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71 Cards in this Set
- Front
- Back
Acid Base Balance #1
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•essential for proper cell function
•depends on regulation of free hydrogen ions •pH = “power of Hydrogen” •Hydrogen comes from food/fluid we ingest |
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Acid Base Balance #2
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•inverse proportion
__^_ # H = ___ pH (acid) ___ # H = __^_ pH (alkaline/base) *When one goes up another goes down. |
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Acid Base Balance #3
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•pH reflects balance b/w carbon dioxide (CO2) regulated by lungs (Respiratory)and bicarbonate(HCO3) regulated by kidneys (metabolic)
20:1 bicard to carbonic acid ratio |
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Acid Base Balance Goal
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•GOAL: maintain homeostasis of H in body fluids
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Acid Base Balance #4
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•body fluids classified as acids or bases
acid – plenty of H = H donor base – very little H = H acceptor |
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Acid Base Balance #5
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•normal blood pH 7.35 – 7.45
< 6.8 or > 7.8 = death |
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ACIDOSIS
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(pH < 7.35) excess H from acid excess or base deficit
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ALKALOSIS
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(pH > 7.45) deficit of H from base excess or acid deficit
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acid base balance evaluated
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ABG (arterial blood gas) obtained from radial, brachial, femoral artery, an arterial line, pulmonary artery
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other methods to evaluate acid base balance
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pulse oximetry
serum anion gap measurement serum potassium (K+) level carbon dioxide (CO2) level chloride level |
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normal blood pH
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7.35 – 7.45
< 6.8 or > 7.8 = death |
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What does ABG's do?
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1.determine acid base status
2.eval. pulm gas exchange 3.assess resp.system 4.eval blood oxygenation 5.monitor resp. therapy |
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•CO2 is a potential ________***
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Acid
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PaCO2 =
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RESPIRATORY COMPONENT (think CO2 in lungs)
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HCO3 =
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METABOLIC COMPONENT
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Acid Base Norms.
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pH 7.35 - 7.45
pa CO2 35 - 45 HCO3 22 - 26 Base excess -2 - +2 pa O2 80 - 100 mm Hg sa O2 95 - 100 % |
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6 Parameters of ABGs
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1.pH
2.partial pressure of CO2 in art. blood (PaCO2) 3.bicarbonate (HCO3) concentration 4.base excess 5.bartial pressure of O2 in art. blood (PaO2) 6.oxygen saturation (O2 sat.) |
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Bicarb =
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Base
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normal or borderline pH (7.35 – 7.45) may indicate
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normal acid base balance OR the body’s attempts to compensate for a slightly abnormal or chronic acid base imbalance – you must analyze PaCO2 and HCO3 levels to determine this
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PaCO2 = respiratory acid base component
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↑ 45 = Hypoventilation= (CO2 retention-hypercapnia) = ACIDOSIS slow breathing
↓ 35 = Hyperventilation=(excessive CO2 loss-hypocapnia) = ALKALOSIS fast breathing |
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HCO3 (Bicarb is Base) Metabolic acid base component
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↑ 26 = ___Alkalosis_
↓ 22 = ___Acidosis |
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Base excess
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+ 2 = base excess (met. alkalosis)
- 2 = base deficit (met. acidosis) |
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PaO2/SaO2
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oxygenation
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PaO2 < 80 =
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hypoxemia or older pt (subtract 1 mm Hg / year of age p 60) look at baseline on older / COPD client
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Electrolyte shifts
chloride – bicarbonate (Cl- = HCO3-) |
If bicarbonate enters the red blood cell, chloride moves out into the extracellular fluid and the reverse is true. Note that the ionic charge is the same (negative) in order to maintain electronic balance.
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Electrolyte shifts
potassium – hydrogen (K+ = H+) |
When extracellular hydrogen ion concentration increases (acidosis), potassium ions will move out of the cell into the extracellular fluid and hydrogen moves into the cell and hydrogen ions move out. Again note that the ionic charge for both is positive.
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What compensates for METABOLIC acid-base imbalances).Second line of defense against acid-base imbalances regulate blood levels of carbon dioxide. CO2 combines with water to form carbonic acid. Increased levels of carbon acid lead to a decrease in pH (acidosis).
_____ fixes Kidneys. |
Lungs
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What compensates for RESPIRATORY acid-base imbalances The kidneys can reabsorb or excrete acids and bases into the urine. They can also produce bicarbonate to replenish lost supplies. Adjustments to pH made by the kidneys can take hours to days.If the blood contains too much acid or not enough base, the pH drops and the kidneys reabsorb bicarbonate and excrete hydrogen. This also causes the kidney to form bicarbonate in the tubules.
