Acid Base Balance 4th Semester Nursing

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  1. What is the normal range for pH?
    7.35 to 7.45 

    • <7.35 acidosis
    • >7.45 alkalosis
  2. What is the PaCONormal range?
    35 to 45 mg 

    • Partial pressure of carbon dioxide (CO2) in arterial blood: 
    • <35mmHg= hypocapnia
    • >45mmHg=hypercapnia
  3. What is the normal range of HCO3?
    • 22-26 mEq/L
    • Bicarbonate concentration in plasma
  4. Metabolic Acidosis: Risk factors
    Acute lactic acidosis usually results from tissue hypoxia due to shock or cardiac arrest

    Patients with type 1 diabetes mellitus are at risk for developing diabetic ketoacidosis

    Acute or chronic renal failure impairs the excretion of metabolic acids. 

    Diarrhea, intestinal suction, abdominal fistulas increase the risk for excess bicarbonate loss.
  5. Metabolic Acidosis: Pathophysiology
    Three basic mechanisms that can cause metabolic acidosis are the following: 

    Accumulation of metabolic acids

    Excess loss of bicarbonate

    An increase in chloride levels
  6. Manifestations of Metabolic Acidosis
    • Anorexia 
    • N&V
    • Abdominal pain 
    • Weakness
    • Fatigue
    • General malaise
    • Decreasing LOC
    • Dysrhythmias
    • Bradycardia
    • Warm, flushed skin
    • Hyperventilation (Kussmaul's respirations)
  7. Metabolic Acidosis: Diagnosis
    • ABG's
    • Serum electrolytes
    • ECG may show changes that reflect both the acidosis (particularly when severe) and the accompanying hyperkalemia. 

    Other diagnostic studies such as the blood glucose and renal function studies may be ordered to identify the underlying cause of metabolic acidosis.
  8. Metabolic Acidosis: Medications
    • Bicarbonate may be given if the pH is less than 7.2 to reduce the effects of the acidosis on cardiac function. 
    • Sodium bicarbonate is the most commonly used alkalinizing solution. others include lactate, citrate, and acetate solutions 

    • Alkalinizing solutions are given IV for severe acute metabolic acidosis. 
    • In chronic metabolic acidosis, the oral route is used.
  9. Metabolic Acidosis:*** Practice Alert***
    AS metabolic acidosis is corrected, potassium shifts back into the intracellular space. This can lead to hypokalemia and cardiac dysrhythmias. Carefully monitor serum potassium levels during treatment.
  10. Metabolic Acidosis:Assessment
    Physical Assessment: Mental status and LOC, VS, apical and peripheral pulses; skin color and temperature; abdominal contour and distention; bowel sounds and urine output.
  11. Metabolic Acidosis: Nursing interventions
    Monitor for signs of respiratory distress

    Monitor for hyperpnea with Kussmauls respirations. Respirations are increased as the lungs attempt to rid the body of excess CO2. 

    Monitor I&O--Provide fluid and electrolyte replacement as prescribed. 

    Prepare to administer meds (buffers) as prescribed: sodium bicarbonate 

    Initiate safety measures and seizure precautions

    • Monitor labs for increased potassium level:  
    • --Normal functioning Kidneys retain potassium when trying to rid body of H ions 

    Note:  As metabolic acidosis resolves, potassium moves back into the cells and serum potassium level decreases. (When excess H ions are present they are pushed into cells, H ions are pushed out) 

    • Monitor labs for increase in calcium level
    • Monitor for decrease in magnesium level  
    • If patient has severe diarrhea, monitor S/S of Metabolic acidosis.
  12. Interventions for metabolic acidosis due to DM or DKA Diabetic Ketoacidosis
    • Give insulin as prescribed to hasten the movement of glucose into cell, which will decrease the concurrent ketosis. 
    • When glucose is properly metabolized, the body will stop converting fats to glucose. 

    Monitor circulatory collapse cause by Polyuria, due to hyperglycemic state; Osmotic diuresis may lead to extracellular volume deficit.

    Interventions for Kidney disease: 

    Dialysis may be used to remove proteins and waste products from blood 

    A diet low in protein and high in calories helps decrease the amount of protein waste products resulting in lower acid levels
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Acid Base Balance 4th Semester Nursing
Acid Base Balance
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