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KEEP CALMKEEP CALM
andand
PASS NCLEXPASS NCLEX
with with
MARK KLIMEKMARK KLIMEK
ReviewReview 1.1. Acid-base ba Acid-base balance/venlance/ventilatorstilators Rule of theRule of the B B’s.. If the’s.. If thepHpH & the & the b bicarb are both in the same icarb are both in the same direction = metadirection = meta b bolicolic If they are in If they are in different directidifferent directions =ons =respiratoryrespiratory pH =pH =7.35-7.457.35-7.45acidosis/alkalosisacidosis/alkalosis HCO3 (bicarb) =HCO3 (bicarb) =22-2622-26 (2+2+2 = 6) (2+2+2 = 6)
CO2 =CO2 =45-3545-35
ex:ex: pH: 7.30 =pH: 7.30 = bicarb: 20 = bicarb: 20 = = metabolic acidosis = metabolic acidosis ex:ex: pH: 7.58 =pH: 7.58 = bicarb: 32 = bicarb: 32 = = metabolic alkalosis = metabolic alkalosis ex:ex: pH: 7.22 =pH: 7.22 = bicarb: 30 = bicarb: 30 = = respiratory acidosis = respiratory acidosis ex:ex: You are provi You are providing care to a ding care to a client with the follclient with the following blood gas reowing blood gas results: pH 7.32, sults: pH 7.32, CO2 49, HCOCO2 49, HCO33 29, PO2 80 & SaO2 29, PO2 80 & SaO2 90%. Based on the 90%. Based on the results, the client is experiencing:results, the client is experiencing: = acidosis, = acidosis, = respiratory = respiratory -opioid: CNS depressant.. know the symptoms -opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..(sedation, respiratory depression, etc)..*principle: acid base signs/symptoms..*principle: acid base signs/symptoms..
as the pH goes… so goes my patient!!!as the pH goes… so goes my patient!!!--when pH goes up; patient goes upwhen pH goes up; patient goes up.. (everything gets .. (everything gets irritable!)irritable!) --when pH goes down; patient goes downwhen pH goes down; patient goes down! (systems in your body ! (systems in your body shut down)shut down) …except with potassium…except with potassium::when pH goes up; potassium when pH goes up; potassium goes downgoes down……when pH goes down;when pH goes down; potassium goes up potassium goes up!!(up) alkalosis: irritibility, hyper-reflexia (3 & (up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia,4), tachypnea, tachycardia, borboryg borborygmimi (increased bowel sounds), seizure, aspirate..(increased bowel sounds), seizure, aspirate..(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic (down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreasedileus (decreased bowel sounds), coma, bowel sounds), coma, respiratory arrespiratory arrest (ambu-barest (ambu-bag!!)g!!) Kussmaul breathingKussmaul breathing is a is adeep and laboreddeep and laboredbreathingbreathing pattern pattern often associated with s often associated with severeevere metabolic acidosis, particularly diabetic ketoacidosis (DKA) metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also but also kidney failure…kidney failure… MAC MAC Kussmaul Kussmaul !!!!M:M:metabolicmetabolic AC: AC:acidosisacidosis ex:ex: pT haspT hasrespiratory acidosisrespiratory acidosis… (select all that apply)..… (select all that apply)..+1 reflexes+1 reflexes diarhheadiarhhea adynamic ileusadynamic ileus spasmspasm urinary retentionurinary retention tachycardiatachycardia 2nd degree mobits type 2 2nd degree mobits type 2 heart blockheart block hypokalemiahypokalemia SATASATAquestions:questions:*never only 1… never all of them**never only 1… never all of them* diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowelsdiarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels down = paralytic ileusdown = paralytic ileus …with scenarios.. always ask first…with scenarios.. always ask first“is it lung?”“is it lung?”==respiratory respiratory …then ask if the pt is…then ask if the pt isover-ventilating or over-ventilating or under-ventilatingunder-ventilating??over-ventilaover-ventilating = ting = alkalosisalkalosis under-ventunder-ventilating = ilating = acidosisacidosis …it’s about the SaO2…it’s about the SaO2!!! (pay attention!!)!!! (pay attention!!) if it isn’t lung =if it isn’t lung =metabolicmetabolic....if pt has if pt has prolonged gastricprolonged gastricvomiting or suctioningvomiting or suctioning… it’s always… it’s alwaysmetabolic alkalosismetabolic alkalosis…… why? losing acid = why? losing acid = becomes basic..becomes basic.. for every for everything else that is not lung thing else that is not lung - choose- choosemetabolic acidosismetabolic acidosis....-if you don’t know the answer… always answer-if you don’t know the answer… always answermetabolic acidosismetabolic acidosis....
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