1. 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
  2. mechanisms to maintain pH
    "Buffering, respiratory compensation, metabolic compemsation"
  3. 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
  4. 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
  5. Metabolic compensation
    compensates through rate of elimination or reabsorption of H+ and HCO3 in the kidneys; This mechanism takes hours to days
    "uncompensated (acute), partially compensated, compensated (chronic), Corrected"
  7. corrected compensation
    "—the pH is within normal limits, all acid-base parameters return to normal ranges "
  8. 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)"
    "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)"
  10. 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)"
  11. Respiratory Alkalosis
    "Primary H2CO3 deficit or decreased CO2; pH >7.45, pCO2 < 35mmHg, & HCO3 - normal or < 22mEq/L"
  12. S&S Respiratory Alkalosis
    "—dizziness, diaphoresis, palpitations, dyspnea, panic, anxiety, tetany, convulsions"
  13. Nursing interventions for Respiratory Alkalosis
    "—reduce anxiety by sedation, rebreathe CO2"
  14. Respiratory Acidosis
    "Primary H2CO3 excess or increased CO2; pH <7.35, pCO2 > 45mmHg, HCO3 -normal or > 26mEq/L"
  15. S&S of Respiratory Acidosis
    "—warm flushed skin, tachycardia, H/A, decreased LOC, muscle twitching, papilledema"
  16. 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
  17. 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"
  18. S&S of Metabolic Alkalosis
    "—hypotension, tachycardia, hyperreflexia, tetany, dysrhythmias, confusion, decreased LOC, seizures, respiratory failure"
  19. nursing interventions for Metabolic Alkalosis
    "—monitor GI symptoms and treat, monitor Cardiac output r/t volume depletion, give KCL, treat cause of condition"
  20. Causes of Respiratory Acidosis
    "alveolar hypoventilation; chest trauma, pain, opiates, brain tumor, chronic conditions like COPD, MS, Stroke"
  21. 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;
  22. Causes of Respiratory Alkalosis
    "alveolar hyperventilation –fever, infection, mechanical ventilators, salicylate poison, stimulate resp. center, anxiety"
  23. 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"
  24. 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"
  25. S&S of Metabolic Acidosis
    "—anorexia, n/v, abd pain, weakness, decreased LOC, bradycardia, dysrhythmias, warm flushed skin, hyperventilation, Kussmaul’s breathing in the diabetic"
  26. 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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