#4

4. Describe the acid/base status of the client with
a) NG TUBE – METABOLIC ALKALOSIS (bicarb exceeds 20:1 ratio)

Causes
GI losses - vomiting, gastric suctioning, pyloric stenosis
Hypokalemia - potassium-losing diuretics, kidneys excrete H+ ,try to conserve K
Hyperaldosteronism, Cushing's syndrome
Excessive antacid intake
Diuretics
Placing patient with COPD on mechanical ventilation, relief of chronic respiratory acidosis
Clinical picture
Depressed respirations
Hypocalcemia - decreased ionized Ca - dizziness, tingling of fingers & toes, c ircumoral paraesthesia, carpopedal spasm, hypertonic muscles
Hypokalemia often present
Compensation
Hypoventilation - retain CO2
Kidneys excrete more HCO3
Treatment
Treat underlying cause
Give NS for kidney to absorb Na and Cl allowing excretion of HCO3
Nursing considerations
Replace GI losses with isotonic fluids, flush NG tube with NS
Teach patient not to use baking soda as antacid
Monitor K levels
http://classes.kumc.edu/son/nurs466/lecture%20notes/ABG.htm

b) client with diagnosis of COPD – RESPIRATORY ACIDOSIS (excess CO2)
Causes
Lung diseases - COPD, ARDS
Neuromuscular diseases affecting respirations - Guillian-Barre, multiple sclerosis
Anesthesia
Pneumonia
Clinical picture
Acute
Feeling of fullness in head - cerebral vasodilation
Confusion, dizziness, lethargy, restlessness, decreased attention span
Decreased respirations
Dysrhythmias
Chronic
Weakness, dull headache
Barrel chest, use of accessory muscles to breathe
Compensation
Kidneys retain HCO3
Treatment
Administer oxygen - low concentration if chronic
Keep airway clear, postural drainage & vibration, humidified air
Force fluids
Promote lung expansion - incentive spirometer, blowing up balloons.
Nursing considerations
Assess respiratory status frequently- effort, accessory muscle use, lung sounds, skin color, mental status
Monitor serial ABGs
Assist patient into comfortable positions that facilitate lung expansion - Semi- or high Fowlers
Be prepared to intubate
Teach exercises to enhance expiration - pursed lip breathing
http://classes.kumc.edu/son/nurs466/lecture%20notes/ABG.htm

c) Ileostomy - METABOLIC ACIDOSIS (low bicarb:carbonic acid ratio cause ph to fall)

· Gastrointestinal HCO3- loss. HCO3- is lost as a result diarrhea, external pancreatic drainage (transplant or pancreatitis) or small bowel drainage (ileostomy).

http://umed.med.utah.edu/ms2/renal/Word%20files/i)%20Acid_Base%20Disorders.htm