NURS 3375 NURSING OF ADULTS WITH
COMPLEX NEEDS Final Exam SS Notes
2025 University of Texas at Arlington
Acid Base Balance
Normal pH 7.35-7.45
The normal pH is maintained by the buffer system- respiratory and renal
system
- Work together but at different
speeds Bicarbonate and carbonic
acid buffer
- Stong acid converted into weak acid - resp. Or renal system can get
rid of the weak acids
Lungs
- Help maintain normal pH by excreting CO2 and water
- With sudden changes in blood pH, the resp system reacts within
minutes and reaches maximum effectiveness in hours
- Increased resp rate and depth= more CO2 expelled
- Decreased resp rate and depth= more CO2 remains in the
blood- less expelled Kidneys
- Maintain normal pH by reabsorbing or excreting bicarbonate and
eliminating hydrogen ions
- acidosis - generate additional bicarbonate and increase the amount
of hydrogen ion elimination
- Take 2-3 days to respond maximally to sudden changes in pH
PaO2- partial pressure of oxygen in the artery- oxygen that is dissolved in the
blood
- P=partial bc there are other gases that are dissolved in the blood
- 80-100 mmhg
,SaO2= oxygen saturation of aterial blood
- 90% or above
SpO2= oxygen saturation from pulse oximetry -
noninvasive Normal CO2=35-45
Normal HCO3= 22-28
ROME- Respiratory Opposite- Metabolic Equal
- Metabolic- pH value is equal to HCO3- both high or both low or both
normal
- Respiratory- pH is low, CO2 high or vice versa
- If oxygenation is low- label with
hypoxemia Anytime pH is abnormal-
uncompensated
Anytime pH is normal with other problems- compensated
Causes of Respiratory Acidosis
- Retention of CO2= not breathing -> caused by altered LOC, plastic bag
over their head, or resp failure
- S/S: shallow, weak ineffective breaths (guppy breathing) or
no respirations, disorientation, dyspnea, cyanosis or pallor
- Compensation is by the kidneys= hold onto HCO3, make more HCO3
or get rid of H+- takes days to occur- nurse must intervene
- O2 controlled by resp rate-
, - With compensated Resp. acidosis- pH will be normal, CO2 high and
HCO3 high- HCO3 will be high because it is compensating for the
acidosis- if it was a metabolic problem, then the pH will be high
- Seen with chronic COPD patients- these patients have problems
with exhalation and frequently retains CO2 - kidneys have time to
compensate- allowing for normal pH
Causes of Metabolic Acidosis
- Too much acid production= ketoacids (DKA), poison ingestion, renal
failure, diarrhea, tissue hypoxia/lactic acid production
- S/S: Varied-DKA=acetone breath. Renal failure= edema. Kussmaul
Respirations
- Respiratory compensation- remove acids/CO2. Resp. rate will be
rapid and deep= Kussmaul resp.
If patient is acidotic and HYPOkalemic- be cautious before
correcting/treating acidosis Causes of uncompensated respiratory and
metabolic acidosis
- Too much acid production= DKA, poison, renal failure, diarrhea, tissue
hypoxia, AND resp. Failure (inability of the patient to remove CO2 and
bring in O2)--- both systems are broken
- S/S: varied or none at all
- Compensation: The renal and respiratory system are broken-> the
pt is without the ability to compensate and is most likely critically ill-
> requiring mechanical ventilation perhaps dialysis
Respiratory Failure, Mechanical Vent and Airway Management
Manifestations of Resp. Failure
- Use of accessory muscles, wheezing, rapid resp. rate, elevated
HR/BP=SNS stimulation
- If cyanosis were present=late sign
- Resp. failure is present when retained CO2 causes resp.
