[TRANS 7] ACID-BASE IMBALANCE

ACID-BASE IMBALANCE PROTEIN BUFFER

• Acid-base balance depends on the regulation of free hydrogen ions • contribute to buffering of extracellular fluids
(H+) in body fluids determines the extent of acidity and alkalinity,
both of which are measured in pH. FOUR TYPES OF ACID BASE IMBALANCE:
• Remember, pH levels are inversely proportionate to H+ • respiratory acidosis
concentration, which means H+ concentration increases, pH • respiratory alkalosis
decreases (acidosis). • metabolic acidosis
• Conversely, when H+ concentration decreases, pH increases • metabolic alkalosis
(alkalosis) Note: Not a clinical diagnosis or disease, rather they are clinical
• NOTE: Ph identifies if it is acidity or alkalinity syndromes associated with a wide variety of diseases.
KEY ELEMENTS
• Acids – hydrogen ion donors ACIDOSIS
• Bases – hydron ion acceptors • any pathologic process that cause a relative excess of acid (volatile
• Ph – expression of hydrogen concentration in a solution or fixed in the body)
• PCO2 (partial pressure of CO2) – the measure of carbon dioxide ALKALOSIS
within arterial or venous blood
• indicates a primary condition resulting in excess in base
• HCO3 (Bicarbonate) – by product of the body’s metabolism
NORMAL GAS VALUES
TWO (2) CATEGORIES OF METABOLIC Ph 7.35-7.45
PROCESSES: PO2 80-100 %
VOLATILE PaCO2 35-45 mmHg
HCO3 22-26 mEq/L
• can be eliminated from the body as a gas
• e.g. Carbonic acid ((H2CO3) is the only volatile acid produced in
the body RESPIRATORY ACIDOSIS
CARBONIC ACID EXCESS
NONVOLATILE • pH 7.35;
• that must be metabolized or excreted from the body in fluid • PaCO2 >42 mmHg ;
• e.g. Lactic acid, hydrochloric acid, phosphoric acid, and sulfuric • HCO3 normal
acid
• NOTE: Eliminated through liquid CAUSES
ACUTE RESPIRATORY CONDITIONS
REGULATORY MECHANISM • less surface area decreases the amount of gas exchange that can
RESPIRATORY SYSTEM occur, thus impending carbon dioxide exchange.
• Regulates carbonic acid in the body by eliminating or retaining • NOTE: related respiratory problem
carbon dioxide DEPRESSION OF RESPIRATORY CENTER
• all metabolic acid are nonvolatile excreted to the kidneys, except
CHEMICAL BUFFERS carbonic acid which is excreted as gas
• Substances that prevent major changes in pH by removing present
in body fluid, buffers bind with hydrogen ions to minimize the IATROGENIC CAUSE: INADEQUATE MECHANICAL
change in pH. VENTILATION
• excessive oxygen administration to client with COPD which
RENAL SYSTEM hypoventilation occurs
• Jupiter is a gas giant and the biggest planet in the Solar System • NOTE: Mas hindi makahinga ang patient, only 1-2L/min via nasal
cannula
CHEMICAL BUFFERS • NOTE: moderate giving of o2
CARBONIC-BICARBONATE SYSTEM, • NOTE: in newborn, 1-2L/min
BICARBONATE (HCO3–)
MANIFESTATIONS
• a weak base
• hypercapnia – due to rapid rise of PaCO2 level
• when an acid is added to the system, the hydrogen ion in the acid
combines with bicarbonate, and the pH changes only slightly. • headache – co2 dilates cerebral blood vessels
• warm and flush skin – related to the peripheral vasodilation as well
as to impaired gas exchange
PHOSPHATES
• decreasing level of consciousness
• important intracellular buffers • fine flapping tremors
• helping to maintain a stable pH within the cells. • decreased reflexes
• rapid, shallow respirations; elevated pulse rate; and tachycardia

