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Saunders 7 - Chapter 9 Acid-Base Balance

作者:龙同学
Monitor the client’s respiratory status closely. In acidosis, the respiratory rate and depth increase in an attempt to exhale acids. In alkalosis, the respiratory rate and depth decrease;CO2 is retained to neutralize and decrease the strength of excess bicarbonate. 
When the client experiences an acid-base imbalance, monitor the potassium level closely because the potassium moves in out of the cells in an attempt to maintain acid-base balance. The resulting hypokalemia or hyperkalemia predisposes
the client to associated complications. 
Respiratory acidosis
If the client has a condition that causes an obstruction of the airway or depresses the respiratory system,monitor the client for respiratory acidosis. 
Cause the Respiratory Acidosis
0. Asthma
0. Atelectasis
0. Brain trauma
0. Bronchiectasis
0. Bronchitis
0. CNS depressants(sedatives.opioids. anesthetics)
0. Emphysema and COPD
0. Administering high oxygen levels per nasal cannula to clients who are CO2 retainers
0. Hypoventilation
0. Pneumonia
0. Pulmonary edema
12. Pulmonary emboli
Respiratory alkalosis
If the client has a condition that causes overstimulation of the respiratory system,
monitor the client for respiratory alkalosis. 
Causes of Respiratory alkalosis
0. Fever
0. Hyperventilation
0. Hypoxia
0. Hysteria
0. Overventilation
6. Pain
Interventions
Monitor electrolyte values,particularly potassium and calcium levels;monitor ABG levels. 
Prepare to administer calcium gluconate
for tetany. 
Metabolic acidosis
Cause 
An insufficient supply of insulin in a client with diabetes mellitus can result in matabolic acidosis known as diabetic ketoacidosis. 
0. Diabetes mellitus or diabetic ketoacidosis
0. Excessive ingestion of acetylsalicylic acid 
0. High-fat diet
0. Insufficient metabolism of carbohydrates
0. Malnutrition
0. Renal insufficiency ,acute kidney injury ,or chronic kidney disease
0. Severe diarrhea
Assessment 
Kussmaul’respirations(deep and rapid)
Monitor the client experiencing severe diarrhea for manifestations of matabolic acidosis. 
Metabolic alkalosis
Cause
0. Diuretic
0. Excessive vomiting or gastrointestinal suctioning
0. Hyperaldosteronism
0. Ingestion of and/or infusion of excess sodium bicarbonate. 
0. Massive transfusion of whole blood. 
Monitor the client experiencing excessive vomiting or the client with gastrointestinal suctioning for manifestations of metabolic alkalosis. 
Interventions
Monitor ABGs and potassium and calcium levels. 
Arterial Blood Gases(ABGs)
PH 7.35-7.45
Paco2 35-45mmHg
Bicarbonate(HCO3) 21-28mEq/L
Pao2 80-100mmHg
Performing the Allen’s Test Before Radial Artery puncture
1.Explain
2.Apply pressure over the ulnar and radial arteries simultaneously
3.Ask the client to open and close the hand repeatedly
4.Release pressure from the ulnar artery while compressing the radial artery 
5.Assess the color of the extremity distal to the pressure point (if pinkness fails to return within 6 to 7 seconds,the ulnar artery is insufficient,indicating that the radial artery should not be used for obtaining a blood specimen. )
6.Document the fingings 
prepare a heparinized syringe 
Maintain pressure for 5mins or for 10mins if the client is taking an anticoagulant
Label and transport it ice to the lab
Record the client’s temperature and the type of supplemental O2 that the client is receiving
Analyzing arterial Blood Gas results
Pyramid steps
Pyramid steps1
PH
Pyramid steps2
Paco2
If paco2 reflects an opposite relationship to the PH,the condition is a respiratory imbalance. If the paco2 dose not reflect an opposite relationship to the PH,go to pyramid step3. 
Pyramid step3
Look at the HCO3,dose the HCO3 reflect a corresponding relationship with the PH?
If it dose, the condition is a matabolic imbalance. 
Pyramid step4
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