nur108 acidosis&alkalosis 2014 lec&problems.pptx 0

8/10/2019 NUR108 Acidosis&Alkalosis 2014 Lec&Problems.pptx 0

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ACID-BASE Balance

NUR 1082014


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Acidosis and Alkalosis

Electrolyte & acid-base balance bot are

in!l"enced te #$ ion Body !l"ids %"st %aintain a nor%al acid-

base balance to s"stain li!e 'e acidity or al(alinity o! a sol"tion is

deter%ined by its concentration o!ydro)en ions and ydro*yl ions

+eneral In!or%ation


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Body !l"ids %"st %aintain a nor%al acid-

base balance to s"stain li!e

'e acidity or al(alinity o! a sol"tion is

deter%ined by its concentration o!

ydro)en ions and ydro*yl ions

+eneral In!or%ation


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Acidosis and

AlkalosisACID An acid is a s"bstance containin)

ydro)en ions tat can be liberated or

released

An al(ali or base is a s"bstance tat canacce,t or tra, a ydro)en ion

A.AI /BASE


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Acidosis and Al(alosis

ACIDSIS A condition caracteried by a e*cess o!

ydro)en ions in te EC3 in ic te ,#

!alls belo 567 An acid releases # ions en dissoled

in ater


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A.ASIS A condition caracteried by a lac( o!

ydro)en ions in te EC3 in ic te

,# e*ceeds 9547 A base is a s"bstance tat binds to #

ions when dissolved in water


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Acid - Base

,# ,# : is a "nit o! %eas"re%ent "sed to

describe acid-base balance E*,ression o! ydro)en ion concentration

and te acidity o! a s"bstance Ne"tral ; 50 Nor%al blood ,las%a ,# is sli)tly

al(aline ; 567 -547


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BU33ER A s"bstance tat ,reents body !l"ids

!ro% beco%in) oerly acidic or al(aline a=or ce%ical b"!!ers !o"nd in blood?

Carbonic acid-bicarbonates


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BU33ER Ce%ical b"!!ers are ,resent in IC3 &

EC3

3o"nd in all body tiss"es Act itin seconds to %aintain acid-base Nor%ally te body %aintains ,# by

%aintainin) a ration o! bicarbonate/#C6


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CHEMICAL REGULATION

3irst and i%%ediate res,onder

cc"rs "nconscio"sly - an ada,tiesyste%

#as a brie! e!!ect - act itin seconds

Ratio o! carbonic acid to bicarbonate is1?20

CARBNIC ACID-SDIU>BICARBNA'E BU33ER S@S'E>


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CHEMICAL REGULATORS

PLASMA PROTEIN BUFFER SYSTEM ost ,lenti!"l and ersatile syste% A %a=or intracell"lar b"!!er Cannot correct lon)-ter% i%balances


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C#E>ICA RE+UA'RS


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Biological Regulaion

Cell"lar absor,tion or release o! #$ ions

Cl1 leaes te cell and #C6 enters

called te cloride si!t

CEUAR EE

#E>+BIN-@#E>+BIN S@S'E>


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Faco#s In$luencing Acid%Base

Balance

ery yo"n) and elderly are %osts"sce,tible beca"se o! !l"id balance and

%etabolic actiities in tese a)e )ro",s A)in) ,rocess can)es l"n) !"nction and

can lead to i%balances

A+E


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Faco#s In$luencing Acid%Base Balance

I3E-S'@E 3ad dietin) can lead to acidosis An*iety can lead to res,iratory al(alosis Cronic alcoolis% can lead to acidosis


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DRU+S

Di"retics Steroids De,ressants Sti%"lants


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EE 3 #EA'#

Clients it ,"l%onary disease diabetes

%ellit"s or ane%ia are at ris( !or acidosis

or al(alosis Clients ta(in) steroids or di"retics are at

ris(

D"rin) illness %etabolic actiities arealtered and i%balances can occ"r ra,idly


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Co,yri)t 2012 by


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Co,yri)t 2012 by


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"n)s

Re)"late acid-base balance by eli%inatin)or retainin) carbon dio*ide

Does tis by alterin) ratede,t o!

