NUR2392 Multidimensional Care II Exam 2 Graded A+
Uncompensated
pH and one other value is abnormal
Partial compensation
pH, CO2, and HCO3 are all off
Full compensation
pH is normal
Acidosis
reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle.
Alkalosis
increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation
ABG considerations
- Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia)
- Assess neuro status
- Fall precautions
Bicarb HC03
kidney compensation (slow and powerful)
Respiratory PaC02
Respiratory compensation (fast but limited)
Metabolic acidosis causes
DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure
activity, fever, hypoxia, ischemia, ethanol/methanol intoxication
Metabolic acidosis signs and symptoms
bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp
compensation), warm, flushed, dry skin.
Metabolic acidosis treatment
hydration and medication to treat underlying problems (DKA - give insulin).
Metabolic alkalosis causes
antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting,
nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics.
, Metabolic Alkalosis s/s
anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis,
hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP,
increased Digoxin toxicity, decreased respiratory effort (muscle weakness).
metabolic alkalosis treatment
restore fluid/electrolyte imbalances
Respiratory acidosis cause
Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway
obstruction, alveolar-capillary block.
Respiratory acidosis s/s
bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-
cyanotic dry skin.
Respiratory acidosis treatment
(Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen
therapy (lowest flow possible), ventilation.
Respiratory alkalosis cause
Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage
acute pulmonary issues.
respiratory alkalosis s/s
anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia),
parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low
BP, increased Digoxin toxicity, hyperventilation
respiratory alkalosis treatment
restore fluid/electrolyte imbalances
How do acid/base imbalances affect electrolytes
- Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during
buffering.
- Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when
kidney compensation is present
- Alkalosis = hypocalcemia and hypokalemia
- Acidosis = HYPERkalemia
alkalosis
hypocalcemia and hypokalemia
Uncompensated
pH and one other value is abnormal
Partial compensation
pH, CO2, and HCO3 are all off
Full compensation
pH is normal
Acidosis
reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle.
Alkalosis
increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation
ABG considerations
- Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia)
- Assess neuro status
- Fall precautions
Bicarb HC03
kidney compensation (slow and powerful)
Respiratory PaC02
Respiratory compensation (fast but limited)
Metabolic acidosis causes
DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure
activity, fever, hypoxia, ischemia, ethanol/methanol intoxication
Metabolic acidosis signs and symptoms
bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp
compensation), warm, flushed, dry skin.
Metabolic acidosis treatment
hydration and medication to treat underlying problems (DKA - give insulin).
Metabolic alkalosis causes
antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting,
nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics.
, Metabolic Alkalosis s/s
anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis,
hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP,
increased Digoxin toxicity, decreased respiratory effort (muscle weakness).
metabolic alkalosis treatment
restore fluid/electrolyte imbalances
Respiratory acidosis cause
Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway
obstruction, alveolar-capillary block.
Respiratory acidosis s/s
bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-
cyanotic dry skin.
Respiratory acidosis treatment
(Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen
therapy (lowest flow possible), ventilation.
Respiratory alkalosis cause
Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage
acute pulmonary issues.
respiratory alkalosis s/s
anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia),
parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low
BP, increased Digoxin toxicity, hyperventilation
respiratory alkalosis treatment
restore fluid/electrolyte imbalances
How do acid/base imbalances affect electrolytes
- Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during
buffering.
- Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when
kidney compensation is present
- Alkalosis = hypocalcemia and hypokalemia
- Acidosis = HYPERkalemia
alkalosis
hypocalcemia and hypokalemia
