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Acid Base Balance Review & Questions II. Ana Corona, MSN, FNP-C Nursing Instructor September 2007. Basic Questions.

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acid base balance review questions ii

Acid Base BalanceReview & Questions II

Ana Corona, MSN, FNP-C

Nursing Instructor

September 2007

basic questions
Basic Questions
  • There are three critical questions to keep in mind when attempting to interpret arterial blood gases (ABGs). First Question: Does the patient exhibit acidosis or alkalosis? Second Question: What is the primary problem? Metabolic? or Respiratory? Third Question: Is the patient exhibiting a compensatory state? In order to understand ABG analysis and remember what is abnormal, you need to review what is normal.
remember definitions
Remember Definitions
  • Acidosis (acidemia) occurs when pH drops below 7.35
  • Alkalosis (alkalemia) occurs when the pH rises above 7.45
  • A primary respiratory problem is determined if the PaC02 is less than 35mmHg (alkalosis) or greater than 45 mmHg (acidosis).
  • A primary metabolic problem is when the HC03 is less than 22mEq/L (acidosis) or greater than 26mEq/L (alkalosis).
compensation
Compensation
  • Our bodies have compensatory mechanisms that assist us to return to a state of homeostasis (equilibrium).
  • The body attempts to compensate for whatever the primary problem is in an effort to return the acid-base balance to normal.
an illustration of compensation is given below
An illustration of COMPENSATION is given below:
  • A newly diagnosed Type 1 diabetic client has a ‘primary’ problem of metabolic acidosis (pH 7.29; HCO3 16 mEq/L) due to an increase in ketone bodies (ketoacidosis).
  • The nurse notes that the ABGs show a below normal PaCO2 value (27mmHg) and the client is breathing faster in an attempt to ‘blow off’ the carbon dioxide (CO2:’acid’) to create a respiratory alkalosis, the opposite of metabolic acidosis!
  • Hint! In order to recognize ‘compensation’ look for a change in the buffering system that was not involved in the ‘primary’ problem.
review the three essential steps of abg analysis
Review the three essential steps of ABG analysis
  • Number One:

Determine if the client is demonstrating an acidotic (remember: pH less than 7.35) or alkalotic (pH greater than 7.45).

  • Number Two:

What is the 'primary problem?

If the client is acidotic with aPaC02greater than 45 mmHg

it is RESPIRATORY

If the client is acidotic with a HC03 less than 22 mEq/L it is

METABOLIC!

If the client is alkalotic with a PaC02 less than 35 mmHg it

is RESPIRATORY!

If the client is alkalotic with a HC03 greater than 26 mEq/L

it is METABOLIC!

abg analysis
ABG analysis
  • Number Three:Is the client compensating?
  • Are both components (HCO3 and PaCO2) shifting in the same direction?
  • Up or down the continuum?
  • Above or below the normal ranges?
  • If this is noted, you know that the client’s buffering systems are functioning and are trying to bring the acid-base balance back to normal.
1 case study
1 case study

Jean Thomas is a 25-year-old secretary admitted to the emergency room with diaphoresis, hyperventilation, palpitations, and trembling. Jean tells the nurse that she has been "very upset and nervous" over a poor employment evaluation. A tentative diagnosis of acute anxiety episode is made.

Which of the following acid-base imbalances would likely occur as a result of Jean's hyperventilation?

A.  Respiratoryacidosis

B.  Respiratory alkalosis

C.  Metabolic acidosis

D.  Metabolic alkalosis

answer to 1
Answer to 1
  • The intended response is B, since hyperventilation will cause an increased loss of CO2
2 case study
2 Case Study

A client recovering from surgery is difficult to arouse following surgery.