______ fixes Lungs |
Kidneys
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CO2 =
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Respiratory component
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HCO3 =
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Metabolic component
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pH 7.1
CO2 63 HCO3 28 |
Uncompensated Res. Acidosis
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pH 7.51
CO2 28 HCO3 25 |
Uncompensated Res. Alkalosis
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pH 7.54
CO2 44 HCO3 35 |
Uncompensated Metabolic Alkalosis
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pH 7.41
CO2 39 HCO3 25 |
Normal
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pH 7.12
CO2 58 HCO3 |
Uncompensated Res/Met Acidosis
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pH 7.36
CO2 55 HCO3 34 |
Compensated Resp. Acidosis
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pH 7.43
CO2 30 HCO3 20 |
Compensated Resp. Alkalosis
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Respiratory Acidosis
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Keeping in too much C02
Kidneys hold HCO3 & release H+ |
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Respiratory Acidosis General Info.
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1.Respiratory acidosis occurs when alveolar hypoventilation results in increased serum carbon dioxide levels.
2.Alveolar hypoventilation is the most common cause of respiratory acidosis. 3.The kidneys attempt to compensate by increasing the renal reabsorption of _HC03 and by excreting Hydrogen. This can take 24 to 48 hours. |
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Causes of Respiratory Acidosis
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1.Pneumonia
2.COPD 3.Oversedation 4.Respiratory arrest 5.Airway obstruction 6.Cystic fibrosis 7.Brain trauma or tumor causing excessive pressure on the respiratory center 8.Obesity |
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Clinical Manifestations of Respiratory Acidosis
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1.Hypoventilation respirations (slow)
2.Dyspnea 3.Dizziness 4.Tremors 5.Warm flushed skin 6.Asterixis 7.Tachycardia 8.Confusion 9.Coma |
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Treatment of Respiratory Acidosis
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1. Treat Cause
2. Apply 02 3. Approve ventilation (sit them up, lift HOB 4. Avoid sedatives and narcotics 5. Give HC03-increase bicarb faster the kidney 6. Suction |
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Nursing Diagnosis Respiratory Acidosis
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1. Impaired gas exchange
2. Altered mental status 3. altered tissue perfusion 4. Alteration in health main. secondary to COPD |
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Nursing Implications of Respiratory Acidosis #1
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1.Encourage the patient to turn, cough, and breathe deeply every 2 hours to improve ventilation
2.Maintain a patient airway through suctioning to prevent CO2 retention 3.Monitor ABG levels 4.Monitor vital signs particularly respiratory rate and depth 5.Position the patient in the semi-Fowler’s or orthopneic position to ease breathing 6.Encourage the patient to drink 2 to 3 liters of fluids per day unless contraindicated to help thin secretions and aid in expulsion |
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Nursing Implications of Respiratory Acidosis #2
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7.Administer supplemental O2 but be cautious with the patient with COPD because O2 will depress ventilatory drive (in these patients hypoxia is the stimulus to breathe)
8.Monitor serum potassium (K) levels for hyperkalemia because K moves out of the cell during respiratory acidosis 9.Administer meds such as bronchodilators for bronchospasms and antibiotics for respiratory infection 10.Administer sedatives cautiously because these could depress respirations 11.Assist with intubation Check Baseline before calling Doc. |
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Respiratory Alkalosis
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Release HCO3, Hold H+-
Greater than 7.41 and Less than 35 |
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Respiratory Alkalosis General Info
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1.Respiratory Alkalosis occurs when alveolar Hyperventilation results in decreased serum CO2 levels
2.Decreased CO2 levels lead to decreased H2CO3 (Carbonic Acid) production 3.The kidneys attempt to compensate by increasing renal excretion of_HCO3_, but this can take 24 to 48 hours |
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Causes of Respiratory Alkalosis
Hyperventilation secondary to: |
Anxiety or hysteria Overventilation with mechanical ventilator Fever Pain Sepsis Brain trauma
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Clinical Manifestations of Respiratory Alkalosis
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1.Hyperventilation respirations
2.Light headedness 3.Vertigo 4.Headache 5.Paresthesia 6.Tinnitus 7.Palpitations 8.Syncope (loss of consciousness/fainting) 9.Convulsions 10.Coma |
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Treatment of Respiratory Alkalosis
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1. Treat Cause
2. Increase CO2-rebreather mask, or rebreathe into paper bag 3. Sedation if possible |
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Nursing Diagnosis for Respiratory Alkalosis
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1. Anxiety
2. Impaired gas exchange 3. Decreased cardiac output 4. altered home maintenance 5. activity intolerance |
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Nursing Implications for Respiratory Alkalosis #1
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1.Monitor vital signs specifically respiratory rate and depth
2.Instruct the patient to breathe slowly and less deeply to decrease CO2 loss 3.If necessary have the patient breathe into a paper bag or use a rebreather mask to rebreathe CO2 4.Administer sedatives as ordered to slow the respiratory rate but monitor closely for respiratory depression and CO2 retention 5.Intervene prn to relieve pain or anxiety as this could cause or worsen hyperventilation |
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Nursing Implications for Respiratory Alkalosis #2
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6.Monitor ABG values particularly PaCO2 levels
7.Monitor serum potassium levels because K is exchanged for H ions and moves from the extracellular to the intracellular space resulting in low serum K levels 8.Monitor laboratory results for values indicating compensation such as decreased HCO3 levels and normalization of pH 9.Provide emotional support |
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K+ and H+ can't...
