NCLEX: Mark Klimek - Lecture 1 (Acid/Base Balance)

What are the normal pH values?

7.35-7.45

What are the normal CO2 values?

35-45

What are the normal HCO3 values?

22-26

If pH is <7.35, the acid-base imbalance is…

Acidic

If pH is >7.35, the acid-base imbalance is…

Alkalotic

If the pH and Bicarb move in the SAME direction, then the acid-base imbalance is…

Metabolic

If the pH and Bicarb move in the OPPOSITE direction, then the acid-base imbalance is…

Respiratory

(Example #1) Metabolic or respiratory? pH=7.3, HCO3=20

Metabolic acidosis

(Example #2) Metabolic or respiratory? pH=7.58, HCO3=32

Metabolic alkalosis

(Example #3) Metabolic or respiratory? pH=7.22, HCO3=35

Respiratory acidosis

"As the pH goes…

… so goes my patient, except for potassium."

If pH goes over 7.45, s/s include…

pH is up, so my patient goes up… except for potassium.

Tachycardia, tachypnea, HTN, seizures, irritability, spastic, diarrhea, borborygmic (increased bowel sounds), hyperreflexia (3+, 4+)….. HYPOkalemia!

What is the nursing intervention for s/s of ALKALOSIS?

Patient needs suctioning because of seizures.

If pH goes below 7.35, s/s include…

pH is down, so my patient goes down… except for potassium.

Bradycardia, bradypnea, low BP, coma, flaccid, obtunded/lethargic, constipation, absent bowel sounds, hyporeflexia (0, 1+)… HYPERkalemia!

What is the nursing intervention for s/s of ACIDOSIS?

Respiratory arrest -- Patient needs to be ventilated with an Ambu bag!

"MAC Kussmaul" helps you to remember that…

Metabolic ACidosis is the only acid-base imbalance that causes Kussmaul respirations (deep, rapid breathing).

Causes of acid-base imbalances: First ask yourself, "Is it LUNG?" If yes, then it's _.

Respiratory

Causes of acid-base imbalance: If under-ventilated, then it's _.

Acidosis

Causes of acid-base imbalance: If over-ventilated, then it's _.

Alkalosis

What type of acid-base derangement is present in the following condition: Drowning?

Respiratory acidosis

pH is decreased due to underventilation.

What type of acid-base derangement is present in the following condition: Being in labor?

Respiratory alkalosis

pH is increased due to overventilation.

What type of acid-base derangement is present in the following condition: Patient is on PCA (Patient-Controlled Anesthesia)?

Respiratory acidosis

pH is decreased due to underventilation.

Causes of acid-base imbalances: First ask yourself, "Is it LUNG?" If no, then it's _.

Metabolic

If the patient has prolonged gastric vomiting or suction of acid, pick which acid-base imbalance?

Metabolic alkalosis

For anything else that is "NO" for LUNG and does not involve prolonged vomiting or suctioning, pick which acid-base imbalance?

Metabolic acidosis

High-pressure alarms are always due to…

increased resistance to air flow.

Look for obstructions and fix it.

What is the appropriate order
to address high pressure alarm
in a mechanical ventilator?

(1) Kinks in tubes = unkink it.
(2) Condensed water in dependent tube = Empty it.
(3) Mucus plugs = Ask patient to turn, cough, deep breathe, and…
(4) Suction the tubing PRN.

Low-pressure alarms are always due to…

decreased resistance to air flow.

Look for leaks or disconnections from the main tubing or O2 sensor tube.

What do you do when a low-pressure alarm is due to a disconnected tube that is on the floor?

Bag the patient and call Respiratory Therapist.

If the ventilator setting is too high, the patient is -ventilated, which is a acid-base imbalance.

Over-ventilated = Respiratory alkalosis

If the ventilator setting is too low, the patient is -ventilated, which is a acid-base imbalance.

Under-ventilated = Respiratory acidosis

The physician wants to wean patient off vent in the morning. At 6 am, the ABGs say respiratory acidosis. What would you do next?

Patient is UNDER-ventilated. Notify the physician that the patient is not ready to be weaned off vent.