res,irations 3aster rate%ore de,t ; )et rid o! %ore

C2 and ,# rises

Sloer rateless de,t ; retain C2 and,# loers


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.idneys

Re)"late by selectiely e*cretin) or

conserin) bicarbonate and ydro)en ions Sloer to res,ond to can)e


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3actors A!!ectin) Body 3l"id

and Acid-Base Balance A)e +ender

Body sie Eniron%enta

l te%,erat"re

i!estyle

Cronic diseases Ac"te conditions

>edications 'reat%ents E*tre%es o! a)e

Inability to access !oodand !l"ids


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Acid-Base I%balances

Res,iratory acidosis Res,iratory al(alosis

>etabolic acidosis >etabolic al(alosis


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Res*i#ao#" Acidosis

Ac"te res,iratory acidosis


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Cronic res,iratory acidosis E%,yse%a Cystic !ibrosis

Adanced %"lti,le sclerosis Bronciectasis Broncial ast%a

yastenia )rais +"illian-Barre

Res,iratory Acidosis


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3actors !aorin) y,oentilation besity or ,re)nancy

'i)t abdo%inal binders or dressin)s


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DE3ININ+ C#ARAC'ERIS'ICS /S&S

Ac"te res,iratory acidosis

3eelin) o! !"llness in te ead

>ental clo"diness disorientation Diiness - Hea(ness

"sc"lar titcin)

Har% !l"sed s(in Unconscio"sness



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Res,iratory Acidosis?

#y,erca,nia A state o! e*cessie carbon dio*ide in tebody

*H 567 PaCO+? 9 47 %%#) /e*cess C2 &

carbonic acid HCO,? nor%al 9 2J %EG it renal

co%,ensation


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Cronic res,iratory acidosis

Hea(ness

D"ll eadace ,# belo 567


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'REA'>EN'

Directed at i%,roin) entilation e*act

%eas"res ary it te ca"se Broncodilators to red"ce broncos,as% Antibiotics !or in!ections onitor S



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AdeG"ate ydration 2-6 day S",,le%ental 2 ca"tio"sly in

C


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Res*i#ao#" Alkalosis

E*tre%e an*iety #y,o*e%ia-as,y*iation soc( #i) !eer Early salicylate into*ication sti%"lates

res,iratory center +ra%-ne)atie bactere%ia


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'yroto*icosis 'etany Car,o,edal s,as% Central nero"s syste%s lesions

inolin) te res,iratory center E*cessie entilation by %ecanical

entilators #y,erentilation : an*iety

Res,iratory Al(alosisE'I+ICA 3AC'RS


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Ne"rolo)ical conditions s"c as %enin)itis

or ence,alitis

#i) eniron%ental te%,erat"res i)altit"des

ac( o! o*y)en


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Res,iratory Al(alosis

DE3ININ+ C#ARAC'ERIS'ICS /S&S Ra,id dee, res,irations i)teadedness d"e to cerebral

asoconstriction and decreased cerebralblood !lo

Inability to concentrate

N"%bness and tin)lin) o! e*tre%ities erti)o Synco,e


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A state o! e*cessie loss o! carbon dio*ide

in te body ,# 9 547


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#y,erentilation syndro%e 'innit"s bl"rred ision


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Res,iratory Al(alosis'REA'>EN'

I! an*iety is te ca"se client needs to be

el,ed to nor%alie res,irations %oe

to a G"iet area teacin) slo nor%al

breatin) Breatin) into a ,a,er ba) is "sed only i!

