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ACID BASE BALANCE
RULE OF THE B’S
1.If the pH and the Bicarb are in the same direction METABOLIC 2.If the pH and the Bicarb are in different directions RESPIRATORY
Examples:
pH 7.25 (v) HCO3 20 (v) Metabolic Acidosis pH 7.21 (v)
HCO3 38 (^)
Respiratory Acidosis pH 7.50 (^)
HCO3 30 (^)
Metabolic Alkalosis pH 7.50 (^) HCO3 25 (normal) Respiratory Alkalosis (NORMAL) SIGNS & SYMPTOMS Know the principles, not the lists.
PRINCIPLE: “As the pH goes, so does my patient, except for potassium”
ALKALOSIS (^)ACIDOSIS (v) HyperreflexiaHeadache IrritabilityHyporeflexia TachypneaBradycardia TachycardiaBradypnea BorborygmiParalytic/adynamic ileus Seizures *need suctionComa HypokalemiaRespiratory arrest *need ambu bag HYPOkalemiaMACkussmau’s (ONLY METABOLIC
ACIDOSIS “MAC”)
Heart block HYPERkalmia
CAUSES OF IMBALANCES
OVER-VENTILATINGUNDER-VENTILATING
RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS
Examples:
-Pregnant woman hyperventilating.-Ventilator setting is TOO HIGH.
Examples:
-Emphysema -Drowning -Pneumonia -PCA pump (toxicity) -Ventilator setting is TOO LOW.
- What if it is NOT A LUNG SCENARIO? It is METABOLIC
PROLONGED SUCTIONING
OR VOMITING
ANYTHING ELSE!
METABOLIC Alkalosis METABOLIC Acidosis
Examples:
- Surgery with NG tube suction for
- days
-Hyperemesis gravidum
Examples:
-Acute RF -Infantile diarrhea -3 rd degree burns over 60% of body -Hyperemesis gravidum with dehydration
NOTE: Always pay attention to
MODIFYING PHRASE rather than original statement..
- Is it a LUNG SCENARIO? YES. It is RESPIRATORY.
VENTILATORS AND ALARMS
HIGH PRESSURE ALARM
Ventilator is working too hard to get air into lungs. There is INCREASED RESISTANCE due to
OBSTRUCTIONS.
1.Kinks unkink 2.Water condensing into dependent loops empty 3.Mucus in airway turn, cough and deep breathe, suction PRN.
LOW PRESSURE ALARM
Ventilator finds that it is working too easy to get air into lungs. There is DECREASED RESISTANCE due to DISCONNECTIONS.
1.Main tubing is disconnected reconnect 2.Oxygen sensor tubing, which senses FiO2, is disconnected. This is the black coated wire reconnect Question MD orders to disconnect ventilator in AM @ 0900hr. At 0600hr, ABC reveals respiratory acidosis. What do you do?a.Follow order b.Call MD and hold order c.Call RT d.Begin to decrease settings.B is the answer because the patient is not able to breathe without the ventilator. The settings are TOO low. Patient should be in respiratory ALKALOSIS.
ALCOHOLISM
#1 PROBLEM: DENIAL
Psychological problem in abuse is denial, which is refusal to accept the reality of a problem.Denial is the #1 problem in all abuse situations.It is #1 because how can you treat someone who can’t admit that they have a problem?You treat denial by confronting it by pointing out the difference between what they say and what they do.Confrontation attacks the problem. Aggression attacks the person.You say you’re not an alcohol, but it’s 10AM and you already drank a 6-pack.You say you’re not a spouse abuser, but she has a restraining order against you.They deny, you confront.Denial of loss + grief is different.Stages of Grief: DABDA: Denial, anger, bargaining, depression, and acceptance You want to support this type of denial.Guy lost one hand and wants to play piano. You do not tell him he can’t. You ask him more about piano.Pay attention to the question, is it loss or abuse?With loss you support. With abuse you confront.
#2 PROBLEM: DEPENDENCY VERSUS CODEPENDENCY
Dependency: Abuser gets significant other to do things for them. The abuser is dependent on others.Call in sick for me. Go buy me this. Drop me off here.Codependency: Significant other derives positive self-esteem from making decisions for or doing things for the abuser.Aren’t I such a great wife for calling in sick for you?
Abuser: Life without responsibility
Significant Other: Positive self esteem
Treatment:
Set limits and enforce them. Teach significant other to say NO.Work on self-esteem of the codependent person to solve the issue.oI’m saying no and I’m a good person because I’m saying no.May solve the problem but may lose relationship.
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