The nurse in the PACU has been administering Morphine Sulfate IV to

the client for pain. The client’s respiratory rate is 7 per minute with

shallow breathing. The patient does not respond to any stimuli! The

nurse assesses the ABCs and obtains ABGs STAT! The STAT results

come back from the laboratory and show:

pH = 7.15 Pa C02 = 68 mmHg HC03 = 22 mEq/L

  • Compensated Respiratory Acidosis
  • Uncompensated Metabolic Acidosis
  • Compensated Metabolic Alkalosis
  • Uncompensated Respiratory Acidosis
2 case study13
2 case study
  • The answer is #1

uncompensated respiratory acidosis

3 case study
3 Case Study
  • An infant, three weeks old, is admitted to the Emergency Room. The mother reports that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 4 days. The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABGs come back from the laboratory and show: pH = 7.37 Pa C02 = 29 mmHg HC03 = 17 mEq/L
  • Compensated Respiratory Alkalosis
  • Uncompensated Metabolic Acidosis
  • Compensated Metabolic Acidosis
  • Uncompensated Respiratory Acidosis
slide15
3
  • Answer is #3
  • Compensated Metabolic Acidosis
4 case study
4 case study
  • A client, 5 days post-abdominal surgery, has a nasogastric tube. The nurse notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs come back from the laboratory and show:

pH = 7.52 Pa C02 = 35 mmHg HC03 = 29 mEq/L

  • Compensated Respiratory Alkalosis
  • Uncompensated Metabolic Acidosis
  • Compensated Metabolic Acidosis
  • Uncompensated Metabolic Alkalosis
slide17
4
  • Answer is #4
  • Uncompensated Metabolic Alkalosis
5 case study
5 case study
  • A client is admitted to the hospital and is being prepared for a craniotomy (brain surgery). The client is very anxious and scared of the impending surgery. He begins to hyperventilate and becomes very dizzy. The client looses consciousness and the STAT ABGs reveal:
  • The results from the ABGs come back from the laboratory and show:
  • pH = 7.57
  • Pa C02 = 26 mmHg
  • HC03 = 24 mEq/L
  • Compensated Metabolic Acidosis
  • Uncompensated Metabolic Acidosis
  • Uncompensated Respiratory Alkalosis
  • Uncompensated Respiratory Acidosis
slide19
5
  • The answer is #3
  • Uncompensated Respiratory Alkalosis
6 case study
6 case study
  • A two-year-old is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The father of the infant reports to the nurse that he has observed slight tremors and behavioral changes in his child over the past three days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are:
  • pH = 7.36
  • Pa C02 = 69 mmHg
  • HC03 = 36 mEq/L
  • Compensated Respiratory Alkalosis
  • Uncompensated Metabolic Acidosis
  • Compensated Respiratory Acidosis
  • Uncompensated Respiratory Alkalosis
slide21
6
  • Answer is #3
  • Compensated Respiratory Acidosis
7 case study
7 case study
  • A young woman, drinking beer at a party, falls and hits her head on the ground. A friend dials "911" because the young woman is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears.
  • Which primary acid-base imbalance is this young woman at risk for if medical attention is not provided?
  • metabolic acidosis
  • metabolic alkalosis
  • respiratory acidosis
  • respiratory alkalosis
slide23
7
  • Correct answer is #3
  • Respiratory Acidosis
8 case study
8 case study
  • An 11-year old boy is admitted to the hospital with vomiting, nausea and overall weakness. The nurse notes the laboratory results: potassium: 2.9 mEq.
  • Which primary acid-base imbalance is this boy at risk for if medical attention is not provided?
  • metabolic acidosis
  • metabolic alkalosis
  • respiratory acidosis
  • respiratory alkalosis
slide25
8
  • Correct Answer is #2
  • Metabolic Alkalosis
9 case study
9 case study
  • An elderly gentleman is seen in the emergency department at a community hospital. He admits to taking many tablets of aspirin (salicylates) over the last 24-hour period because of a severe headache. He complains of an inability to urinate. His vital signs are: Temp = 98.5; apical pulse = 92; respiration = 30 and deep.
  • Which primary acid-base imbalance is the gentleman at risk for if medical attention is not provided?
  • metabolic acidosis
  • metabolic alkalosis
  • respiratory acidosis
  • respiratory alkalosis
slide27
9
  • Correct Answer is #1
  • Metabolic Acidosis
10 case study
10 case study
  • A young man is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute.
  • Which primary acid-base disturbance is the young man at risk for if medical attention is not provided?
  • metabolic acidosis
  • metabolic alkalosis
  • respiratory acidosis
  • respiratory alkalosis
slide29
10
  • Correct Answer is #4
  • Respiratory Alkalosis
11 review question
11 Review question

