Acid-Base Imbalances

4935

Respiratory Acidosis
Caused by: disturbances in ventilation, perfusion or diffusion that result in hypoventilation

Common causes:
Neuromuscular problems Depression of the respiratory center in the brain Lung disease Airway obstruction

 Neuromuscular problems: Gullian-Barre syndrome, Myasthenia Gravis, and Polio Depression of the respiratory center in the brain: trauma, tumors, vascular disorders, some medications, and infections Lung disease: respiratory infections, COPD, asthma attacks, chronic bronchitis, pulmonary edema, pneumothorax. Airway obstruction: retained secretions, retained objects, anaphylaxis, laryngeal spasm, and some lung diseases.

Who is at risk?
Children Mechanical ventilation Post-operative patients Anyone on analgesics or sedatives

Signs and Symptoms

Apprehension Restless Headache Confusion- Coma Depressed DTR N&V Warm flushed skin Dyspnea Tachycardia Diaphoretic Diminished breath sounds Hypoxemia, cyanosis, cardiac arrest ( In late stages) Respirations: initially: Rapid shallow respirations (but not in all cases)
In an attempt to compensate, the respiratory rate and depth increase

Tests show what?

pH: PaCO2: HCO3: Serum Electrolytes: Elevated K, because it is moving out of the cell and there in more of it in circulation

Treatment
Maintain a patent airway Bronchiodialators O2 as needed Drug therapy to treat hyperkalemia Antibiotics if there is an infection Chest PT

Monitoring
Assess vitals and respiratory status Monitor neurological status Report alterations in ABG, electrolytes, pulse ox. Give O2 as ordered Encourage coughing/ deep breathing/ positional changes Maintain Hydration: Watch I&O

Documentation
VS/ cardiac rhythm I&O Notification of MD O2 therapy/ vent settings and medications given Character of pulmonary secreations Electrolytes and ABG results.

Respiratory Alkalosis
Caused by: too much CO2 is being eliminated. This causes a decrease in the PaCO2 and an increase in the pH. Common Causes:
Hyperventilation due to pain or anxiety Hypermetabolic states Liver Failure Conditions that affect the brains resp control center Hypoxia

 Anxiety/Pain: May increase respiratory rate Hypermetabolic states: Fever and sepsis Drugs: nicotine, salicylates, chatecholamines Conditions that affect the resp. control center of the brain: elevated progesterone levels, stroke, trauma Hypoxia: High altitude, pulmonary embolus, hypotension

Signs and Symptoms

Respirations are rapid and deep: as the body tries to compensate, the respiration rate and depth eill go down Anxious/ restless Headache/ lightheadedness Muscle weakness/ tingling in the fingers and toes ECG changes/ arrhythmias/ tachycardia Hyperreflexia/ carpopedal spasm/ tetany

Extreme cases: confusion/ alternating apnea and hyperventilation/ siezures/coma

Tests show what?

pH PaCO2 Possible Hypokalemia Possible Hypocalcemia ECG: possible arrhythmias

Treatment/ Monitoring
Correct underlying disorder Relaxation techniques Watch VS Report changes in cardiac, neuro, or neuromuscular functioning Watch and report changes in the ABG and electrolytes Provide undisturbed rest periods

Documentation
VS I&O IV therapy Interventions (including those to relieve anxiety)/ response ABG/ electrolyte results Safety measures Any time you notify the doctor about a change

Metabolic Acidosis
Caused by: either a loss of HCO3 from extracellular fluids or an accumulation of metabolic acids, or a combination of both

Common causes: Overproduction of ketone bodies Impaired kidney function GI losses Poisoning/ drug toxicity

 Overproduction of Ketone bodies: diabetes, chronic alcoholism, malnutrition, starvation, poor intake of carbohydrates, hyperthyroidism, severe infection with a fever

Impaired Kidney Function: renal failure and acute tubular necrosis

GI losses: severe diarrhea, intestinal malabsorption Poisoning/ Drug toxicity: salicylates, methanol, ethylene glycol

Signs and Symptoms

Kussmauls respirations: rapid and deep Hypotension/ arrhythmias Skin warm and dry Weakness/ decreased DTR/ decreased muscle tone A/N/V headache LOC deterioration

The tests show

pH HCO3 PaCO2 Hyperkalemia Elevated glucose and ketones in diabetic ketoacidosis ECG changes (sometimes)

Treatment
Sodium bicarb IV Abx if there is an infection Antidiarrheal if needed Rapid acting insulin if diabetic ketoacidosis is a problem Ventilation if needed Dialysis in patients with renal failure Safety and seizure precautions

Monitoring
Watch ABGs and electrolytes Maintain IV line and flush before and after bicarb is given VS, cardiac rhythm Notify MD of changes in neuro status Position semi-fowlers/ and turn if in a stupor Monitor LOC Watch I&O

Documentation
Assessment findings (including neuro) I&O IV therapy and response ABG and electrolyte results VS and cardiac rhythm Vent or dialysis if utilized Notification of the MD Patient teaching

Metabolic Alkalosis
Caused by: either a loss of acid or increase/ gain of bicarb or both Common Causes: Hypokalemia Acid loss from GI tract Diuretic therapy Kidney disease Transfusions/ drugs

 Hypokalemia: Diuretic use Loss from GI tract: Excessive vomiting, pyloric stenosis, NG tube suctioning, GI surgeries Diuretic therapy: Thiazide and loop diuretics Kidney disease: renal artery stenosis Drugs: corticosteroids, antacids that contain baking soda. Sodium bicarb

Signs and Symptoms

Respirations will be slow and shallow in an attempt to compensate until hypoxia occurs cyanosis Muscle twitching, weakness, and tetany Hyperactive DTR/ parasthesia of fingers, toes and mouth Apathy, confusion, coma A/N/V Polyuria Arrhythmias/ death

Tests show
pH HCO3 PaCO2 Low potassium, calcium, and chloride Possible ECG changes

Treatment
Stop diuretics and NG suctioning Anteimetics if underlying cause is N/V Acetazolamide (Diamox) may be given IV ammonium chloride in sever cases O2 Seizure precautions if necessary Irrigate NG with NS instead of tap water (helps with retention of electrolytes)

Monitoring
VS/ cardiac rhythm/ respiratory status LOC I&O ABG and electrolytes Assess for muscle weakness, tetany or decreased activity Notify the MD of any changes in status

Documentation
VS IV therapy Interventions and patient response Medications given I&O O2 therapy Notification of the MD Safety measures ABG and electrolyte results