ALINGASA, APORTADERA, BAGASLAO, ESTORBA, INSEQUEL, NAMOC | FINALS | BSN 3I 27

 o NOTE: Mabilis ang breathing pero hindi full ang respiratory

• NOTE: Hyperventilation consider respiratory alkalosis

NURSING DIAGNOSIS
• Ineffective Breathing Pattern Related To Hypoventilation NURSING DIAGNOSIS
• Impaired Gas Exchange Related To Alveolar Hypoventilation • Decreased cardiac output secondary to dysrhythmias and / or fluid
o NOTE: because of hypoventilation volume deficits
o N: st prolonged
• Anxiety Related To Breathlessness
o NOTE: high rr but not equal • Risk for sensory/ perceptual alterations related to changes in
• Risk For Injury Related To Decreased Level Of Consciousness neurological functioning secondary to acidosis
o N: due to acidosis in decreased LOC
NURSING MANAGEMENT • Risk for fluid volume deficit related to excessive loss from the
kidneys or gastrointestinal system
• Maintain patent airway o N: risk pag episode of diarrhea
o NOTE: do suctioning and use mechanical ventilator in COPD o N: if frequent kay actual diagnosis na
patients
•
• Monitor vital signs
• Monitor neurologic status and report significant changes MEDICAL MANAGEMENT
• Administer oxygen as ordered • ABG analysis
o NOTE: too much o2 but cannot exhale Co2
• Serum potassium levels usually elevated as hydrogen ions move
• Accurate intake and output records
into the cells and potassium moves out to maintain electroneutrality
• Report any variations in ABG levels o N: respiratory and metabolic acidosis indicates hyperkalemia
• Coughing and deep breathing exercises • Rapid acting insulin to reverse diabetic ketoacidosis and drive
potassium back into the cell.
METABOLIC ACIDOSIS o N: low sugar content
BASE BICARB DEFICIT o N: potassium back in the body
• Intravenous Sodium bicarbonate to neutralize blood acidity in
• pH 7.35; patients with bicarbonate loss
• pCO2 normal ; o N: since low HCO3 the give HCO3 through oral and iv (run as
• HCO3 <26 mEq/L side drip from of 50 mech in 50ml
• NOTE: Ph: Low HCO3: low PCo2: Normal
• NOTE: severe diarrhoea, vomiting NURSING MANAGEMENT
Nursing care includes immediate emergency interventions and long
CAUSES term treatment of the condition and its underlying causes. Observe the
following guidelines:
RENAL INSUFFICIENCY a. Monitor vital signs
• decreased ability of the kidney to excrete acids b. Monitor neurologic status
c. Maintain patent IV line
DIABETIC KETOACIDOSIS • N: giving NA HCO3 at least 30 mins
• N Give side drip and as fast drip
• decrease insulin prevents glucose uptake, thus, stored fats are d. careful administration of sodium bicarbonate
oxidized (acetoacetic acid) and is metabolize for energy e. Proper positioning to promote chest expansion and facilitate
• NOTE: decrease CR output and chain content breathing.
f. Record intake and output
PROLONGED VOMITING, SEVERE DIARRHEA
• due to loss of alkaline substances RESPIRATORY ALKALOSIS
CARBONIC ACID DEFICIT
MANIFESTATION • pH 7.45;
• weakness, fatigue, general malaise • PaCO2 <35 mmHg;
• Anorexia, nausea, vomiting, abdominal pain • HCO3 normal
• Diminished muscle tone and reflexes
• Skin is warm and dry CAUSES
• Kaussmaul’s respiration VOMITING
• Decreasing level of consciousness
• loss of hydrochloric acid from the stomach
• Decrease cardiac output and blood pressure