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Be in the same place
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Metabolic Acidosis
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Holds H+, releases HCO3
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Metabolic Acidosis General Information
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1.Metabolic Acidosis results from excessive accumulation of fixed acids or loss of fixed bases in body fluids
2.Fixed acids, such as hydrochloric acid, are produced by metabolism of ingested food 3.The respiratory system attempts to compensate through Hyperventilation (gets rid of CO2); respiratory compensation begins within minutes but takes several hours to take full effect |
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Causes of Metabolic Acidosis
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1.Diabetic Ketoacidosis-very high sugar
2.Salicylate toxicity-aspirin overdose 3.Acute or chronic renal failure 4.TPN 5.Severe diarrhea (excessive loss of alkaline secretions from intestines and pancreas) *Got rid of base then left acid (so acidosis) 6.Diuretic therapy (excessive loss of HCO3 through kidneys) |
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Clinical Manifestations of Metabolic Acidosis
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1.Hperventilations Respirations (_Kussmauls)
2.Lethargy 3.Drowsiness 4.Headache 5.Confusion 6.Fruity breath 7.Flushed warm skin 8.Nausea and vomiting 9.Convulsions, coma |
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Treatment of Mebabolic Acidosis
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1. Correct cause
2. Bicard IV 3. Fluid and Electrolyte 4. Insulin (for diabetic) 5. dialysis-filer it out from your blood. |
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Nursing Diagnosis for Metabolic Acidosis
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1. Fatigue
2. Dist. thought process 3. In Br pattern |
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Nursing Implications for Metabolic Acidosis #1
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1.Monitor patients at risk for metabolic acidosis (diabetes mellitus, sepsis, shock)
2.Monitor VS 3.Monitor ABG values 4.Monitor HCO3 and K levels; low HCO3 and high K levels may be an early sign of acidosis |
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Nursing Implications for Metabolic Acidosis #2
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5.Administer sodium bicarbonate cautiously through existing IV line in a large vein
6.Provide cardiac monitoring 7.Administer IV fluids containing lactate, lactate is converted to HCO3 in the liver 8.If the patient is acidotic due to hyperglycemia administer insulin 9.In renal failure, drug overdose, poisoning, assist with peritoneal dialysis or hemodialysis to correct pH |
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Random Metabolic Acidosis info
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Kidneys are getting rid of too much base HCO3
Lungs blow off CO2 |
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Metabolic Alkalosis
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Caused by:
Holding HCO3 or losing acids so lung holds C)2 |
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Metabolic Alkalosis General Info
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1.Metabolic Alkalosis results from excessive accumulation of fixed bases or excessive loss of fixed acids in body fluids
2.A major cause is loss of a fixed acid such as HCL from the stomach via NG suctioning or excessive vomiting 3.The lungs attempt to compensate through hypoventilation |
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Metabolic Alkalosis Causes
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1.Excessive NG suctioning
2.Excessive vomiting 3.Ingestion of large amounts of sodium bicarbonate 4.Prolonged diuretic therapy, esp. potassium wasting 5.Cushing’s Syndrome |
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Metabolic Alkalosis Clinical Manifestations
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1.Hypoventilation
2.Dizziness 3.Paresthesia in fingers and toes 4.Circumoral paresthesia 5.Confusion 6.Irritability 7.Convulsions and coma |
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Metabolic Alkalosis Treatment
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1. Treat cause
2. IV fluids and elec. replacements (esp K+) 3. Stop diuretics 4. stop suctionsing 5. antiemetics |
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Metabolic Alkalosis Nursing Diag.
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1. Altered mental status
2. decrease cardiac output 3. high risk for injury 4. fluid volume deficit |
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Metabolic Alkalosis Nursing Implications #1
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Monitor patients at risk for metabolic alkalosis (excessive vomiting or prolonged NG suctioning)
2.Assess fluid intake and output to determine the amount of gastric fluid loss 3. Monitor vital signs, especially respirations, which usually decrease as the body attempts to conserve CO2 4.Control vomiting, administer antiemetics 5.Administer IV fluid and electrolyte supplements to replace fluid volume, K and chloride losses |
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Metabolic Alkalosis Nursing Implications #2
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Monitor electrolytes
Monitor heart rate and rhythm to detect hypokalemia Warn the patient and family about the danger of excessive HCO3 ingestion Teach the patient about K wasting diuretics to watch symptoms of hypokalemia such as weakness and excessive urine output; teach to replace K either by increased dietary intake of K rich foods or oral supplements (bananas, dried fruit and potatoes) |