"nable to cal% te client and G"ietin)

%eas"res do not or(


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Correct te "nderlyin) ca"se >onitor S


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Mea-olic Acidosis

Diarrea Intestinal !ist"las Ureterosi)%oidosto%y #y,erali%entation Acidi!yin) Dr")s Alcool into*ication

E'I+ICA 3AC'RS


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Renal t"b"lar acidosis Syste%ic in!ections

In)estion o! to*ins Diabetic acidosis Starational acidosis

actic acidosis Renal !ail"re

Mea-olic AcidosisE'I+ICA 3AC'RS


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#i)-!at diet Decreased tiss"e ,er!"sion !ro%

tra"%a andor b"rns .$ conserin) di"retics can ca"se

.$ e*cess can res"lt in Na$ loss

and #C6 loss

Mea-olic AcidosisE'I+ICA 3AC'RS


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Mea-olic AcidosisDE3ININ+ C#ARAC'ERIS'ICS /S&S

#eadace Con!"sion can)es in C Drosiness ."ss%a"l Res,irationsF 3r"ity breat Na"sea andor o%itin)


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>etabolic Acidosis

A condition caracteried by a de!iciency

o! bicarbonate ions in te body in relation

to te a%t o! carbonic acid in te body *H 567 PaCO+? nor%al 67 %%#) it

res,iratory co%,ensation HCO,. 22 %EG /inadeG"ate bicarbonate


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>onitor SF >onitor AB+Ks Ad%inister IKs as ordered

Correct te "nderlyin) ca"se Ad%inister 2 ca"tion in Conitorassessreassess !or res"lts o!

care

Mea-olic Acidosis'EA'>EN'


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Mea-olic Alkalosis

o%itin) E*cessie N+ s"ctionin) C"sin)Ks syndro%e .$ losin) di"retic tera,y can ca"se .$

loss can ca"se Na$ retention

#y,o(ale%ia

E'I+ICA 3AC'RS


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E*cessie base in)estion #y,eraldosteronis%

AC'# ad%inistration Na#C6 ad%inistration d"rin) C


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A condition caracteried by an e*cess o!bicarbonate ions in te body in relation to

te a%t o! carbonic acid in te body

,# 9 547


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Acid%Base Co&*ensaion

So%eti%es tere is a can)e in bot te

,C2 and te #C6

ne o! te leels indicates te ,ri%aryso"rce or ca"se o! te can)e

'e oter re!lects te bodyKs e!!ort to

co%,ensate

A id B C i


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'e bodyKs ability to co%,ensate %ay be

so )ood tat te ,# !alls itin nor%al

ran)e


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Co%,ensation inoles o,,osites In ,ri%ary %etabolic acidosis co%,ensation

co%es in te !or% o! res,iratory al(alosis

'e ,#? 525 ; Acidosis 'e ,C2? 25 ; Al(alosis

'e #C6? 10 ; Acidosis

'e bicarb leel corres,onds to te ,# %a(in)te %etabolic co%,onent te ,ri%ary ,roble% and

te decrease in ,C2 te atte%,t at

co%,ensation

Acid-Base Co%,ensation

A id B C ti


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'e l"n)s are G"ic( to react to ,roble%s

and te (idneys are %"c sloer


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Unco%,ensated : ,# is abnor%al

eiter


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Res*i#ao#" Acidosis

Unco%,ensated Co%,ensated ,# 567 Nor%al ,C2 9 47 9 47 #C6 Nor%al 9 2J

R i Alk l i


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Res*i#ao#" Alkalosis

Unco%,ensated Co%,ensated ,# 9 547 Nor%al ,C2 67 67 #C6 Nor%al 22

M - li A id i


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Mea-olic Acidosis

Unco%,ensated Co%,ensated ,# 567 Nor%al ,C2 Nor%al 67 #C6 22 22

> t b li Al( l i


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>etabolic Al(alosis

Unco%,ensated Co%,ensated ,# 9 547 Nor%al ,C2 Nor%al 9 47 #C6 9 2J 9 2J

N i #i t


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N"rsin) #istory

C"rrent istory & ,ast %edical istory Diabetes %ellit"s Cronic l"n) diseases

>edications 3"nctional & socioecono%ic !actors Deelo,%ental !actors 3l"id and N"tritional inta(e 3l"id o"t,"t

N i #i t


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N"rsin) #istory?

Cronic Diseases Res,iratory? Caln"trition Anore*ia nerosa B"li%ia Ileosto%y

N i #i t


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N"rsin) #istory?

