Summary NUR 2392 Multidimensional Care II (NUR2392) Week 5 and 6 Notes - Rasmussen College

Week 5 and 6 MDC 2 Notes Acid & Base

 Acids: release H ions when dissolved in H20
 Bases: bind with H ions in solutions
 Buffers: maintain normal body fluid pH
 Normal levels
o pH: 7.35 to 7.45 (acidic basic)
o paCO2: 35-45 (basic acidic)
o HCO3: 22-26 (acid basic)
o paO2L: 80-100

**If there is less H ion [], the pH rises and becomes more alkaline or basic
**More H ion [], the pH drops and becomes acidic

 3 systems maintaining pH
o Buffers: moves or releases H ions
o Respiratory system: hyperventilation or hypoventilation; regulates
carbonic acid by elimination or retaining CO2
o Renal system: kidney movement of bicarbonate and long term
regulation of acid base in body
 May take hours or days for this to have an impact on the body
 Compensation (body correcting blood pH changes)
o Body attempts to correct changes in blood pH to maintain acid-base
balance. Respiratory compensation occurs through the lungs by
increasing CO2
o pH <6.9 or >7.8 are usually fatal
 Aerobic metabolism = 2 forms of acid
o Respiratory acid (carbonic acid)
o Metabolic acids
 Steps to determine ABG
1. Figure out if pH is acidic or basic
2. Evaluate pCO2 (acid) to see where it falls.
a. If paCO2 falls below= respiratory alkalosis
b. If paCO2 falls above= respiratory acidosis
3. Evaluate HCO3 to see the direction of the metabolic component
4. ABG Interpretation- Compensation


Respiratory Acidosis Metabolic Acidosis
Deficit HCO3 Deficit HCO3
Caused by hypoventilation Common in cases of kidney disease and
diabetes
Respiratory Alkalosis Metabolic Alkalosis
Excess HCO3 Excess HCO3
Caused by hyperventilation Caused by steroid or diuretic therapy,

, or excessive anti-acids




 Acid-base imbalances
** Potassium goes up in acidosis

o Acidosis
 pH below 7.35
 Respiratory cause: retention of CO2
 Metabolic cause: loss of bicarbonate
o Metabolic acidosis
 pH <7.35
 HCO3 <22 mEq/L
 Causes: over production of H+ ions, underproduction of
bicarbonate ions, under elimination of H+ ions, and over
elimination of bicarbonate ions
 Sings and symptoms: hypotension, depressed activity,
hyporeflexia, skeletal muscle weakness, warmed, flushed, and
dry skin in metabolic acidosis
 Diagnostic tests: ABG & electrolytes
 Multidimensional care: improve airway and oxygenation, drug
therapy, O2 therapy, pulmonary hygiene, ventilation support,
prevention complication
o Respiratory acidosis
 pH <7.35
 PaCO2 > 45mmHg
 Causes: retention of CO2 (causing  production of free H ions)
 Signs and symptoms: variable respirations, kussmal
respirations, pale to cyanotic and dry skin in respiratory
acidosis
 Diagnostic test: arterial blood gas & serum electrolytes
 Multidimensional care: improve airway and oxygen, drug
therapy (bronchodilators, anti-inflammatory, mucolytic),
oxygen therapy, pulmonary hygiene, ventilation support,
prevention of complications
o Patient centered care
 CNS changes
 Neuromuscular changes: decreased muscle tone, deep tendon
reflexes
 Cardiovascular changes: (early) increased HR, cardiac output
changes; (worsening) hyperkalemia, decreased HR, EKG
changes, hypotension