INCREASED RESPIRATORY RATE

Question 19

TX. Metabolic Acidosis

Answer 19

TX. THE PROBLEM
Drug to help acidosis, I.V. push
Sodium Bicarb - wont fix the cause but it will buy you time.

Question 20

Describe the Pathophysiology of Metabolic Alkalosis

Answer 20

Kidneys are sick, so problem chemical = Bicarb and Hydrogen. Lungs compensate with CO2.

PT in Alkalosis, therefore retaining to much Bicarb (base) & excreting hydrogen.

pH is high- the more alkaline the higher the pH.

Question 21

S&S: Metabolic Alkalosis

Answer 21

• Depends on cause
• Observe LOC
• Serum Potassium increases in Metabolic Acidosis and
  decreases in metabolic Alkalosis.
• Monitor for muscle cramps and life threatening arrhythmia’s.

Question 22

Tx. Metabolic Alkalosis

Answer 22

Fix the problem

Replace potassium

Question 23

Testing strategy:

1. Metabolic Acidosis = ?
2. Metabolic Alkalosis =?

Answer 23

Metabolic Acidosis = HYPERkalemia

Metabolic Alkalosis = HYPOkalemia