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31 Cards in this Set
- Front
- Back
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Normal pH, PaCO2, HCO3
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pH=7.35-7.45
PaCO2=35-45 mm Hg HCO3=22-26 mEq/L |
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Partial compensation
Complete or full compensation |
Partial compensation: the pH will still be out of the normal range
Complete or Full compensation: The pH will go back to normal |
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Respiratory compensation
Metabolic compensation |
Metabolic disturbance: Lungs compensate (respiratory compensation)
Respiratory disturbance: Kidneys compensate (Metabolic compensation) |
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Step: 1
Determine if the pH, PaCO2 & HCO3 are within normal limits. |
pH: 7.35-7.45
Paco2 35-45 mm Hg HCO3 22-26 mEq/L |
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Step: 2
Determine if acidity or alkalinity is the problem: |
If the pH > 7.45 then it is alkalosis
If the pH < 7.35 then it is acidosis |
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Step: 3
Check the PaCO2 & HCO3 levels to see which has the same acid-base status as the pH. |
PaCO2
Respiratory acidosis > 45 Respiratory alkalosis < 35 HCO3 Metabolic acidosis < 22 Metabolic alkalosis > 26 |
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Step: 4
Determine the extent of the compensation. Look at the value that does not match the acid-base status (PaCO2 or HCO3) |
Absent: value within normal range
Partial: the value is abnormal and the pH is abnormal Complete: the value is abnormal and the pH is normal |
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pH = 7.30 (normal 7.35-7.45)
HCO3- = 20 mEq/liter (normal 22-26) PaCO2 = 32 mm Hg (normal 35-45) |
All values are outside of the normal range. pH = acidosis HCO3 = metabolic PaCO2 = metabolic acidosis. Metabolic compensation will be by respiratory. So there is partial compensation on this one.
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pH 7.52
PaCO2 47mm Hg HCO3 36 mEq/L |
pH=alkalosis, PaCO2 is high, & HCO3 is high. Metabolic alkalosis. pH is high and bicarb is high which means there is metabolic alkalosis. There is partial compensation because PaCO2 is outside the normal.
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pH 7.30
PaCO2 58 mm Hg HCO3 26 mEq/L Pao2 50 Sao2 80 |
pH is low which means acidosis, PaCO2 is high, HCO3 is normal. Respiratory acidosis PaCO2 will go in opposite direction. This means you have a lot of CO2 in body. No compensation because HCO3 (bicarb) is normal. PaO2 and SaO2 is low because it should be around 95. PaO2 is low because it should be 80-100 and this person is not oxygenating well.
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pH 7.55
PaCO2 28 mm Hg HCO3 24 mEq/L |
pH is high = alkalosis PaCO2 is low and HCO3 is normal. Respiratory acidosis and no compensation.
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Respiratory Acidosis
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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 |
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Who is at risk for respiratory acidosis?
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Children
Mechanical ventilation Post-operative patients Anyone on analgesics or sedatives |
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Signs and symptoms of respiratory acidosis?
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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 |
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Treatment of respiratory acidosis
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Maintain a patent airway
Bronchiodialators O2 as needed Drug therapy to treat hyperkalemia Antibiotics if there is an infection Chest PT |
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Monitoring respiratory acidosis
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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 |
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Respiratory alkalosis
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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 brain’s resp control center Hypoxia |
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Signs and symptoms of respiraotry alkalosis
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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 |
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Treatment/ Monitoring of respiratory alkalosis
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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 |
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Metabolic acidosis
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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 |
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Signs and symptoms of metabolic acidosis
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Kussmaul’s respirations: rapid and deep
Hypotension/ arrhythmias Skin warm and dry Weakness/ decreased DTR/ decreased muscle tone A/N/V headache LOC deterioration |
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Treatment metabolic acidosis
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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 |
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Monitoring metabolic acidosis
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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 |
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Metabolic Alkalosis
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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 |
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Signs and symptoms metabolic alkalosis
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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 |
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Treatment metabolic alkalosis
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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) |
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Monitoring metabolic alkalosis
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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 |
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Metabolic alkalosis common causes
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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 |
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Metabolic acidosis common causes
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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 |
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Respiratory alkalosis common causes
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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 disease, pulmonary embolus, hypotension |
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Respiratory acidosis common causes
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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. |
