Acid–base imbalance is an abnormality of the human body’s normal balance of acids and bases that causes the plasma pH to deviate out of the normal range (7.35 to 7.45).

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Acid-Base Imbalances Nursing Care Plan &
Management
Description
Acid–base imbalance is an abnormality of the human body’s normal balance of acids and
bases that causes the plasmapH to deviate out of the normal range (7.35 to 7.45).
I. Respiratory Alkalosis
Respiratory Alkalosis is an acid-base imbalance characterized by decreased partial
pressure of arterial carbon dioxide and increased blood pH
Contributing Factors:
hyperventilation due to anxiety
hypoxia
improper mechanical ventilation
fever
salicylate poisoning
Signs and Symptoms/ Clinical Manifestations:
light headedness
inability to concentrate
convulsions
positive Chvostek’s sign nausea and vomiting
muscle twitching
Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH above
7.45 and partial pressure of carbon dioxide below 35 mmHg.

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Nursing Diagnoses:
Impaired gas exchange
Ineffective Breathing pattern
Ineffective Tissue perfusion
Acute confusion
Risk for injury
Medical Management / Nursing Interventions:
Institute safety measures for the patient with vertigo or the unconscious patient.
Encourage the anxious patient to verbalize fears
Administer sedation as ordered to relax the patient
Keep the patient warm and dry
Encourage the patient to take deep, slow breaths or breathe into a brown paper
bag (inspire CO2).
Monitor vital signs
Monitor ABGs, primarily PaCO2; a value less than 35 mmHg indicates too little
CO2 (carbonic acid)
II. Respiratory Acidosis
Respiratory Acidos is is an acid-base imbalance characterized by increased partial
pressure of arterialcarbon dioxide and decreased blood pH.
Contributing Factors:
chronic obstructive respiratory disorders
chest wall trauma, pulmonary edema, atelactasis, pneumothorax, drug overdose,
pneumonia, Guillain-Barre syndrome
any condition that results in hypoventilation
Signs and Symptoms/ Clinical Manifestations:
increased pulse and respiratory rate
Increased blood pressure
mental cloudiness and feeling of fullness in head
weakness
dull headache
Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH below
7.35 and partial pressure of carbon dioxide above 45 mmHg.

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Nursing Diagnoses:
Impaired gas exchange
Ineffective Breathing pattern
Ineffective Tissue perfusion
Acute confusion
Risk for injury
Medical Management / Nursing Interventions:
Institute safety measures
Assist with positioning
Monitor I&O and administer fluids as ordered
Administer oxygen and medications for order; monitor hourly vital signs and
respiratory status (may requires mechanical ventilation)
Monitor arterial blood gases (ABGs); pH, PaCO2, HCO3
III. Metabolic Alkalosis
Metabolic Alkalosis is an acid-base imbalance characterized by excessive loss of acid or
excessive gain of bicarbonate.
Contributing Factors:
vomiting
gastric suctioning
excessive intake of alkali (antacids, baking soda)
Signs and Symptoms/ Clinical Manifestations:
tingling of fingers
dizziness, confusion
tetany
slow, shallow respirations, possibly apnea
Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH above
7.45 and HCO3 above 26 mEq/L; urine chloride concentrations help to
differentiate between vomiting or diuretic ingestion or one of the causes of
mineralocorticoid excess.

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IV. Metabolic Acidosis
Metabolic Acidosis is an acid-base imbalance resulting from excessive absorption or
retention of acid or excessive excretion of bicarbonate.
Contributing Factors:
ketoacidosis
lactic acidosis
prolonged fasting
salicylic poisoning
oliguric renal disease
abnormal bicarbonate losses, which can occur in loss of fluid from the lower GI
tract from surgery, drains or severe diarrhea
Signs and Symptoms/ Clinical Manifestations:
headache
drowsiness and confusion
weakness
increased respiratory rate and depth
nausea and vomiting
diminished cardiac output with pH below 7, which results in hypotension, cold
clammy skin and cardiac arrhythmias.
Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH below
7.35 and HCO3 below 22 mEq/L; serum potassium level reveals hyperkalemia