Chp: 9 Acid Base Balances

A. Increasing serum bicarbonate level.

If the body is in a state of alkalosis, the renal buffering system provides acid-base compensation by which method?

A. Increasing serum bicarbonate level.

B. Excreting hydrogen ions via urine output.

C. Making urine more alkaline

D. increasing pH.

A. Respiratory acidosis

The nurse is reviewing a patient's arterial blood gas measurements: pH, 7.48; PaCO2, 33 mm Hg; HCO3-, 22 mEq/L. What do the results indicate?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

B. Administering bronchodilators

Which treatment method would be used for a patient who is exhibiting respiratory acidosis?

A. Administering aspirin therapy

B. Administering bronchodilators

C. Administering a sedative

D. Administering oxygen

A. Encouraging slow, deep breathing

C. Providing emotional support

D. Assisting with activities of daily living

The nurse is caring for a patient with respiratory alkalosis. What nursing interventions would the nurse expect to include? (Select all that apply.)

A. Encouraging slow, deep breathing

B. Administering sodium bicarbonate, as ordered

C. Providing emotional support

D. Assisting with activities of daily living

E. Providing hemodynamic monitoring

A. Metabolic Acidosis

Amanda is admitted with diabetic ketoacidosis secondary to an upper respiratory infection.

Her blood gas results reveal the following: pH, 7.25; PaCO2, 35; and HCO3-, 18.

What is Amanda's acid-base status?

A. Metabolic Acidosis

B. Metabolic Alkalosis

C. Respiratory Acidosis

D. Respiratory Alkalosis

C. Fully compensated

Ron was admitted with metabolic alkalosis from his frequent antacid use. His blood gas results reveal the following: pH, 7.44; PaCO2, 48; and HCO3-, 28.

What is Ron's acid-base status?

A. Partially compensated

B. Uncompensated

C. Fully compensated

A. Metabolic alkalosis

Jan is recovering from a bowel obstruction. She's had a nasogastric tube in place for several days, connected to suction. These are today's blood gas results: pH, 7.50; PaCO2, 40; and HCO3-, 30.

What is her acid-base status?

A. Metabolic alkalosis

B. Metabolic acidosis

C. Respiratory alkalosis

D. Respiratory acidosis

D. Respiratory acidosis

Kirk has chronic lung disease and is frequently admitted to the hospital. Today, his admission blood gas results reveal the following: pH, 7.18; PaCO2, 50; and HCO3-, 25.

How should the nurse document this finding?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory alkalosis

D. Respiratory acidosis

B. Partially compensated

Jessica is in the emergency department for severe asthma and has been receiving aggressive bronchodilator treatments. Her repeat blood gases are as follows: pH, 7.24; PaCO2, 50; and HCO3-, 27.

What level of compensation is she showing?

A. Fully compensated

B. Partially compensated

C. Uncompensated

C. PaCO2

Marvin has just learned that his wife died. He is hysterical and screaming and crying. His respiratory rate is 32.

What part of his arterial blood gas will be low?

A. Respiratory alkalosis

B. HCO3

C. PaCO2

D. Respiratory acidosis

C. Respiratory alkalosis

Suzie is taking her NCLEX-RN exam and is tachypneic and hyperventilating. If blood gases were drawn, what acid-base imbalance would be expected?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory alkalosis

D. Respiratory acidosis

B. Uncompensated

Rationale: The pH is abnormal and the CO2 is abnormal BUT the HCO3 is normal. The kidneys don't want to help the lungs.

Bill's arterial blood gases are pH, 7.30; PaCO2, 65; and HCO3-, 24 from an acute pulmonary event. He is short of breath and having difficulty breathing.

What is his compensation status?

A. Respiratory alkalosis

B. Uncompensated

C. Fully compensated

D. Partially compensated

C. pH value of 7.42

Which finding in a patient's arterial blood gas result indicates a normal blood pH level?

A. pH value of 7.30

B. pH value of 7.25

C. pH value of 7.42

D. pH value of 7.55

B. Decreased serum pH and bicarbonate levels

Metabolic acidosis is indicated by which arterial blood gas result?