Ac"te Conditions Ac"te )astroenteritis Boel obstr"ction #ead in="ry or decreased C 'ra"%a? b"rns cr"sin) in="ries S"r)ery

3eer drainin) o"nds !ist"las


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"sc"lar syste%


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a(e a is"al ins,ection >"co"s %e%branes dry d"ll in

a,,earance 'on)"e dry it crac(s


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otor !"nction? ea(ness decreased

%otor stre)t Dee, tendon Re!le* /D'


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Res,iratory Acidosis?

#y,erca,nia A state o! e*cessie carbon dio*ide in te

body *H 567 PaCO+? 9 47 %%#) /e*cess C2 &

carbonic acid HCO,? nor%al 9 2J %EG it renal

co%,ensation



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A state o! e*cessie loss o! carbon dio*ide

in te body *H9 547 PaCO+? 67 %%#) /inadeG"ate C2 &

carbonic acid HCO,? nor%al 22 %EG it renal

co%,ensation


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>etabolic Al(alosis


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>etabolic Al(alosis

A condition caracteried by an e*cess o!

bicarbonate ions in te body in relation to

te a%t o! carbonic acid in te body *H9 547 PaCO+? nor%al 9 47 %%#) it

res,iratory co%,ensation HCO,. 9 2J %EG /e*cess bicarbonate

Hen Analyin) AB+s


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Hen Analyin) AB+s

oo( O eac n"%ber se,arately ,#? acidosis s al(alosis


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Hen Analyin) AB+s #C6 Bicarbonate?

I! 22 %EG bicarbonate leels areloer tan nor%al indictin) acidosis

I! 9 2J %EG bicarbonate leels

are i)er tan nor%al indicatin)

al(alosis Deter%ine e ca"se o! te acid-base

i%balance /loo( at ,# Deter%ine i! te ori)in o! te i%balance is

res,iratory or %etabolic

Hen Analyin) AB+s


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Hen Analyin) AB+s

oo( !or eidence o! co%,ensation oo( at te al"e tat does not %atc

te ,#

I!


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NANDA N"rsin) Dia)nosis

Deficient or Excess Fluid Volume Risk for Imbalanced of Deficient Fluid

Volume Impaired Gas Exchange



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3l"id and Acid-base I%balances aseidence o!? /etiolo)y Impaired Oral Mucous Membrane Impaired Skin Integrit Decreased !ardiac Output Ineffecti"e #issue $erfusion%cti"it Intolerance Risk for In&ur%cute !onfusion


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)

>aintain or restore nor%al !l"id balance >aintain or restore nor%al electrolyte

balance intracell"lar & e*tracell"lar

co%,art%ents >aintain & restore ,"l%onary entilation &

o*y)enation


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N"rsin) Interention


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N"rsin) Interention

>odi!y !l"ids? Q,"s Can)e diet to %eet electrolyte de%ands ral electrolyte s",,le%ents


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1 oo( at te


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No e ill ,lay it so%e AB+ sets

Inter,ret te !olloin)?


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Inter,ret te !olloin)?

,# : 560


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,# : 560 lo acidosis


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,# : 571


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,# : 571 i) al(alosis etabolic al(alosis


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,# : 521


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,# : 521 lo acidosis etabolic Acidosis


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,# : 572


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,# : 572 i) al(alosis


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J5 yo client as os,italied itA>I 'e AB+s are?


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J5 yo client as os,italied it

A>I 'e AB+s are?


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+eneral In!or%ation



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+eneral In!or%ation

46 ! l d i d i l


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46 yo !e%ale as ad%itted to te os,ital

co dys,nea !or te ,ast 6 days 'e

AB+s are?


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46 yo !e%ale as ad%itted to te os,ital

co dys,nea !or te ,ast 6 days 'e

AB+s are?


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46 yo !e%ale as ad%itted to te

os,ital co dys,nea !or te ,ast6 days 'e AB+s are?


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nur108 acidosis&alkalosis 2014 lec&problems.pptx 0

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