acidosis and there is hypoxemia
Treatment:
- Apply supplemental oxygen- humidified O2 can help liquefy secretions
and reduce drying of mucous membranes- if hypoxemia must give O2-
lowest amount for least amount of time- breathing treatment, elevate
HOB, turn cough and deep breath if a post surgical patient, steroid,
assess hbg level
- Another option= CPAP-continuous positive
airway pressure CPAP
- The machine exerts positive pressure throughout respiratory cycle
to help keep the alveoli open (doesnt allow airway/alveoli to
collapse)
- Delivered non invasively- may prevent intubation
, - Keeping the alveoli open allows for a longer time for gas exchange
- Increases WOB- pt must exhale forcible against CPAP- use
cautiously with pts with myocardial conditions bc if we increase
their WOB they can have an MI
Intubation
COMPLEX NEEDS Final Exam SS Notes
2025 University of Texas at Arlington
Acid Base Balance
Normal pH 7.35-7.45
The normal pH is maintained by the buffer system- respiratory and renal
system
- Work together but at different
speeds Bicarbonate and carbonic
acid buffer
- Stong acid converted into weak acid - resp. Or renal system can get
rid of the weak acids
Lungs
- Help maintain normal pH by excreting CO2 and water
- With sudden changes in blood pH, the resp system reacts within
minutes and reaches maximum effectiveness in hours
- Increased resp rate and depth= more CO2 expelled
- Decreased resp rate and depth= more CO2 remains in the
blood- less expelled Kidneys
- Maintain normal pH by reabsorbing or excreting bicarbonate and
eliminating hydrogen ions
- acidosis - generate additional bicarbonate and increase the amount
of hydrogen ion elimination
- Take 2-3 days to respond maximally to sudden changes in pH
PaO2- partial pressure of oxygen in the artery- oxygen that is dissolved in the
blood
- P=partial bc there are other gases that are dissolved in the blood
- 80-100 mmhg
,SaO2= oxygen saturation of aterial blood
- 90% or above
SpO2= oxygen saturation from pulse oximetry -
noninvasive Normal CO2=35-45
Normal HCO3= 22-28
ROME- Respiratory Opposite- Metabolic Equal
- Metabolic- pH value is equal to HCO3- both high or both low or both
normal
- Respiratory- pH is low, CO2 high or vice versa
- If oxygenation is low- label with
hypoxemia Anytime pH is abnormal-
uncompensated
Anytime pH is normal with other problems- compensated
Causes of Respiratory Acidosis
- Retention of CO2= not breathing -> caused by altered LOC, plastic bag
over their head, or resp failure
- S/S: shallow, weak ineffective breaths (guppy breathing) or
no respirations, disorientation, dyspnea, cyanosis or pallor
- Compensation is by the kidneys= hold onto HCO3, make more HCO3
or get rid of H+- takes days to occur- nurse must intervene
- O2 controlled by resp rate-
, - With compensated Resp. acidosis- pH will be normal, CO2 high and
HCO3 high- HCO3 will be high because it is compensating for the
acidosis- if it was a metabolic problem, then the pH will be high
- Seen with chronic COPD patients- these patients have problems
with exhalation and frequently retains CO2 - kidneys have time to
compensate- allowing for normal pH
Causes of Metabolic Acidosis
- Too much acid production= ketoacids (DKA), poison ingestion, renal
failure, diarrhea, tissue hypoxia/lactic acid production
- S/S: Varied-DKA=acetone breath. Renal failure= edema. Kussmaul
Respirations
- Respiratory compensation- remove acids/CO2. Resp. rate will be
rapid and deep= Kussmaul resp.
If patient is acidotic and HYPOkalemic- be cautious before
correcting/treating acidosis Causes of uncompensated respiratory and
metabolic acidosis
- Too much acid production= DKA, poison, renal failure, diarrhea, tissue
hypoxia, AND resp. Failure (inability of the patient to remove CO2 and
bring in O2)--- both systems are broken
- S/S: varied or none at all
- Compensation: The renal and respiratory system are broken-> the
pt is without the ability to compensate and is most likely critically ill-
> requiring mechanical ventilation perhaps dialysis
Respiratory Failure, Mechanical Vent and Airway Management
Manifestations of Resp. Failure
- Use of accessory muscles, wheezing, rapid resp. rate, elevated
HR/BP=SNS stimulation
- If cyanosis were present=late sign
- Resp. failure is present when retained CO2 causes resp.
acidosis and there is hypoxemia
Treatment:
- Apply supplemental oxygen- humidified O2 can help liquefy secretions
and reduce drying of mucous membranes- if hypoxemia must give O2-
lowest amount for least amount of time- breathing treatment, elevate
HOB, turn cough and deep breath if a post surgical patient, steroid,
assess hbg level
- Another option= CPAP-continuous positive
airway pressure CPAP
- The machine exerts positive pressure throughout respiratory cycle
to help keep the alveoli open (doesnt allow airway/alveoli to
collapse)
- Delivered non invasively- may prevent intubation
, - Keeping the alveoli open allows for a longer time for gas exchange
- Increases WOB- pt must exhale forcible against CPAP- use
cautiously with pts with myocardial conditions bc if we increase
their WOB they can have an MI
Intubation