A. Within range pH and increased carbon dioxide levels

B. Decreased serum pH and bicarbonate levels

C. Increases in serum pH and bicarbonate levels

D. Decrease in serum pH and increases in both carbon dioxide and bicarbonate levels

A. Serum pH levels

C. Bicarbonate levels

D. Carbon dioxide level

E. Oxygen

What are the component parts of an arterial blood gas? (Select all that apply.)

A. Serum pH levels

B. Pulse oximetry

C. Bicarbonate levels

D. Carbon dioxide level

E. Oxygen

B. Metabolic acidosis

A patient's diagnostic test results indicate an increased anion gap. Based on this finding, what would the nurse anticipate that the patient's labs reveal?

A. Respiratory acidosis

B. Metabolic acidosis

C. Respiratory alkalosis

D. Metabolic alkalosis

A. 22 to 26 mEq/L

Which range of HCO3- levels in blood would be considered normal?

A. 22 to 26 mEq/L

B. 35 to 45 mm Hg

C. 7.35 to 7.45

D.

C. Hyperventilation

Which respiratory condition can cause respiratory alkalosis in a patient with an acid-base imbalance?

A. Hypoventilation

B. Bronchial obstruction and atelectasis

C. Hyperventilation

D. Severe pulmonary infection

D. Respiratory acidosis

A nurse checks the arterial blood gas (ABG) results of an older adult and finds that the patient's pH is 7.34, PaCO2 is 46 mm Hg, and the HCO3- is 27 mEq/L. Which interpretation of the lab results by the nurse is correct?

A. Metabolic alkalosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Respiratory acidosis

A. Accelerating bicarbonate reabsorption

Which compensatory mechanism in the body of a patient diagnosed with respiratory acidosis would help correct the imbalance?

A. Accelerating bicarbonate reabsorption

B. Decreasing hydrogen excretion

C. Increasing respiratory rate and depth

D. Retaining CO2 through breathing patterns

A. Cardiovascular

B. Neuromuscular

D. Respiratory

F. Central nervous

When caring for a patient with an acid-base imbalance, the nurse would be alert for complications in which body system? (Select all that apply.)

A. Cardiovascular

B. Neuromuscular

C. Genitourinary

D. Respiratory

E. Gastrointestinal

F. Central nervous

C. Respiratory acidosis

This patient has smoked for over 40 years and has advanced lung disease. Which acid-base imbalance would the nurse monitor for in the patient?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

C. 35 to 45 mm Hg

Which range of PaCO2 levels in blood would be considered normal?

A. 7.35 to 7.45

B. 22 to 26 mEq/L

C. 35 to 45 mm Hg

D.

B. Providing heart failure treatment like diuretics for decreasing fluid in the lungs.

Which treatment is an example of nonpulmonary treatment?

A. Performing chest tube insertion to increase lung expansion or remove drainage

B. Providing heart failure treatment like diuretics for decreasing fluid in the lungs

C. Removing a foreign body from the airway, if required

D. Inserting an artificial airway for performing mechanical ventilation

A. In uncompensated ABG, PaCO2 or HCO3- is abnormal.

B. In uncompensated ABG, there is no indication that the renal or respiratory system has tried to correct the imbalance.

D. In uncompensated ABG, pH is abnormal.

Which is true regarding uncompensated arterial blood gas (ABG)? (Select all that apply.)

A. In uncompensated ABG, PaCO2 or HCO3- is abnormal.

B. In uncompensated ABG, there is no indication that the renal or respiratory system has tried to correct the imbalance.

C. In uncompensated ABG, pH is normal.

D. In uncompensated ABG, pH is abnormal.

E. In uncompensated ABG, both PaCO2 and HCO3- are abnormal.

D. Metabolic alkalosis

If a patient is admitted with nausea and vomiting and placed on nasogastric suctioning, the nurse would recognize the patient would be at most risk of which acid-base imbalance?

A. Respiratory alkalosis

B. Metabolic acidosis

C. Respiratory acidosis

D. Metabolic alkalosis

B. The renal buffer in the kidneys excretes HCO3- in a state of alkalosis.

Which statement is correct regarding the characteristics of a renal buffer?

A. The renal buffer acts by regulating pH levels.

B. The renal buffer in the kidneys excretes HCO3- in a state of alkalosis.

C. The renal buffer is the least effective, yet fastest acting, buffering system.

D. The renal buffer in the kidneys excretes bicarbonate in a state of acidosis.

C. pH

A nurse is checking the arterial blood gas (ABG) results of an older adult who has developed postsurgical acid-base imbalance. Which ABG result confirms that the patient has developed metabolic acidosis?

