KEEP CALM 2020. 4. 25. KEEP CALM AND PASS NCLEX WITH MARK KLIMEK REVIEW 1. ACID-BASE BALANCE/VENTILATORS

KEEP CALM and PASS NCLEX with MARK KLIMEK Review 1. Acid-base balance/ventilators Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic If they are in different directions = respiratory pH = 7.35-7.45 acidosis/alkalosis HCO3 (bicarb) = 22-26 (2+2+2 = 6) CO2 = 45-35 ex: pH: 7.30 = ↓ bicarb: 20 = ↓ = metabolic acidosis ex: pH: 7.58 =↑ bicarb: 32 = ↑ = metabolic alkalosis ex: pH: 7.22 =↓ bicarb: 30 =↑ = respiratory acidosis ex: You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3 29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing: ↓ = acidosis, ↑ = respiratory -opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc).. *principle: acid base signs/symptoms.. as the pH goes… so goes my patient!!! -when pH goes up; patient goes up.. (everything gets irritable!) -when pH goes down; patient goes down! (systems in your body shut down) …except with potassium: when pH goes up; potassium goes down… when pH goes down; potassium goes up! (up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure, aspirate.. (down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased bowel sounds), coma, respiratory arrest (ambu-bag!!) Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC Kussmaul!! M: metabolic AC: acidosis ex: pT has respiratory acidosis… (select all that apply).. +1 reflexes diarhhea adynamic ileus spasm urinary retention tachycardia 2nd degree mobits type 2 heart block hypokalemia SATA questions: *never only 1… never all of them* diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels down = paralytic ileus …with scenarios.. always ask first “is it lung?” = respiratory …then ask if the pt is over-ventilating or under-ventilating? over-ventilating = alkalosis under-ventilating = acidosis …it’s about the SaO2!!! (pay attention!!) if it isn’t lung = metabolic.. if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis… why? losing acid = becomes basic.. for everything else that is not lung - choose metabolic acidosis.. -if you don’t know the answer… always answer metabolic acidosis..