ACIDBASE

Know what the concept means

Recognize conditions that place individual at risk of acid-base imbalances
Respiratory conditions
Respiratory acidosis
Risk factors; drug overdose, airway obstruction, chest trauma, pulmonary
edema, neuromuscular disease, atelectasis, COPD, Pneumonia,
Pulmonary Edema, Guillain-Barre Syndrome
Manifestations
i.
Hypoventilation
ii.
Vasodilation/ low BP
iii.
Dyspnea
iv.
Headache
v.
Dysrhythmias / high potassium
vi.
Drowsiness/ dizziness/ disorientation
vii.
Muscle weakness
Metabolic acidosis; DKA, salicylate overdose, renal failure, severe diarrhea,
sepsis, shock
Who are at risk?
i.
The kidneys are an essential buffer system for acids, and in the older adult,
ii.

the kidneys are less able to compensate for an acid load.

The older adult has decreased respiratory function, leading to impaired

compensation for acid-base imbalances.

iii.
In addition, tissue hypoxia from any cause may alter acid-base balance.
Compensatory mechanisms
Increased CO excretion by lungs
2
Kussmaul respirations (deep and rapid)
Kidneys excrete acid
Identify when acid-base imbalance is developing or has developed
Provide appropriate nursing and collaborative interventions for individuals experiencing
an imbalance
What are common signs and symptoms of respiratory acidosis?
Disorientation, Headache, Muscle Twitching, Seizure, Tachycardia,
Hypotension, Flushed and Warm skin
What diagnostic testing might be done?

 ABG, EKG, BMP

What treatment might be anticipated at this time? Antidote for drug overdose:
Narcan (Narcotics) and/or Romazicon
What are the priority nursing diagnosis Monitor ABGs, Monitor I&O, Monitor Vital Signs, Monitor EKG, Maintain
a Calm Environment, Provide Oral Hygiene, Seizure Precaution, Place
the Patient in Semi-Fowlers to Fowlers position, Techniques,
Administer Oxygen, Administer Bronchodilator, Administer Antibiotics,
Mucomyst if Patient has Pneumonia, Possible use of Mechanical

VentilationTeach Deep Breathing Techniques, Report any Changes in Respiratory

Status, Follow Instructions of Narcotic Usage

Control Underlying Causes, Encourage Pursed-lip Breathing
Administer Antidote for drug overdose: Narcan (Narcotics) and/or
Romazicon (Benzodiazepine). Gastric Lavage and Activate Charcoal can
be also used.
Respiratory Acidosis intervention
Impaired Gas Exchange-Monitor respiratory status, skin color and mental
status. Administer oxygen, and Place patient in semi-fowler or fowler
position.
Ineffective Airway Clearance- Monitor respiratory status, skin color and
mental status. Administer oxygen, and Encourage fluid intake, Encourage
deep breathing and coughing, Place patient in semi-fowler or fowler position.
Anxiety-Reduce environmental stimuli, Initiate AIDET (Acknowledge,
Introduction, Duration, Explanation, and Thank you), and Remain with the
patient
Risk for Injury-Monitor Neurological Status and Implement safety precautions.

Respiratory alkalosis panic attack

Hyperventilation due to:

Hypoxemia

Initial stage of PE
Fever
Pregnancy
high altitude
Metabolic acidosis,
Early salicylate intoxicosis aspirin overdose
Neurologic
Lesions
Trauma
Infection

Risk factors

i.
Critically ill
ii.
Mechanical ventilation
Manifestation

Seizure
Deep rapid breathing
Hyperventilation
Tachycardia
Low or normal BP
Hypokalemia
Numbness/tingling
Light headedness
Nausea, vomiting

What are the risk factors for respiratory alkalosis?

Hyperventilation induced by hypoxia, anxiety, pain, brain tumor,
and fever, Mechanical Ventilation, ASA Overdose

How would you assess this patient?

Past medical history related to Pulmonary, and/or Psychiatric problems,
Medication history
Vertigo, Anxiety, Tetany like symptoms, Seizure, Hyperactive
reflexes, Rapid Shallow Breathing, Palpitations, Tachycardia,
Sweating
ABG, EKG, BMP, Drug Screen Test

How would you counsel/educate this patient to prevent future episodes?

Teach Deep Breathing and Relaxation Techniques, Stress Management
What are the possible interventions?

