Acid Base Imbalances

Question 1

whats the normal pH level

Answer 1

7.35-7.45

Question 2

whats the normal bicarb lvl

Answer 2

22-26

Question 3

what are the steps to interpreting blood gasses:

Answer 3

1) look at pH and bicard lvls
2) determine if each lvl is high, low, or normal

Question 4

what does a pH above 7.45 mean

Answer 4

• alkalosis

Question 5

what does a pH below 7.35 mean

Answer 5

• acidosis

Question 6

if both the pH and bicard are in the same direction ( both high or both low), what does that mean?

Answer 6

• metabolic

(think: bicarb both bolic)

Question 7

if the pH and bicarb are in different directions (one is high while the other is low), what does that mean?

Answer 7

• respiratory

Question 8

ex. the pH and bicard are low. What is this?

Answer 8

• metabolic acidosis

Question 9

ex. the pH and bicard are both high. what is this?

Answer 9

• metabolic alkalosis

Question 10

ex. the pH is low, and the bicarb is high. What is this?

Answer 10

• respiratory acidosis

Question 11

ex. the pH is 7.5 and bicard is 25. what is this?

Answer 11

• respiratory alkalosis

Question 12

what is the general principle for the symptoms of a high pH?

Answer 12

• as the pH goes up, so does my patient

Question 13

what are examples of symptoms of a high pH

Answer 13

• irritability
• hyperreflexia (+3, +4)
• tachypnea
• tachycardia
• borborygmi (increased bowel sounds)
• seizures (have suction at bedside)

Question 14

what is the general principle for signs of a low pH

Answer 14

• as the pH goes down, so does my patient

Question 15

what are examples of signs of a low pH

Answer 15

• hyporeflexia (0-1)
• bradycardia
• lethargy, obtundant, coma
• paralytic/adynamic ileus
• resp arrest (have ampu bag at bedside)
• 2* mobitx type 2 heart block

Question 16

when my pH goes up, so does my patient EXCEPT…

Answer 16

K+ (and vice versa). K+ goes down

Question 17

what is kussmaul breathing

Answer 17

deep, rapid, and labored breathing

Question 18

kussmaul breathing is only seen with…

Answer 18

• metabolic acidosis

(think: mac kussmaul)

Question 19

what is the general principle for the causes of acid-base imbalances

Answer 19

• often, what causes something is the opposite of its symptoms
  ex. diarrhea causes metabolic acidosis, but once the pt gets acidosis, they get paralytic ileus as a symptoms

Question 21

what are the steps to determining what type of acid-base imbalance a patient is in when given a scenario (no lab values)

Answer 21

1) ask: is it a lung scenario ? (if so, resp)
2) is the pt over or under ventilating (not RR, r/t gas exchange & SpO2)

Question 22

if a pt is over ventilating, what does it mean? under?

Answer 22

• over ventilating = alkalosis (think: pH up so ventilation up)
• under = acidosis

Question 23

ex. a woman is over using their breathing techniques in labour. what are they in?

Answer 23

• respiratory alkalosis

Question 24

ex. a child who was a victim of near drowing. what are they experiencing?

Answer 24

• respiratory acidosis

Question 25

ex. pt has emphysema & air trapping. what are they experiencing?

Answer 25

• respiratory acidosis

Question 26

ex. pt has a PCA pump, what imbalance would tell you they need to come off it?

Answer 26

• resp acidosis

(risk of resp. depression = under ventilation(

Question 27

if a pt has prolonged gastric vomitting or suction, what would they have?

Answer 27

• metabolic alkalosis

Question 28

if any other pt scenario does not involve the lung, vommiting, or suction, what would they have?

Answer 28

• metabolic acidosis

Question 29

ex. if a pt has hyperemesis gravida, what would they have?

Answer 29

• metabolic alkalosis

Question 30

ex. if a pt has hyperemesis gravida and is now dehydrated, what would they have?

Answer 30

• metabolic acidosis

Question 31

what 2 types of alarms could go off on a ventilator?

Answer 31

• high pressure
• low pressure

Question 32

a high pressure ventilator alarm is caused by?

Answer 32

• increase resistance to air flow
  1) obstructions (kink in tubing)
  2) water condensing in tubes
  3) mucus secretions in airway

Question 33

what do you do if water is condensing in ventilator

Answer 33

• empty it

Question 34

what do you do if mucus secretions are in the airway of someone on a ventilator

Answer 34

1. change position
2. DB&C
3. suction

Question 35

what is a low pressure ventilator alarm caused by?

Answer 35

• decreased resistance
  1) disconnections in tubing
  2) 02 sensory tubing disconnected

Question 36

ex. you receive an order to wean a pt off of a ventilator. 6am ABGS show respiratory acidosis. what do you do?
1) follow order
2) call RT
3) hold order & call Dr
4) begin to decreased settings

Answer 36

3:
- pt is under ventilating (would want to see resp alkalosis) = needs ventilator