respiratory acidosis lab values
pH<7.35
PCO2 >45
causes of respiratory acidosis
hypOventilation caused by:
-OD of narcotics/alcohol
-tumor
-COPD and other respiratory conditions (severe asthma and emphysema)
-neuromuscular disease that affects the respiratory system (Myasthenia Gravis, GB syndrome)
-pulmonary edema
-airway obstructio
signs and symptoms
-dyspnea
-cyanosis
-muscle twitching
-sweating
-HTN
-decreased LOC
-peripheral vasodilation
-cardiac dysrhythmias
Treatment for respiratory acidosis
-treat underlying condition
-mechanical ventilatory support to help "blow off" CO2
-focus is on increasing ventilation (C&DB, reverse sedation, bag/intubate)
what will NOT fix respiratory acidosis
Oxygen
respiratory alkalosis lab values
pH > 7.45,
CO2 < 35 mmHg
causes of respiratory alkalosis
Hyperventilation (pt. blows off too much CO2) caused by:
� Fear
� Pain
� Increased respiratory rate in very ill patient
� Post-op patient on ventilator, overventilation
� Voluntary over breathing, ie. anxiety, fever
� High altitude
� Hypoxia
� Initial sta
S/S of respiratory alkalosis
� Decreased LOC
� Seizures
� Decreased BP
� Hypokalemia
� Dizziness
� Light-headedness
� Paresthesia's
� Palpitations
treatment of respiratory alkalosis
-Treat underlying cause.
-Slow down the respiratory rate by reassuring the patient, sedation, and/or have them breathe into a paper bag.
metabolic acidosis lab values
pH <7.35
HCO3 <22
Causes of metabolic acidosis
body gains acid or loses bases by
-diarrhea
-drainage of pancreatic juices
-intestinal fistula
-renal failure
-diabetic ketoacidosis
-lactic acidosis
-shock
-salicylate OD
-sepsis
signs and symptoms of metabolic acidosis
-hypOtension
-deep and fast breathing (Kussmal's)
-disorientation
-drowsiness
-lethargy, coma
-poor peripheral circulation
-hyperventilation (secondary to compensation)
-cardiac dysrhythmias
treatment for metabolic acidosis
-ID and reversal of cause
-IV sodium bicarb may be required
-support BP by volume or inotropes
-treat dysrhythmias
metabolic alkalosis lab values
pH >7.45
HCO3 >26
Causes of metabolic alkalosis
body loses acids or gains bases by
-prolonged vomiting
-NG suctioning
-diuretic abuse
-sodium bicarb OD
-overuse of antacids
-hyperaldosteronism
-Cushing's syndrome
signs and symptoms of metabolic alkalosis
-mental confusion
-stupor
-apathy
-muscle weakness (secondary to low potassium)
-dizziness
-tetany
-convulsions
-hypOventilation (secondary to compensation)
treatment for metabolic alkalosis
-treat underlying cause
-potassium replacement
-saline infusion
in acidosis, pH.....
decreases
in alkalosis, pH.....
increases
if CO2 has the opposite relationship to the pH, then the imbalance is...
respiratory
if HCO3 has the same relationship to the pH, then the imbalance is...
metabolic
when does compensation occur?
pH is in the normal range of 7.35-7.45
if the condition is a respiratory imbalance, look at the ___ to determine state of compensation
HCO3
If HCO3 is normal, then the condition is...
uncompensated
if HCO3 is abnormal, then the condition is...
partially compensated
if the condition is a metabolic imbalance, look at the ___ to determine state of compensation
CO2
if the CO2 is normal, then the condition is...
compensated
if the CO2 is abnormal, then the condition is..
partially compensated
pH 7.58
CO2 20
HCO3 19
alkalosis
respiratory
partial compensation
pH 7.72
CO2 48
HCO3 35
alkalosis
metabolic
partial compensation
pH 7.64
CO2 47
HCO3 30
alkalosis
metabolic
partially compensated
pH 7.34
CO2 51
HCO3 37
acidosis
respiratory
partially compensated
pH 7.8
CO2 29
HCO3 24
alkalosis
respiratory
uncompensated
pH 7.16
CO2 46
HCO3 38
acidosis
respiratory
partially compensated
pH 7.68
CO2 52
HCO3 34
alkalosis
metabolic
partially compensated
pH 7.65
CO2 28
HCO3 17
alkalosis
respiratory
partially compensated
pH 7.33
CO2 32
HCO3 18
acidosis
metabolic
partially compensated
pH 7.12
CO2 28
HCO3 13
acidosis
metabolic
partially compensated
The nurse is evaluating the laboratory work of a patient who has uncontrolled metabolic acidosis. Which outcome would result from this condition?
A.pH 7.40
B.PaO2 98 mmHg
C.Bicarbonate 38 mEq/L
D.Serum potassium of 5.7 mEq/L
D. Serum Potassium of 5.7 (because the kidneys aren't working)
Which of the following would be associated with metabolic acidosis?
A Central nervous system depression
B Increased serum bicarbonate level
C Prolonged vomiting or gastric suctioning
D pH greater than 7.40
A.
Central nervous system depression
A patient diagnosed with diabetes mellitus has not been following his established meal plan and did not eat lunch today. What is an expected outcome for this patient?
A Metabolic acidosis
B Metabolic alkalosis
C Respiratory acidosis
D Respiratory alkalosi
A.
Metabolic acidosis
The nurse is reviewing standing orders for a pt who has chest pain. The pt has hx of COPD, lab results show he has mild respiratory acidosis. The nurse would question which order?
A.Encourage oral fluids
B. Keep HOB elevated
C. O2 therapy at 4 L/min
D. Be
C. O2 therapy at 4L/min
The nurse is caring for a client with an NG tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
B. Metabolic alkalosis(Stomach contents are acidic- NG tube is pulling all that out to make body system more basic)
A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note whic
D. An increased pH with an increased HCO3.
A nurse caring for a client with an ileostomy understands the the client is most at risk for developing which acid-base disorder?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D Respiratory Alkalosis
A. Metabolic Acidosis(Intestinal secretions are high in bicarbonate)
A patient has experienced several fractured ribs after being involved in an automobile accident. She is receiving pain medication frequently. What is an expected outcome for this patient?
A Metabolic acidosis
B Metabolic alkalosis
C Respiratory acidosis
D
C.
Respiratory acidosis
A patient is experiencing a cardiac arrest. A possible outcome for this patient in the form of acid-base imbalance is:
A Metabolic alkalosis
B Respiratory alkalosis
C Metabolic alkalosis and respiratory alkalosis
D Metabolic acidosis and respiratory acido
D.
Metabolic acidosis and respiratory acidosis