II.

ACID-BASE BALANCE
A. Major chemicals you have to remember:
1. Bicarb, Hydrogen, CO2
Acid-Base Balance

2. Lung chemicals CO2 ________

3. Kidney chemicals ________ and ___________________
4. These chemicals can either make you sick or compensate. It depends on which
imbalance you have.

B. pH:
1. What does pH tell you about the blood?

If the blood is ____________, alkaline, or neutral.

2. Normal pH range _________-________.

3. pH below 7.35 ____________
4. pH above 7.45 ____________

If the pH is messed up it can be dangerous

5. The _________ does not like it when the pH is messed up.

6. Heres how the body keeps the pH within normal range:
Compensating Organs
Kidneys

Lungs

Remove acid through __________

One way to get rid of CO2

Bicarb? __________

What is it? ___________

OR
__________
Kidneys takes hours to days to do
their job

Hypoventilation retain _______

Hyperventilation eliminate _____
Lungs respond _______________

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C. Respiratory Acidosis:
1. Pathophysiology:
a. Is this a lung problem or a kidney problem? ________
Acid-Base Balance

b. What chemical is causing the problem? ___________

Normal Lab Values

pH: 7.35-7.45
PaO2: 80-100 mmHg
PaCO2: 35-45 mmHg
HCO3: Bicarbonate:
22-26 mEq/L

c. Do we have too much or too little of this chemical in the body? ____________
d. Hypoventilating or hyperventilating? ______________________
e. Whos going to compensate? __________________
f. How? With what chemicals? _____________ and hydrogen
g. The body must ________________ the acid.
h. The body will retain bicarb.
i. Is the pH high or low? _________
2. Causes:
Retain _______________
Mid abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung,
pneumonia
*TESTING STRATEGY*
3. S/S:
CO2 = LOC
CO2 = O2
a. Headache, ___________________, sleepy
CO2 and O2 have an inverse
b. If not corrected, could lead to a ________________
relationship.
c. Hypoxic

Give them ___________________

Early sign and symptoms of hypoxia? _______________ & ______________

*TESTING STRATEGY*
Restlessness think Hypoxia FIRST

4. Tx:
a. Fix the _____________________ problem.
b. Treat pneumonia, get rid of secretions by postural drainage, percussion (vibration
therapy), deep breathing exercises, suctioning, fluids, elevate HOB, and incentive
spirometry.

c. Pneumothorax client will have _____________ tubes

d. Encourage post-op to turn, cough and _______ ___________.

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D. Respiratory Alkalosis:
1. Pathophysiology:
a. Whos sick? ______________ Whos going to compensate? ______________
Acid-Base Balance

b. Kidneys excrete ___________________. Retain _____________________.

c. Problem chemical? _________________________
d. Gaining or losing CO2? ______________________
e. Hypoventilating or hyperventilating? ______________________________
f. pH? _________________
2. Causes:
a. Problem? ________________________
b. Hysterical
c. Acute aspirin overdose

The client is breathing too ________ and,

therefore, removing _____________.

d. Situation: Hysterical client

3. S/S:

Lightheaded, faint, peri-oral numbness, numbness and tingling in fingers and toes.

4. Tx:
a. Do not wait for kidneys to kick in.
b. Breathe into a ________________________.
c. May__________ client to decrease respiratory rate.
d. Treat the cause
e. Monitor ABGs

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E. Metabolic Acidosis:
1. Pathophysiology:
a. Whos sick? _________________Whos going to compensate? ___________
Acid-Base Balance

b. With what chemical? __________________________

c. Problem chemicals? _________________ & ________________________
This client is retaining ______________ or does not have enough bicarb.

d. pH? ________
e. Respiratory rate will _________________
2. Causes:
a. DKA
b. Starvation

Cells are starving for ______________, so the body will

break down protein and ________, produce __________,
ketones are ___________.

c. Renal failure
d. Severe ____________________.
3. S/S:
a. Depend on the ______________________.
b. Hyperkalemia

Muscle twitching, muscle weakness, flaccid paralysis,__________________.

c. Increased respiratory rate

4. Tx:
a. Treat the __________.
b. Drug to help acidosis? _____________ bicarb

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F. Metabolic Alkalosis:
1. Pathophysiology:
a. Whos sick? __________________Whos going to compensate? __________
Acid-Base Balance

b. With what chemical? ____________________

c. Problem chemicals? _____________ & hydrogen
d. The client is in alkalosis, so they are retaining too much ___________ and
excreting hydrogen.

e. pH? ____________
2. Causes:
a. Loss of upper GI contents
b. Too many antacids. Too much _______________.
c. Too much IV bicarb
3. S/S:
a. Depends on cause
b. Observe LOC
c. Serum K+ will go _________ in metabolic acidosis and go ________ in
metabolic alkalosis.

d. Monitor for ____________________and ________________________.

4. Tx:
a. Fix the problem.
b. Replace _____________.
*TESTING STRATEGY*
Metabolic Acidosis = Hyperkalemia
Metabolic Alkalosis = Hypokalemia

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Acid-Base Balance

G. ABG Interpretation Practice Problems:

1. Problem:

Normal:

pH: 7.32 _______________

pH: acidosis 7.35 7.45 alkalosis

PCO2: 41 ______________

PCO2: basic 35 45 acidic

HCO3: 20 ______________

HCO3: acidic 22 - 26 basic

Interpretation: ______________________

2. Problem:

Normal:

pH: 7.56 ________________

pH: acidosis 7.35 7.45 alkalosis

PCO2: 31 _______________

PCO2: basic 35 45 acidic

HCO3: 25 _______________

HCO3: acidic 22 26 basic

Interpretation: ______________________

3. Problem:

Normal:

pH: 7.26 ________________

pH: acidosis 7.35 7.45 alkalosis

PCO2: 51 _______________

PCO2: basic 35 -45 acidic

HCO3: 29 _______________

HCO3: acidic 22 26 basic

Interpretation: ______________________

4. Problem:

Normal:

pH: 7.45 _________________

pH: acidosis 7.35 7.45 alkalosis

PCO2: 52 ________________

PCO2: basic 35- 45 acidic

HCO3: 35 ________________

HCO3: acidic 22 26 basic

Interpretation: ______________________

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