MDC II Exam 2
look at pH
What is your first step when interpreting ABGs?
Respiratory acidosis
What acid-base imbalance would you expect to see in an asthmatic patient?
COPD
asthma
muscle weakness
▪ inadequate chest expansion
▪ pneumonia
▪ pulmonary edema
▪ sleep apnea
▪ respiratory depression r/t: drugs, alcohol, anesthesia, electrolyte imbalance
▪ high ICP
Common causes of Respiratory Acidosis
Vital Signs, think LOW & SLOW
▪ bradycardia, thready weak pulses
▪ hypotension
▪ hypoxia
Electrolyte Imbalance
▪ hyperkalemia
Skin
▪ pale, cyanotic
CNS Depression, think LOW & SLOW
▪ lethargy
▪ confusion
▪ stupor
▪ coma
▪ headache
Musculoskeletal, think LOW & SLOW
▪ hyporeflexia
▪ muscle weakness
▪ flaccid paralysis
Cardiac
▪ heart dysrhythmias (due to hyperkalemia)
▪ increased cardiac output
▪ EKG changes - tall T waves, wide QRS, prolonged PR interval
S/S of Respiratory Acidosis
(acidosis has similar s/s no matter if met. or resp.)
stabilize airway (patent)
bronchodilators
▪ O2
▪ Pulmonary hygiene (positioning and breathing/coughing techniques)
, ▪ Suction PRN
▪ If on ventilation, increase ventilation rate.
▪ Endotracheal intubation
For underlying causes:
▪ Correct electrolyte balance (hyperkalemia)
▪ Antibiotics (if it's infection)
Treatment for Respiratory Acidosis
▪ increase respirations to increase pH
What does your body do to compensate for respiratory acidosis?
▪ impaired gas exchange
Nursing Diagnosis for Respiratory Acidosis
respiratory acidosis
low pH, high CO2
metabolic acidosis
low pH, low HCO3
respiratory alkalosis
high pH, low CO2
metabolic alkalosis
high pH, high HCO3
Uncompensated
pH and one other value are abnormal.
Fully compensated
pH is normal, but the other 2 are abnormal.
Partially compensated
all 3 values are abnormal
overproduction of hydrogen ions
aspirin toxicity
▪ kidney failure, liver failure, pancreatitis
▪ diarrhea (ACI-dosis sounds like ASS)
▪ dehydration
▪ ingestion of acids: ethanol, methanol, salicylate acid
▪ lactic acidosis
▪ diabetic ketoacidosis, starvation
▪ hypermetabolism: excessive exercises, seizures, fever, hypoxia
Causes of Metabolic Acidosis
look at pH
What is your first step when interpreting ABGs?
Respiratory acidosis
What acid-base imbalance would you expect to see in an asthmatic patient?
COPD
asthma
muscle weakness
▪ inadequate chest expansion
▪ pneumonia
▪ pulmonary edema
▪ sleep apnea
▪ respiratory depression r/t: drugs, alcohol, anesthesia, electrolyte imbalance
▪ high ICP
Common causes of Respiratory Acidosis
Vital Signs, think LOW & SLOW
▪ bradycardia, thready weak pulses
▪ hypotension
▪ hypoxia
Electrolyte Imbalance
▪ hyperkalemia
Skin
▪ pale, cyanotic
CNS Depression, think LOW & SLOW
▪ lethargy
▪ confusion
▪ stupor
▪ coma
▪ headache
Musculoskeletal, think LOW & SLOW
▪ hyporeflexia
▪ muscle weakness
▪ flaccid paralysis
Cardiac
▪ heart dysrhythmias (due to hyperkalemia)
▪ increased cardiac output
▪ EKG changes - tall T waves, wide QRS, prolonged PR interval
S/S of Respiratory Acidosis
(acidosis has similar s/s no matter if met. or resp.)
stabilize airway (patent)
bronchodilators
▪ O2
▪ Pulmonary hygiene (positioning and breathing/coughing techniques)
, ▪ Suction PRN
▪ If on ventilation, increase ventilation rate.
▪ Endotracheal intubation
For underlying causes:
▪ Correct electrolyte balance (hyperkalemia)
▪ Antibiotics (if it's infection)
Treatment for Respiratory Acidosis
▪ increase respirations to increase pH
What does your body do to compensate for respiratory acidosis?
▪ impaired gas exchange
Nursing Diagnosis for Respiratory Acidosis
respiratory acidosis
low pH, high CO2
metabolic acidosis
low pH, low HCO3
respiratory alkalosis
high pH, low CO2
metabolic alkalosis
high pH, high HCO3
Uncompensated
pH and one other value are abnormal.
Fully compensated
pH is normal, but the other 2 are abnormal.
Partially compensated
all 3 values are abnormal
overproduction of hydrogen ions
aspirin toxicity
▪ kidney failure, liver failure, pancreatitis
▪ diarrhea (ACI-dosis sounds like ASS)
▪ dehydration
▪ ingestion of acids: ethanol, methanol, salicylate acid
▪ lactic acidosis
▪ diabetic ketoacidosis, starvation
▪ hypermetabolism: excessive exercises, seizures, fever, hypoxia
Causes of Metabolic Acidosis
