Acidbase Cheat Sheet Exstended

RESPIRATORY ACIDOSIS pH pCO2 Compensation HCO3 abnormal (›26) Kidneys retain HCO3 (delayed) Causes Clinical Manifestations Treatments CNS depression COPD Pneumothorax Hypoventilation Bronchial obstruction & atelectasis Severe pulmonary infections Heart failure & pulmonary edema Massive pulmonary embolus Myasthenia gravis Multiple sclerosis Dyspnea (shortness of breath) Restlessness Headache Tachycardia Confusion Lethargy Dysrhythmias Respiratory destress Drowsiness Decreased responsiveness ↑ pulse, respirations & BP Respiratory         Bronchodilators Oxygen Treat hyperkalemia Antibiotics Chest physiotherapy Removal of foreign objects from airway (suction) Chest tube insertion Artificial airway Non-pulmonary Nursing Interventions Complications RESPIRATORY ALKALOSIS ↓ ↑  Reversal of sedation  Heart failure treatment (diuretics)  Fowler’s position Maintain patient’s airway Monitor ABG levels Supplemental oxygen Assisting with intubation PRN Monitoring K levels Use sedatives cautiously Providing reassurance and teaching PRN Paralysis Coma ↑ ↓ HCO3 abnormal (‹22) Kidneys secrete HCO3 (delayed) Anxiety, nervousness, fear & pain Fever & gram-negative septicemia Hyperventilation Aspirin overdose (salicylates) Thyrotoxicosis (↑ thyroid hormone) Central nervous system lesions Hypoxemia Hepatic failure pregnancy Light-headedness Confusion ↓ concentration Paresthesia’s (tingling/ prickling) Tetanic spasms in the extremities (sudden involuntary contraction) Cardiac dysrhythmias Palpitations Sweating Dry mouth Blurred vision Correct underlying cause      D/C causative agent Reduce fever (cooling/antibiotics) Eliminate source of sepsis Oxygen Sedative or anxiolytic (antianxiety) therapy Other Rebreathing of exhaled CO2 (paper bag/cupped hands method)  Adjusting mechanical ventilation  Encouraging slow deep breathing Monitor vitals Emotional support & reassurance Assisting with ADL’s Teaching PRN Seizures Chest pain METABOLIC ACIDOSIS pH HCOC Compensation Causes pCO2 abnormal (›45) Respiratory hypoventilation (↑pCO2 & K) Immediate Excess of acid Gain of base     Renal failure (↓ kidney excretion) Ketoacidosis Anaerobic metabolism Starvation Salicylate intoxication Loss of base   Diarrhea Intestinal fistulas Headache Clinical Manifestations Confusion Nursing Interventions Complications ↑ ↑ pCO2 abnormal (‹35) Respiratory hyperventilation (↓ pCO2 & K) Immediate  Treatments METABOLIC ALKALOSIS ↓ ↓ Restlessness Lethargy Weakness Stupor (minimal responsiveness)/coma Kussmaul’s respirations (↑ rate & dept of respirations) Nausea & vomiting Dysrhythmias Warm, flushed skin Seizures Twitching Peripheral vasodilation Fruity breath NaHCO3 IV replacement (pH ‹7.1) Parenteral fluid replacement Rapid-acting insulin (diabetic patients) Antidiarrheals Dialysis Mechanical ventilation Monitor vitals Giving NaHCO3 PRN Providing reassurance & teaching PRN Cardiac dysrhythmias (pH ‹7.0) Renal osteodystrophy (bone disease) Renal encephalopathy    Excessive use of bicarb Lactate given with dialysis Excessive use of antacids Loss of acids  Vomiting  Nasogastric suctioning  Hypokalemia  Hypochloremia  Diuretics  ↑ aldosterone Muscle twitching & cramps Tetany (involuntary muscle contraction) Dizziness Lethargy Weakness Disorientation Convulsions Coma Nausea Vomiting Depressed respirations D/C thiazide diuretics D/C nasogastric suctioning Antiemetic (for nausea & vomiting) Acetazolamide (↑ renal excretion of bicarb) Monitoring vitals Monitoring level of consciousness IV fluids & electrolyte supplements Providing reassurance & teaching Dysrhythmias (pH›7.55) Coma