DIURETIC THERAPY
• can lead to a loss of hydrogen, potassium from the kidneys

ALINGASA, APORTADERA, BAGASLAO, ESTORBA, INSEQUEL, NAMOC | FINALS | BSN 3I 28

HYPERVENTILATION METABOLIC ALKALOSIS
• most common cause of acute respiratory alkalosis CARBONIC ACID EXCESS
• N: it is rapid breathing • pH > 7.45 ;
• N: but in pulse oxi kay normal • HCO3 above 26 mEq/L ;
• N: use paper bag para bumalik ang Co2 • PCo2 normal
• N: if paper bag is not available, use cuff of hands
CAUSES
CUSHING’S DISEASE • Diuretic Therapy
• causes retention of sodium and chloride and urinary loss of • Ingestion Of Nahco3
potassium and hydrogen • Aldosterone Excess
• Prolonged Steroid Therapy
SEVERE ANEMIA, ACUTE HYPOXIA • Prolonged Gastric Suctioning or Vomiting
• overstimulation of the respiratory system causes to breathe faster • Massive Blood Transfusion
and deeper
MANIFESTATIONS
MANIFESTATION • Increased myocardial activity, palpitations
• Slow, shallow respirations • Nausea, vomiting
• Confusion or syncope • Increased heart rate
• Nausea, vomiting • Dizziness, lightheadedness
• Hyperactive reflexes • Hyperactive reflexes
• Numbness and tingling sensation • Rapid, shallow breathing
• Twitching, weakness and tetany
• Dysrhythmia
• Polyuria

LABORATORY FINDINGS
• ABG analysis
• NOTE: rapid and shallow breathing parin • ECG changes, low T wave
• NOTE: excess bases (hypokalemia), shows numbness o NOTE: inverted p wave
• ECG reading of hypokalemia: • Serum electrolyte levels
o Hallmark signs o low potassium, calcium and chloride, HCO3 elevated
▪ Sd depression
▪ Prominent q wave MEDICAL MANAGEMENT
▪ Inverted q wave • Replacement of electrolytes
o NOTE: Give K via oral
• Antiemetics may be administered to treat underlying nausea and
MEDICAL MANAGEMENT vomiting Acetazolamide (Diamox)
a. Identify and eliminate causative factor if possible o to increase renal excretion
o NOTE: give antiemetics due to severe vomiting
b. Sedative or Anxiolytics agents may be given NURSING DIAGNOSIS
c. Respiratory support, (e.g., oxygen therapy to prevent hypoxemia;
breathe into a paper bag) • Ineffective breathing pattern related to hypoventilation
d. ABG analysis • Impaired gas exchange related to alveolar hypoventilation
e. ECG • Anxiety related to breathlessness

NURSING DIAGNOSES NURSING MANAGEMENT

• Ineffective breathing pattern related to hyperventilation • Monitor vital signs
• Altered thought processes related to altered cerebral functioning • Assess patient’s level of consciousness
o NOTE: The patient is LETHARGIC • Administer oxygen
o treat hypoxemia
NURSING MANAGEMENT • Monitor Intake and output
• Allay anxiety whenever possible to prevent hyperventilation
• Monitor vital signs, and report changes ACID BLOOD GAS (ABG) ANALYSIS
• Report variations in ABG and ECG • is an essential part of diagnosing, and managing a patient’s
• Maintain a calm, quiet environment oxygenation status and acid-base balance
• NOTE: Patients tend to verbalize their feelings • the usefulness of this diagnostic tool is dependent on being able to
correctly interpret results.

ALINGASA, APORTADERA, BAGASLAO, ESTORBA, INSEQUEL, NAMOC | FINALS | BSN 3I 29

 NORMAL GAS VALUES
Ph 7.35-7.45
PO2 80-100 %
PaCO2 35-45 mmHg
HCO3 22-26 mEq/L

EVALUATION OF ABN BLOOD GAS VALUES

SUPPLEMENTAL LINKS
• https://www.youtube.com/watch?v=JjN5ITbLsZc
• https://youtu.be/EML9vE1nOgk
• https://youtu.be/0 BSv4iN8T2E
QUIZ

ALINGASA, APORTADERA, BAGASLAO, ESTORBA, INSEQUEL, NAMOC | FINALS | BSN 3I 30

ALINGASA, APORTADERA, BAGASLAO, ESTORBA, INSEQUEL, NAMOC | FINALS | BSN 3I 31