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componets of acid-base
pH 7.35-7.45 free H+ in blood; pCO2 35-45 mmHg respiratory component; HCO3 22-26 mEq/L renal/metabolic component; Base Excess - +2 to 2mEq/L HCO3 concentration
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mechanisms to maintain pH
"Buffering, respiratory compensation, metabolic compemsation"
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Buffering
prevents major changes in pH by removing or releasing H+; uses chemical reaction between acids and bases to maintain neutral environment. The major reversible reaction is H+ + HCO3 < --> H2CO3 < --> CO2 + H2O; The body maintains 20:1 ratio of HCO3 to H2CO3; This mechanism occurs within minutes
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Respiratory Compensation
increase or decrease alveolar ventilation; Hyperventilate to decrease CO2 levels thus decrease H2CO3 and increase pH; Hypoventilate to increase CO2 levels thus increase H2CO3 and decrease pH; This mechanism takes minutes to hours
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Metabolic compensation
compensates through rate of elimination or reabsorption of H+ and HCO3 in the kidneys; This mechanism takes hours to days
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FOUR LEVELS OF COMPENSATION
"uncompensated (acute), partially compensated, compensated (chronic), Corrected"
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corrected compensation
"the pH is within normal limits, all acid-base parameters return to normal ranges "
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COMPENSATED (chronic)
"the pH is within normal limits, the acid-base imbalance has been neutralized but not corrected. The acid-base components are abnormal but balanced. Remember the body maintains the 20:1 ratio. Examples : pH 7.36, pCO2 55, HCO3 33 (comp respiratory acidosis); pH-7.36, pCO2 23, HCO3 13 (comp metabolic acidosis)"
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PARTIALLY COMPENSATED
"the pH is abnormal but the body buffers and regulatory mechanisms have started to respond to the imbalance. Thus, the acid-base components are abnormal. Examples pH 7.26, pCO2 23, HCO3 8 ( part compensated met acidosis)"
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uncompensated
"ABNORMAL pH due to buffer and regulatory mechanisms have not begun to correct the imbalance. (also described as acute); Also the acid or base component is abnormal examples- pH 7.16, pCO2 82, HCO3 26 (resp acidosis); pH 7.52, pCO2 42, HCO3 35 (metabolic alkalosis)"
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Respiratory Alkalosis
"Primary H2CO3 deficit or decreased CO2; pH >7.45, pCO2 < 35mmHg, & HCO3 - normal or < 22mEq/L"
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S&S Respiratory Alkalosis
"dizziness, diaphoresis, palpitations, dyspnea, panic, anxiety, tetany, convulsions"
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Nursing interventions for Respiratory Alkalosis
"reduce anxiety by sedation, rebreathe CO2"
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Respiratory Acidosis
"Primary H2CO3 excess or increased CO2; pH <7.35, pCO2 > 45mmHg, HCO3 -normal or > 26mEq/L"
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S&S of Respiratory Acidosis
"warm flushed skin, tachycardia, H/A, decreased LOC, muscle twitching, papilledema"
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nursing interventions forRespiratory Acidosis
breathing treatments; O2 and IV therapy be careful when giving oxygen to COPD clients; if client in pain administer medication as ordered
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Metabolic Alkalosis
"Primary excess in ECF of HCO3 due to loss of acid or addition of excess HCO3; pH>7.45, HCO3>26mEq/L, pCO2 normal or > 45mmHg"
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S&S of Metabolic Alkalosis
"hypotension, tachycardia, hyperreflexia, tetany, dysrhythmias, confusion, decreased LOC, seizures, respiratory failure"
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nursing interventions for Metabolic Alkalosis
"monitor GI symptoms and treat, monitor Cardiac output r/t volume depletion, give KCL, treat cause of condition"
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Causes of Respiratory Acidosis
"alveolar hypoventilation; chest trauma, pain, opiates, brain tumor, chronic conditions like COPD, MS, Stroke"
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Causes of Metabolic Alkalosis
increased H+ loss gastric suction; vomiting; diuretics; mineralcorticoid-aldosterone- hypercalcemia; decreased K+; alkali ingestion; blood administration; bicarb administration during a code;
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Causes of Respiratory Alkalosis
"alveolar hyperventilation fever, infection, mechanical ventilators, salicylate poison, stimulate resp. center, anxiety"
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Metabolic Acidosis
"Primary loss of HCO3 from ECF and/or due to increased acid production; pH<7.35, HCO3<22mEq/L, pCO2 normal or < 35mmHg"
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Causes of Metabolic Acidosis
"increased acid production lactic acids; DKA; starvation; poisons; loss of bicarb diarrhea, ileostomy, biliary or pancreatic fistulas; increased CL- production; renal failure causes retention of acids"
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S&S of Metabolic Acidosis
"anorexia, n/v, abd pain, weakness, decreased LOC, bradycardia, dysrhythmias, warm flushed skin, hyperventilation, Kussmauls breathing in the diabetic"
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nursing interventions for Metabolic Acidosis
monitor for cardiac dysrhythmias; replacement of electrolytes; neuro status assess; EKG; GI assess; fluid I & O; correct underlying problem
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