Monitor ABGs, Monitor I&O, Monitor Vital Signs, Monitor EKG, Provide a
Calm Environment, Provide Relaxation Techniques, Seizure Precaution
Control Underlying Causes, Provide the Patient with Rebreather Mask,
Administer Oxygen, and Administer Anxiolytic Agents and/or Sedatives.
Monitor respiratory status, skin color and mental status. Administer oxygen, and
Place patient in semi-fowler or fowler position.
Anxiety-Reduce environmental stimuli, Initiate AIDET, and Remain with the
patient
Risk for Injury-Monitor Neurological Status and Implement safety precautions.
What are your priority nursing diagnosis? - airway

Metabolic alkalosis pyloric stenosis

Hypokalemia
Gastric suction or vomiting
Hypochloremia
Over use of antacids

Compensatory mechanisms
Decreased respiratory rate to increase plasma CO2
Renal excretion of HCO3Manifestation

i.

Restlessness
Dysrhythmias
Confusion
Nausea, vomiting
Tremors, muscle cramps,
Hypokalemia
Tetany
Hyperactive reflexes
What are the risk factors for metabolic alkalosis?

ii.

Severe Vomiting, Gastric Suctioning, Hypokalemia, Peptic

Ulcers, licorice

How would you assess the patient with metabolic alkalosis? How might the
assessment differ with a pediatric patient?

Past medical history related to GI, and/or renal problems,

Dietary intake, Medication history

S/Sx: Irritability, Nervousness, Tremors, Hyperreflexia, Seizures,

Disorientation, Hypoventilation, Tachycardia, Dysrhythmia, HTN, Nausea,
Vomiting

iii.

What are the possible nursing interventions?

Consult with Healthcare Providers for any Antacid use, Report any Severe
Vomiting
Monitor ABGs, Monitor I&O, Monitor Vital Signs, Monitor EKG, Monitor
Skin Color, Place the Patient in Semi-Fowlers to Fowlers position, place
infant on side to avoid aspiration of vomitus, ensure safety by keeping bed
rails elevated,
Administer Oxygen, Control Underlying causes (GI losses), Administer NS to
replace fluid, Administer Histamine 2 Antagonists, Administer Potassium

iv.

What are your priority nursing diagnosis

Risk for Impaired Gas Exchange-Monitor respiratory status, skin color and
mental status. Administer oxygen, and Place patient in semi-fowler or fowler
position.

Deficient Fluid Volume-Monitor I&O, vital signs, CVP, weight, and labs
(Electrolytes, Osmolality, and ABG), Administer IV Fluid.

Risk for Injury-Monitor Neurological Status and Implement safety

precautions.

Metabolic acidosis; (base bicarbonate deficit) occurs when an acid other than carbonic
acid accumulates in the body, or when bicarbonate is lost from body fluids.

Ketoacidosis
Lactic acid accumulation (shock)
Severe diarrhea

 Kidney disease
Manifestation of MA

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.

Headache
Decrease BP
HYPERKALEMIA
MUSCLE TWITCHING
WARM flushed skin
Nausea, vomiting, diarrhea
LOC
Kussmaul resp

Decreased Cardiac Output-Monitor vital signs, EKG, labs (BNP, Creatinine, &
BUN), Peripheral pulses, and Estimated Glomerular Filtration Rate (GFR). Review
prescribed medications.
Risk for Excess Fluid Volume-Auscultate Heart & Lung sounds, Assess I&O,
edema, Central Venous Pressure (CVP), and weight.
Risk for Injury-Monitor Neurological Status and Implement safety precautions.

Vomiting and diarrhea

Diabetes mellitus

Primary Prevention (health promotion, disease prevention)

Metabolic Acidosis- Diabetes and DKA management, Report any Chronic
Diarrhea
Secondary Prevention (screening and diagnosis, occurs after health
problem has arisen)
Metabolic Acidosis- Monitor ABGs, Monitor I&O, Monitor Vital Signs, Monitor
EKG, Assess GI functions, Monitor Anion Gap and signs & symptoms of
Diabetic Ketoacidosis.
Tertiary Prevention (follows occurrence and correction of
healthcare problem, aimed at returning patient to the highest
level of function possible, rehabilitation,)
Metabolic Acidosis- Control Underlying Causes, Restoration of
Fluid, Electrolytes, and Nutrition, Administer Sodium Bicarbonate,
Possible use of Mechanical Ventilation, Administer Antidiarrheal
Agent,

DKA Management: Administer NS bolus (500-1000 ml/hr) for 2 hours,

1/2NS (200-500 ml/hr) until Blood Sugar decrease to 250, and then
change to Dextrose containing IV solution. Regular Insulin IV drip
protocol can be used to regulate the Blood Sugar. Administer
Potassium, Monitor Anion Gap and Blood Sugar closely.

Anxiety, CNS disorders, and mechanical over-ventilation also increase ventilation

rate and decrease the partial pressure of arterial carbon dioxide (PaCO 2) level.
In acute respiratory alkalosis, aggressive treatment of the causes of hypoxemia
is essential and usually does not allow time for compensation to occur. However,
buffering of acute respiratory alkalosis may occur with shifting of bicarbonate
(HCO3) into cells in exchange for Cl.