II.

ACID BASE BALANCE

A. Major chemicals you have to remember:

1. Three major chemicals

• Bicarb (Base)

• Hydrogen (Acid)

• CO2 (Acid)

ACID-BASE BALANCE
2. Major lung chemical: CO2  ________

3. Kidney chemicals: ________ and ___________________

4. Too much or too little of these chemicals (CO2, bicarb, hydrogen) can
cause an acid base imbalance.

B. pH:

1. Normal pH range _________-________

2. pH less than 7.35 ____________

3. pH more than 7.45 ____________

4. The __________________ does not like it when the pH is messed up.

5. If the pH is messed up, it can be dangerous.

Alert:
A person can die from acidosis or alkalosis.

6. Acidotic person = __________________

Alkalotic person = __________________

7. Here’s how the body keeps the pH within normal range:

_____________________

A CLINICAL JUDGMENT APPROACH | STUDENT MANUAL 13

 COMPENSATING ORGANS

Kidneys Lungs
Remove excess acid and One way to get rid of CO2
bicarb by ______________ What is it? _______________
them through the urine.
Hyperventilation-
OR
 CO2_______________
Kidneys can ____________
hydrogen and Bicarb and Hypoventilation-
return to the blood.
ACID-BASE BALANCE

 CO2_______________
Kidneys take hours to days Lungs respond _______________.
to do their job.

C. Respiratory Acidosis:

1. Pathophysiology: NORMAL LAB

VALUES:
a. Which organ has a problem? ______________
pH: 7.35 - 7.45
Which organ is going to compensate? ______________
PaO2: 80 - 100 mmHg
b. What chemical is causing the problem? ___________
PaCO2: 35 - 45 mmHg
HCO3; Bicarbonate:
c. Do we have too much or too little of this chemical 22 - 26 mEq/L
in the body? ____________ _____________

d. Hypoventilating or hyperventilating? TESTING STRATEGY:

________________________________ CO2 = LOC
CO2 = O2
e. The kidneys are compensating with what chemicals? CO2 and O2 have an
_____________ and hydrogen inverse relationship.

f. The body must ________________ hydrogen. The body will retain bicarb.

g. Is the pH high or low? _________

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 2. Causes:

• Retain _______________

Mid-abdominal incision, narcotics, sleeping pills,

pneumothorax, collapsed lung, and pneumonia

3. Signs/Symptoms: TESTING STRATEGY:

Restlessness think
a. Headache, ___________________, sleepy Hypoxia FIRST

ACID-BASE BALANCE
b. If not corrected, could lead to a ________________.

As the acid increases the level of consciousness goes down.

c. Hypoxic

• Give them ___________________.

• Early signs and symptoms of hypoxia? _______________ & _______________

4. Treatment:

a. Fix the _____________________ problem.

b. Pneumonia: Liquefy and mobilize secretions with:

• postural drainage,

• percussion (vibration therapy),

• deep breathing exercises,

• suctioning,

• fluids,

• elevate HOB, and

• incentive spirometry.

c. Pneumothorax client will have _____________ tubes.

d. Encourage post-op clients to turn, cough and _______ ___________.

A CLINICAL JUDGMENT APPROACH | STUDENT MANUAL 15

 D. Respiratory Alkalosis:
1. Pathophysiology:
a. Which organ has a problem? ______________

Which organ is going to compensate? ______________

b. What chemical is causing the problem? ___________

c. Do we have too much or too little of this chemical in the body?

_________________ ________________
d. Hypoventilating or hyperventilating?
ACID-BASE BALANCE

________________________________
e. Gaining or losing CO2?
____________________
f. Kidneys are compensating with what two chemicals? Bicarb and
_________________.

g. The body will _______________________ bicarb. The body must

________________ the hydrogen.

h. pH? _________________

2. Causes:
a. Problem? ________________________

b. Hysterical (situation)
The client is breathing too ___________,
c. Acute aspirin overdose and therefore, removing _____________.

3. Signs/Symptoms:

• Lightheaded or faint feeling, peri-oral numbness, numbness and

tingling in fingers and toes.

4. Treatment:

a. May have to __________ client to decrease respiratory rate.

b. Treat the cause.
c. Monitor ABGs.

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