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Two by-products:

Carbon dioxide

Hydrogen Hydrogen ions = inversely proportional to pH

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ABG

pH

PaO2 PaCO2

HCO3

Base excess

O2Sat (SpO2)

VALUES

7.35-7.45

80-100 mmHg 35-45mmHg

22-26 mEq/L

-2 / +2 (acidosis/alkalosis)

95%-100%

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RESPIRATORYACIDOSIS

Underelimination of

hydrogen ions Overelimination of

bicarbonate ions

METABOLICACIDOSIS

Overproduction of

hydrogen ions Underproduction of

bicarbonate ions

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RESPIRATORYACIDOSIS

Neuromuscular problems Guillain-Barre Syndrome

Myasthenia gravis Poliomyelitis

Diaphragmatic paralysis Respiratory center depression in

CNS Trauma

Lesions Obesity

Drugs Anesthetics

Hypnotics

Opioids Sedatives

METABOLICACIDOSIS

Overproduction of ketones

(body has used up glucosesuppplies; draws in fatstores for energy; convertsfatty acids to ketonebodies)

DM Chronic alcoholism

Starvation

Renal insufficiency Renal failure

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RESPIRATORYACIDOSIS

Lung disease

COPD Asthma

Chronic bronchitis

ARDS

Pulmonary edema

Airway obstruction

Retained secretions

Laryngeal spasm

Tumors

METABOLICACIDOSIS

Excessive GI losses

Diarrhea Intestinal malabsorption

Toxicity

Salicylate ingestion

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RESPIRATORYACIDOSIS

Headache

Cerebral blood vessel dilation Altered LOC

CNS depression

Rapid, shallow breathing,dyspneic and diaphoretic IncreasedCO2

Decreased RR CNS trauma or lesions

Tachycardiaand ventriculararrhythmias Hyperkalemia and hypoxemia

METABOLICACIDOSIS

HeadacheCerebral blood vessel dilation

Altered LOC CNS depression

Rapid, deep breathing(Kussmauls respirations)

Fruity breath odor (fatcatabolism=excretion ofacetone in the lungs)

Decreased DTR Anorexia, nausea, vomiting

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RESPIRATORYACIDOSIS

ABG:

pH = < 7.35 PaCO2 = >45 mmHg

HCO3= >26mEq/L (chronic)

CXR Pneumonia, pneumothorax,

pulmonary edema Serum electrolyte

Hyperkalemia

Drug screening Overdose

METABOLICACIDOSIS

ABG:

pH:

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RESPIRATORYACIDOSIS

Treatment focus: symptoms

and underlying cause: Bronchodilators

Supplemental oxygen

Drug therapy to treat

hyperkalemia

Antibiotic therapy to treatinfection

Chest physiotherapy

Removal of foreign body fromthe patients airway

METABOLICACIDOSIS

Treatment focus:

symptoms and underlyingcause

For patients with DM: rapid-acting insulin (reverse DKAand drive K into the cell)

Sodium bicarbonate Antidiarrhea

Dialysis

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RESPIRATORYACIDOSIS

Impaired gas exchange

Ineffective airwayclearance

Risk for injury

METABOLICACIDOSIS

Decreased cardiac output

Risk for fluid volume excess Risk for injury

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RESPIRATORYACIDOSIS

Monitor VS (RR andCR)

Monitor neurologic status Report any variations inABG levels

Give medications asprescribed

A

dminister oxygen asordered (COPD alert!!!) Perform tracheal

suctioning Institute safety measures

METABOLICACIDOSIS

Same

Same Same

Same

Prepare for mechanical

ventilation or dialysis Position the patient to

promote chest expansion

Same

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RESPIRATORYALKALOSIS

Acid deficit

METABOLICALKALOSIS

Base excess

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RESPIRATORYALKALOSIS

Hyperventilation Anxiety or panic attack

Drugs Nicotine, salicylates,

aminophyllines Hypermetabolic state

Fever, sepsis Conditions affecting

respiratory center High progesterone levels

during pregnancy (stimulate) Trauma (injure)

Hypoxia High altitude, pulmonary

disease, severe anemia

METABOLICALKALOSIS

Excessive acid loss from

the GIT Vomiting

ProlongedNG suctioning

Diuretics

Thiazide and loop

Antacids that containsodium bicarbonate

Kidney disease

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RESPIRATORYALKALOSIS

Alternating periods of

apneaand hyperventilation Complains of tingling in

fingers and toes(paresthesia)

Restlessness

METABOLICALKALOSIS

Results in neuromuscular

excitability Muscle twitching, weakness,

tetany

Increased DTR

Paresthesia

Apathy and confusion

GIT Anorexia, nausea, vomiting

GUT Polyuria

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RESPIRATORYALKALOSIS

ABG result:

pH: >7.45 Bicarbonate: 26mEq/L

PaCO2: >45 mmHg

Serum electrolytes

Low K,Ca

Elevated HCO3

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RESPIRATORYALKALOSIS

Treatment: treat

underlying cause Remove causative agent

(salicylate)

Antipyretic, antibiotic

Oxygen therapy

Anxiolytics Paper bag breathing

METABOLICALKALOSIS

Discontinuation of thiazide

diuretics andNGsuctioning

Antiemetic

Acetazolamide (Diamox)

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RESPIRATORYALKALOSIS

Allay anxiety

Help the patient breathinto a paper bag or cuppedhands

Provide undisturbed restperiods after the RR

returns to normal Institute safety measures

METABOLICALKALOSIS

Monitor VS (RR,CR)

Assess LOC Administer oxygen as

ordered

Institute seizureprecautions

IrrigateNG tube withnormal saline instead oftap water