A. pH >7.45 and HCO3- >28 mEq/L; if compensated, then the PCO2 >45 mm Hg.

B. pH >7.45 and PaCO2

1. Interpret the pH as normal, alkalosis, or acidosis.

2. Determine if the PaCO2 result is normal, alkalosis, or acidosis.

3. Interpret the HCO3 result as normal, alkalosis, or acidosis.

4. Identify the cause of the imbalance by matching the pH with the abnormal PaCO2 or HCO3 result.

5. Decide if compensation is presen

What is the correct sequence of order for ABG interpretation in the proper order?

A. PaO2 value indicates the partial pressure of oxygen in arterial blood and is the most important factor in determining how oxygen binds to hemoglobin.

B. PaO2 values, when high, indicate more oxygen is able to bind with hemoglobin.

C. PaO2 values, when low, indicate less oxygen is able to bind with hemoglobin.

Which statement is correct regarding oxygenation and PaO2? (Select all that apply.)

A. PaO2 value indicates the partial pressure of oxygen in arterial blood and is the most important factor in determining how oxygen binds to hemoglobin.

B. PaO2 values, when high, indicate more oxygen is able to bind with hemoglobin.

C. PaO2 values, when low, indicate less oxygen is able to bind with hemoglobin.

D. PaO2 values lower than normal are associated with high levels of supplemental oxygen administration.

E. PaO2 values are higher than normal indicate hypoxemia.

C. HCO3

Which parameter of the ABG result correlates to the assessment of the base component?

A. pH

B. PaO2

C. HCO3

D. PaCO2

B. Alkalosis

pH: 7.35-7.45

How does the nurse interpret an arterial pH of 7.47?

A. Acidosis

B. Alkalosis

C. Compensation

D. Homeostasis

B. Partially compensated respiratory acidosis

What acid-base imbalance does the nurse suspect on the basis of these results?

pH: 7.31, PaCO2: 52 mm Hg, HCO3: 28 mEq/L

A. Uncompensated respiratory acidosis

B. Partially compensated respiratory acidosis

C. Uncompensated metabolic acidosis

D. Partially compensated metabolic acidosis

B. Respiratory alkalosis

Which acid-base imbalance should be suspected with these ABG results?

pH: 7.47

PaCO2: 31 mm Hg

HCO3: 24 mEq/L

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

C. Increased excretion of HCO3

When the body is in a state of alkalosis, what is the role of the renal buffers?

A. Increased excretion of water

B. Decreased excretion of water

C. Increased excretion of HCO3

D. Decreased excretion of HCO3

D. Metabolic alkalosis

A patient has been diagnosed with an intestinal obstruction. The nurse inserts a nasogastric tube and attaches the tube to low intermittent suction. For which acid-base imbalance is the patient at greatest risk for?

A. Respiratory alkalosis

B. Respiratory acidosis

C. Metabolic acidosis

D. Metabolic alkalosis

D. Prepare the patient for intubation and mechanical ventilation

The patient's ABG results indicate worsening respiratory acidosis. He has rapid, shallow breaths and decreased bilateral breath sounds. Which intervention should be the nurse's first priority?

A. Administer an antibiotic for suspected pneumonia

B. Administer diuretics for heart failure

C. Encourage the patient to breathe into a brown paper bag

D. Prepare the patient for intubation and mechanical ventilation

1. Look at pH first to determine if it is normal, acidotic, or alkalotic

2. Determine the cause of the abnormal pH

a.) Check the PaCO2 (Respiratory)

b.) Check the HCO3 (Metabolic)

c.) Match the PaCO2 or HCO3 to the pH and determine the cause

3. Is the body compensating? (Only compensating IF pH in normal range)

4. Analyze the PaCO2 and SaO2

Steps to interpreting ABG's:

Respiratory acidosis and the Respiratory system is the problem

pH: 7.28, PaCO2: 56 mmHg, HCO3: 25 mEq/L, PaO2: 70, SaO2: 89%

What does these results indicate?

Metabolic Acidosis and the Renal system is the problem

pH: 7.48, PaCO2: 44 mmHg, HCO3: 32 mEq/L, PaO2: 86, SaO2: 95%

What does these results indicate?