The client with severe vomiting is at risk for developing:

  • RESPIRATORY ALKALOSIS WITHOUT DEHYDRATION
  • METABOLIC ACIDOSIS WITH DEHYDRATION
  • RESPIRATORY ACIDOSIS WITHOUT DEHYDRATION
  • METABOLIC ALKALOSIS WITH DEHYDRATION
11 answer
11 answer
  • Answer B is correct. With vomiting comes dehydration. When the client is dehydrated, she will have metabolic acidosis. Answers A and C are incorrect because they are respiratory dehydration. Answer D is incorrect because the client will not be in alkalosis with persistent vomiting.
12 review question
12 Review question

AN OBSTETRIC CLIENT IS ADMITTED WITH DEHYDRATION. WHICH IV FLUID WOULD BE MOST APPROPRIATE FOR THE CLIENT?

  • 0.45 NORMAL SALINE
  • DEXTROSE 1% IN WATER
  • LACTATED RINGER'S
  • DEXTROSE 5% IN .45 NORMAL SALINE
12 answer
12 answer
  • Answer A is correct. The best IV fluid for correction of dehydration is normal saline because it is most like normal serum. Dextrose pulls fluid from the cell, lactated Ringer’s contains more electrolytes than the client’s serum, and dextrose with normal saline will also alter the intracellular fluid. Therefore, answers B, C, and D are incorrect.
13 review question
13 Review Question

A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient?

A: Onset of pulmonary edema

B: Metabolic alkalosis

C: Respiratory alkalosis

D: Parkinson’s disease type symptoms

13 answer
13 answer
  • Answer A is correct: Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
14 review question
14 Review question

A patient’s chart indicates a history of hyperkalemia.  Which of the following would you not expect to see with this patient if this condition were acute?

A:  Decreased HR

B:  Paresthesias

C:  Muscle weakness of the extremities

D:  Migraines

14 answer
14 answer
  • Answer D is correct: choices A - C were symptoms of acute hyperkalemia
15 review question
15 review question

A patient’s chart indicates a history of ketoacidosis.  Which of the following would you not expect to see with this patient if this condition were acute?

A:  Vomiting

B:  Extreme Thirst

C:  Weight gain

D:  Acetone breath smell

15 answer
15 answer
  • Answer C is correct:
  • Weight loss would be expected
16 review question
16 review question

Which of the following conditions correlate with the following information:High pHHigh HCO3 High BENeutral PaCO2

  • Respiratory alkalosis
  • Respiratory acidosis
  • Metabolic acidosis
  • Metabolic alkalosis
16 answer
16 answer
  • The correct answer is D
  • Metabolic Alkalosis
17 review question
17 review question

Which of the following conditions correlate

with the following information:High  pHNeutral HCO3 Neutral BELow PaCO2

  • Respiratory alkalosis
  • Respiratory acidosis
  • Metabolic acidosis
  • Metabolic alkalosis
17 answer
17 answer
  • The correct answer is A
  • Respiratory Alkalosis
18 review question
18 review question

Which of the following conditions correlate with the following information:Low  pHLow HCO3 Low BENeutral PaCO2

  • Respiratory alkalosis
  • Respiratory acidosis
  • Metabolic acidosis
  • Metabolic alkalosis
18 answer
18 answer
  • The correct answer is C
  • Metabolic Acidosis
19 question
19 question

Normal values for PaCO2 are considered:

  • 20-40 mm Hg
  • 25-30 mm Hg
  • 30-40 mm Hg
  • 35-45 mm Hg
19 answer
19 answer
  • The correct answer is D
  • 35 – 45 mmHg
20 question
20 question

Normal values for HCO3 are considered:

  • 15-30 mEq/L
  • 20-35 mEq/L
  • 22-26 mEq/L
  • 24-29 mEq/L
20 answer
20 answer
  • The correct answer is C
  • 22-26 mEq/L