Which Acid-Base Disorder?
The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
What is 2. Metabolic alkalosis? This is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.
Why does potassium rise during acidosis?
What is The body protects itself from the acidic state by moving hydrogen ions into the cells? Therefore, potassium moves out to make room for hydrogen ions and the potassium level increases.
A client with a 3-day history of nausea and vomiting. The client is hypoventilating & has a respiratory rate of 10 breaths/minute. ABG's are?
1.Decreased pH and an increased CO 2
2. Increased pH and a decreased CO 2
3. Decreased pH and a decreased HCO3-
4. Increased pH with an increased HCO3-
What is 4. An increased pH with an increased HCO3-?
RATIONALE: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include hypoventilation and tachycardia.
The nurse notes that a client’s arterial blood gas results reveal a pH of 7.50 and a PaCO2 of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all that apply. 3. Bradypnea 4. Tachycardia 5. Hyperkalemia
What is 4. Tachycardia?
Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.
The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse’s findings? 1. pH 7.25, PaCO2 50 mm Hg 2. pH 7.35, PaCO2 40 mm Hg 3. pH 7.50, PaCO2 52 mm Hg 4. pH 7.52, PaCO2 28 mm Hg
What is 1. pH 7.25, PaCO2 50 mm Hg?
Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal PaCO2 is 35 to 45 mm Hg. In respiratory acidosis, the pH is decreased and the PaCO2 is elevated. Option 2 identifies normal values.
The nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
What is 1. Metabolic acidosis? This is defined as a total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes, an ileostomy, or diarrhea.
Why does potassium drop during alkalosis?
What is The cells release hydrogen ions into the blood in an attempt to increase the acidity of the blood; this forces the potassium into the cells and potassium levels decrease?
Pt has diabetes mellitus & metabolic acidosis. Which labs are correct? 1) pH 7.29, pCO2 35 mm HG, HCO3- 17 mmol/L 2) pH 7.31, pCO2 67 mm HG, HCO3- 32 mmol/L 3) pH 7.39, pCO2 43 mm HG, HCO3- 22 mmol/L 4) pH 7.45, pCO2 38 mm HG, HCO3- 23 mmol/L
What is 1) pH 7.29, pCO2 35 mm HG, HCO3- 17 mmol/L? The pH is below normal and HCO3- below normal.
The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PaCO 2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value will be noted in this condition? 1. Sodium level of 145 mEq/L 2. Potassium level of 3.0 mEq/L 3. Magnesium level of 2.0 mg/dL 4. Phosphorus level of 4.0 mg/dL
What is 2. Potassium level of 3.0 mEq/L?
Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. The correct option identifies the presence of hypokalemia.
In Respiratory Acidosis pH is__ (high or low), PaCO2 is ___ (high or low) and HCO3 is ___.
What is In Respiratory Acidosis pH is low, PaCO2 is high and HCO3 is normal?
If compensated, pH is more normal or normal and HCO3 is abnormal.
A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PaCO2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation
What is 4. Respiratory acidosis, uncompensated? In respiratory acidosis the pH is decreased and the PaCO2 is elevated. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance.
What is the normal serum potassium level?
What is 3.5-5.0 mEq/L?
Consider: pH 7.49, PaCO2 41 mm HG, HCO3- 38 mmol/L
Is the patient compensating? Metabolic alkalosis or acidosis?
What is Uncompensated metabolic alkalosis because an increase in pH, & an increase in HCO3, & PaCO2 is normal?
Respiratory alkalosis can affect electrolyte levels in the body. What are the two main electrolytes affected in this condition?
What are Potassium and Calcium?
A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance? 1. Potassium level of 6.0 2. Potassium level of 2.5 3. Potassium level of 5.0 4. Potassium level of 3.5
What is a Potassium level of 6.0?
In acidosis, the body protects itself from the acidic state by moving hydrogen ions into the cells. Therefore, potassium moves out to make room for hydrogen ions and the potassium level increases.
The nurse plans care for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
What is 3. Respiratory acidosis? Respiratory acidosis is most often caused by hypoventilation in a client with COPD. Other acid-base disturbances can occur in a client with COPD during exacerbation of the disease, but the most likely imbalance is respiratory acidosis. COPD is a respiratory condition, not a metabolic one. Respiratory alkalosis is associated with hyperventilation.
Describe 3 mechanisms used to maintain pH?
What are Kidneys, Lungs, and Buffers?
Which of the following is NOT a cause of metabolic acidosis? 1. Aspirin toxicity 2. Ileostomy 3. Hyperaldosteronism 4. Carbonic anhydrase inhibitors
What is 3. Hyperaldosteronism?
1. Aspirin toxicity-acid byproduct 2. Ileostomy loss of bicarbonate 4. Carbonic anhydrase inhibitors bicarbonate
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition? 1. Bradypnea 2. Tachypnea 3. Bradycardia 4. None of the options are correct
What is 2. Tachypnea?
Which patient is experiencing partially compensated respiratory acidosis? 1. PaCO2 30, pH 7.35, HCO3 26 2. PaCO2 53, pH 7.23, HCO3 28 3. PaCO2 45, pH 7.49, HCO3 21 4. PaCO2 50, pH 7.30, HCO3 23
What is 2. PaCO2 53, pH 7.23, HCO3 28?
pH<7.35, high PaCO2 high and HCO3 is elevated.
Which Acid-Base Disorder is often the result of shock and uncontrolled diabetes?
What is Metabolic Acidosis?
Which acid-base balance system is the fastest?
What is Buffer System?
A patient reports taking Diamox and has been reporting confusion, fatigue, and headaches. On assessment, you note the patient is exhibiting deep and rapid respirations. Which of the following arterial blood gas findings confirm the correct acid-base imbalance for this patient given their symptoms and medication usage? (Hint: Carbonic anhydrase inhibitors) 1. HCO3 12, pH 7.19, PaCO2 29 2. HCO3 23, pH 7.36, PaCO2 36 3. HCO3 10, pH 7.65, PaCO2 47 4. PaCO2 49, pH 7.55, HCO3 21
What is 1. HCO3 12, pH 7.19, PaCO2 of 29?
This patient is at risk for metabolic acidosis, especially since they are taking Diamox (Carbonic anhydrase inhibitors which reduces the reabsorption of bicarb). HCO3 12, pH 7.19, PaCO2 29 are the only ABGs that reflect metabolic acidosis.
A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition? 1.Anxiety attack 2.Chronic obstructive pulmonary disease (COPD) 3.Fever 3.Aspirin toxicity
What is 2.Chronic obstructive pulmonary disease (COPD) as this would increase acidity?
PaCO2 25, pH 7.50, HCO3 19. = Respiratory Alkalosis bc HCO3 & PaCO2 are low.
Which of the following is not a cause of respiratory acidosis? 1. Pulmonary emboli 2. Asthma 3. Chronic obstructive pulmonary disease (COPD) 4. Hyperventilation
What is 4. Hyperventilation?
Hyperventilation increases pH (more basic)