Concepts of Acid-Base Balance Key Points

Question 1

Safe and Effective Care Environment

Answer 1

Assess the cardiovascular system first in any patient at risk for acidosis because acidosis cam lead to cardiac arrest from the accompanying hyperkalemia. (SAFETY)

Assess the airway of any patient who has acute respiratory acidosis. (SAFETY)

Monitor the neurologic status at least every 2 hours in patients being treated for a problem with acid-base balance. (SAFETY)

Use fall precautions for any patient with a problem in acid-base balance.

Question 2

Health Promotion and Maintenance

Answer 2

Teach patients to take drugs as prescribed, especially diuretics, antihypertensives, and cardiac drugs to prevent an acid-base imbalance.

Question 3

Psychosocial Integrity

Answer 3

Perform a mental status assessment in any patient with or at risk for problems of acid-base balance. (Patient Centered Care)

Question 4

Physiological Integrity

Answer 4

Be aware of how the following principles, processes, and mechanisms influence the regulation of acid-base balance:

The normal pH of the body’s extracellular fluids (including blood) is 7.35-7.45.

The more hydrogen ions present, the more acidic the fluid; the fewer hydrogen ions present, the more alkaline the fluid.

pH values below 7.35 indicate acidosis; pH values above 7.45 indicate alkalosis.

Anything that increases the C)2 level in the blood increases the hydrogen ion content and lowers the pH.

Acids are normally formed in the body as a result of metabolism.

Chemical blood buffers are the immediate way that acid-base imbalances are corrected.

The lungs control the amount of C)2 that is retained or exhaled.

The kidneys regulate the amount of hydrogen and bicarbonate ions that are retained or excreted by the body.

If a lung problem causes retention of carbon dioxide, the healthy kidney compensates by increasing the amount of bicarbonate that is produced and retained.

Acidosis reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and GI smooth muscle.

Alkalosis increases the sensitivity of excitable tissues, allowing them to over-respond to normal stimuli and respond even without stimulation.

Check the serum potassium level for any patient who has acidosis. (evidence based practice)

Monitor arterial blood gas (ABG values to evaluate the effectiveness of therapy for acid-base imbalances. (patient centered care)