Normal

pH: 7.38, PaCO2: 45 mmHg, HCO3: 25 mEq/L, PaO2: 80, SaO2: 99%

What does these results indicate?

Respiratory Alkalosis and the Respiratory system is causing the problem

pH: 7.50, PaCO2: 33 mmHg, HCO3: 22 mEq/L, PaO2: 82, SaO2: 94%

What does these results indicate?

Metabolic Acidosis and the Renal system is causing the problem

pH: 7.32, PaCO2: 40 mmHg, HCO3: 18 mEq/L, PaO2: 84, SaO2: 96%

What does these results indicate?

1. Chemical buffers

2. Respiratory buffers

3. Renal buffers

What homeostatic mechanisms keep the pH within normal range?

Buffers

systems act quickly to changes in the pH. They either bind or release hydrogen ions as needed.

Allen's Test

is done to ensure adequate collateral circulation in the event there is hemorrhage or thrombosis of the radial artery that is punctured.

R - Respiratory

O - Opposite

pH (high) ; PCO2 (low) = Alkalosis

pH (low) ; PCO2 (high) = Acidosis

M - Metabolic (Renal)

E - Equal

pH (high) ; HCO3 (high) = Alkalosis

pH (low) ; HCO3 (low) = Acidosis

Acid Base Mnemonic (ROME)

-CNS Depression

-Pneumothorax

-Hypoventilation

-Severe pulmonary infections

-Heart failure with pulmonary edema

- Myasthenia gravis

-Sleep apnea

-Head trauma

-Drug overdose

-Alcohol intoxication

-pneumonia

-COPD/asthma attack

What are some causes of respiratory acidosis?

(Low and Slow)

-Dyspnea

-Restlessness

-Confusion

-Lethargic

-Drowsiness

-Respiratory distress

-Tachycardia

What are the clinical manifestations of respiratory acidosis?

-Treat the cause & early recognition

-Bronchodilators

-Antibiotics

-Sedation reversal (Narcan)

-Pulmonary hygiene

-O2

-Adequate hydration

-Diuretics

-Chest tube

What is the medical management of respiratory acidosis?

-Hyperventilation

-Pain

-Anxiety/Fear/Panic attack

-Hepatic failure

-Pregnancy

-Thyrotoxicosis

-CNS lesions

-Fever

-Increase in the rate of alveolar ventilation

What are the causes of respiratory alkalosis?

(Fast RR)

-Hyperventilation

-Light headedness

-Confusion

-Parathesis

-Cardiac dysrhythmias

-Palpitations

-Sweating

-Dry mouth

-Tetanic spasms

What are some clinical manifestations of respiratory alkalosis?

-Correcting cause of hyperventilation

-Reduce fever

-Eliminate source of sepsis

-O2 therapy

-Sedative for anxiety

-Diuretics for PE

What is the medical management of respiratory alkalosis?

-RENAL FAILURE

-DKA (Kussmal RR)

-Anaerobic metabolism

-Starvation

-Salicylate intoxication

-DIARRHEA

-Intestinal fistulas

What are some causes of metabolic acidosis?

-Headache

-Confusion

-Restlessness

-Lethargy

-weakness

-coma/stupor

-KUSSMAL RESPIRATIONS

-NAUSEA/VOMITING

-warm, flushed skin

-seizures/twitching

What are the clinical manifestations of metabolic acidosis?

-Sodium bicarbonate replacement by IV

-Parental fluid replacement

-Antidiarrheals

What is the medical management of metabolic acidosis?

-Excess use of bicarbonate

-Excess ingestion of antacids

-VOMITING

-NASOGASTRIC SUCTIONING

-Hypokalemia

-Hypochloremia

What is some causes of metabolic alkalosis?

-Muscle twitching and cramps

-Tetany

-Dizziness

-Lethargy

-Weakness

-Convulsions/ coma

-NAUSEA/VOMITING

-depressed respirations

What are some clinical manifestations of metabolic alkalosis?

-Discontinue of potassium-wasting diuretics

-Nasogastric suctioning

-Administered an antiemetic to treat N/V

What is the medical management of metabolic alkalosis?

FULL compensation

Fully normal pH 7.35 - 7.45 means what type of compensation?

PARTIAL compensation

When pH is NOT normal means what type of compensation?