Interventions for acid- base imbalance – Flashcards
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they are not a disease. they are symptoms reflecting metabolic or respiratory problems
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what are acid base imbalances and what are they not
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1)change shape of hormones or enzymes 2)change the distribution of electrolytes 3)alter response of excitable membranes (heart, nerves, skeletal muscle, and GI tract) 4)decrease the uptake activity and effectiveness of hormones
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what can changes in blood pH do?
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an excess of H ions in blood or other ECF
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what is acidosis
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pt with impaired breathing, older clients with chronic health problems,
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who is at greatest risk for acidosis
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over production (diabetic ketoacidosis or seizures) or under elimination (respiratory failure or renal impairment) of acid.
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what is an actual acid excess
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when the amount of acid does not change, but the amount and strength of body bases decrease. such as, over eliminated HCO3 or under producing bases
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what is relative acidosis
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K and any positively charged electrolytes
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increase hydrogen creates imbalance of what electrolytes?
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too many H ions
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what is metabolic acidosis
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overproduction of H ions from excess breakdown of fatty acids, anarobic glucose breakdown and excessive acid intake (alcohol)
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what is over production of H ions caused by?
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when H ions are produced at the normal rate but are not removed at the same rate.
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what is under elimination of H?
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base deficit that leads to acidosis when H ion production and removal are normal but there are not enough HCO3 to balance them.
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what is under production of HCO3?
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leads to acidosis when H production and removal are normal but too many HCO3 have been lost. (diarrhea)
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what is over elimination of HCO3?
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respiratory depression, chemical depression, or physical depression
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what are 3 types of respiratory impairment (respiratory acidosis)?
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reduced function of the brainstem and neurons that trigger breathing movements. result is decreased rate and depth
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what is respiratory depression
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anesthetic, drugs, opioids, poisons, pestisides and methal alcohol
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what is chemical depression
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when neurons are damaged or destroyed by trauma, or when the brain has increased intercranial pressure; brain tumors, stroke, over hydration
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what is physical depression?
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rib fracture, respiratory muscle weakness, obesity, ascities, asthma, aspiration, COPD, pulmonary edema, pneumonia, imphysema, drowning
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important causes to know for respiratory acidosis
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uncorrected acute respiratory acidosis, always leads to anarobic metabolism and lactic acid build up. combined acidosis is more severe (cardiac arrest)
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what are causes of combined acidosis
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risk factors- age, nutrition,drug history, diuretics, diabetes, kidney/resp. problems and pancreatitis, diarrhea, and fever. headaches, decreased LOC, nausea and vomiting.
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what is important to assess for respiratory acidosis?
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clothing, neeck edema, lymph node enlargement, aspiration, bronchoconstriction or mucous.
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what can cause airway obstruction?
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prevents air movement, leads to poor gas exchange, co2 retention and acidosis.
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what does airway obstruction cause?
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increased heart rate and cardio output.
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What are early cardiovascular changes with acidosis?
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hyperkalemia, decreased heart rate, weak peripheral pulses, hypotention
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What are late cardiovascular changes with worsening acidosis?
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lethargy, confusion, unresponsive (assess mental status)
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what are CNS changes with acidosis?
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hyperkalemia and increased H level lead to decreased muscle tone and reflexes, flaccid paralysis, weak respirations
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What are neuromuscular changes with acidosis?
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increased rate/ depth of respirations in attempt to blow off CO2=Kussmaul Respirations
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What are respiratory changes with metabolic acidosis?
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rapid, deep, labored hyperventilation caused by metabolic acidosis
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What are Kussmaul Respirations?
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SHALLOW, rapid respirations with decreased effort.
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What are respiratory changes with respiratory acidosis?
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increased respiratory rate leads to increased gas exchange causing vasodilation (makes skin and mucous membranes look normal)
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What are skin problems with metabolic acidosis?
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ineffective breathing causing decreased gas exchange giving skin and mucous membranes pale cyanotic look.
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What are skin problems with respiratory acidosis?
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Objectively and validated by family observations
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how should behavior changes with acidosis be noted?
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fluid volume deficit, decreased cardiac output, ineffective breathing, skeletal muscle weakness, falls, confusion, fatigue, decreased respiratory effort
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What are nursing diagnoses related to acidosis?
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hydration, insulin for diabetics, antidiarrheal for diahrrea, Bicarb is given only if serum levels are low.
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what are interventions for metabolic acidosis?
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improve ventilation and O2, maintain airway, pulmonary suction, ventilation, bronchodilators, anti inflam, mucolytics
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What interventions for respiratory acidosis?
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cause cardiac arrest
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What can giving O2 to a COPD do?
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promotes gas exchange: upright position, pursed lip breathing to keep alveoli inflated, hydration to thin secretions
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What is pulmonary hygiene?
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Monitor breathing, assess respirations, assess for clubbing of nails, cyanosis, and muscle strength.
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How do you prevent complications with acid base balance patients?
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excess of HCO3 in blood compared to acids
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What is Alkalosis?
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HCO3 is overproduced or under eliminated (anti acids, blood transfusions)
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What is actual base excess?
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amt of base does not change, but the amount and strength of acids decrease (acid deficit from underproduction or over elimination of acid)
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What is relative alkalosis?
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imbalances in electrolytes that cause serious and potentially life threatening problems. Vomiting, ecess cortisol, hyperaldosteronism, thiazide diuretics or gastric suctioning.
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What are decreased cation levels or acid deficit?
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excessive loss of Co2 through hyperventilation. Caused by anxiety fear improper mechanical ventilation, direct stimulation of respiratory center(fever, CNS lesions, silactilyates, progesterone, metabolic acidosis)
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What causes respiratory alkalosis?
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hypocalcemia & hypokalemia
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What are symptoms of alkalosis a result of?
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over excitement of CNS and PNS-dizzy, agitation, seizures
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What are CNS signs of alkalosis?
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1)hypocalcemia increases NS activity, muscle cramps, twitches, increased relaxes, tetany, 2)hypokalemia causes weak muscles
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What are Neuromuscular signs of alkalosis?
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increased rate and depth from anxiety or physiologic changes(BREATH INTO BAG)
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What is the main cause of respiratory alkalosis?
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Increased myocardial irritability-increased HR, thready pulse, heart pumping so fast chambers aren't filling. Hypovolemia-decreased blood volume (hypotension Hypokalemia-digoxin toxicity
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What are cardio problems with alkalosis?
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Muscle spasms (pain), confusion, falls, respiratory effort problems
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What are nursing diagnosis with Alkalosis?
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prevent further H, K, Ca loss and restore fluid balance Drugs-antiemetics, antidiarrheal, antibiotics
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What are nursing interventions focused on with alkalosis?
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Electrolyte balance, heart rate, rhythm, respiratory and oxygen status
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What should be monitored carefully with Alkalosis?
