28. Normal Arterial Values Parameter Arterial Sample pH 7.35-7.45 PaC02 35-45 mmHg Pa02 80-100 mmHG Oxygen Saturation 95-100% Base Excess + or - 2 HC03- 22-26 mEq/L
29. Acid Base Guide Disorder Initial Event Compensation Respiratory Acidosis PaC02 or normal HC03 pH Kidneys eliminate H+ and retain HCO3- Respiratory Alkalosis PaC02 or normal HC03 pH Kidneys conserve H+ and excrete HC03- Metabolic Acidosis or normal PaC02 HC03- pH Lungs eliminate C02 conserve HC03- Metabolic Alkalosis or normal Pac02 HCO3- pH Lungs ventilation to PC02 kidneys conserve H+ to excrete HC03-
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Notas del editor
Respiratory acidosis results from: Impaired respiratory function that reduces the exchange of oxygen & carbon dioxide Retention of carbon dioxide that causes increased production of free hydrogen ions
Metabolic Acidosis results from: Overproduction of hydrogen ions Under-elimination of hydrogen ions Underproduction of bicarbonate ions Over-elimination of bicarbonate ions
Acidosis is: Arterial blood pH level < 7.35 Can be caused by metabolic problems, respiratory problems, or both Clients at greatest risk for acute acidosis: those with problems that impair breathing Major changes in body function: an increase in hydrogen ions creates imbalances of electrolytes, especially potassium
These may vary somewhat from IW; use IW for exam purposes
Overproduction of hydrogen ions Under-elimination of hydrogen ions Underproduction of bicarbonate ions Over-elimination of bicarbonate ions
History Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory (Kussmaul respiration) Skin Psychosocial assessment Laboratory assessment Metabolic acidosis Hydration Medications to control or treat problem causing acidosis Increase aerobic metabolism. Monitor for changes.
Arterial blood pH is > 7.45. Acid-base balance of the blood is disturbed by an excess of bases, especially bicarbonate. Problems of alkalosis are serious and potentially life threatening.
Base excess results from excessive intake of bicarbonates, carbonates, acetates, citrates, and lactates. Acid deficit is caused by disease processes or medical treatments, or by prolonged vomiting, excess cortisol, or hyperaldosteronism.
Hallmark is an increased bicarbonate level with a rising partial pressure of arterial carbon dioxide. Serum potassium level decreases. Calcium binding increases and hypocalcemia results. Most of the serious problems are caused by the resulting hypocalcemia.
Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory Laboratory assessment
Impaired respiratory function reduces exchange of oxygen and carbon dioxide Retention of carbon dioxide causes increased production of free hydrogen ions
History Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory Skin Psychosocial assessment Laboratory assessment Respiratory acidosis Maintain a patent airway and enhance gas exchange Medication therapy to increase airway diameter and to thin pulmonary secretions Oxygen therapy, pulmonary hygiene, ventilation support
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