ACID BASE BALANCE

RESPIRATORY ACIDOSIS:

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• The total concentration of buffer basis is lower than normal with a increase in H+ concentration which is circulating in the blood than can be absorbed by the buffer system.
• PH is decreased; CO2 is increased; O2 is decreased; HCO3 normal

Cause
 Change in normal respiratory pattern.
 Obstruction of airway.
 Depression in respiratory status.


 Hypo ventilation which leads Co2 is retained and the H+ increase leading to the acid state co2+H2o= H2Co3 which decrease PH.
 Medication which depress respiratory Centre Ex: sedatives, narcotics, and anesthetics.
 Bronchitis—due to inflammation causes airway obstruction leads decrease oxygen.
 Atelectasis—excessive mucus collection, with the collapse of alveolar sacs causes mucus plugs.
 Brain trauma—which depress medulla oblongata.




 Emphysema—loss of elasticity of alveolar sacs restricts or flow in and out which cause increase Co2 level
 Asthma—spasms resulting from allergens cause smooth muscles to constrict.
 Pulmonary edema-due to water collection.
 Bronchiectasis—due to dilation of bronchi air flow decreases.
Signs and symptoms
• Increased rate and depth of breathing
• Head ache
• Restlessness
• Mental status changes such as drowsiness and confusion
• Diaphoresis
• Visual disturbances
• Cyanosis
• Tachycardia
• Dysrhythmias leads to VF
• Hyperkalemia
Management
 Monitor for signs of respiratory distress.
 Place the client in semi fowler’s position.
 Administer oxygen.
 Encourage the client to turn, cough, and deep breath exercises
 Find out the cause and treat it with antibiotics for infection and bronchodilator to dilate bronchus.
 Encourage hydration to thin secretions.
 Suction the client if necessary.
 Reduce restlessness by improving ventilation.
 Monitor electrolyte value specially potassium.

RESPIRATORY ALKALOSIS

• A deficit of H2Co3 and decrease in H+ concentration which result in loss of acid
• PH is increased; Co2 is decreased; O2 is increased: HCO3 normal.
Causes:




• Over stimulations of the respiratory status.
• Hyper ventilation –rapid respiration causes the blowing off Co2 leading to a decrease in H2Co3.
• Hysteria- this condition leads to vigorous breathing and excessive exhaling of Co2.
• Over ventilation by mechanical ventilators.
• Condition that increase metabolism such as fever
• Pain or brain trauma –causes over stimulation of the respiratory center in the brainstem.
• Administration of salicylates—stimulate the respiratory Centre , causing hyperventilation
• Hypoxemia –causes respiratory stimulation with resultant carbonic acid deficit
Signs and symptoms
o Initially The Hyperventilation And Respiratory Stimulation Will Cause Abnormal Rapid Respiration Then Respiration Go Down
o Headache
o Light Headedness
o Vertigo
o Mental Status Changes
o Paresthesia Such As Tingling Of Fingers And Toes
o Hypokalemia, And Hypocalcaemia
o Tetany
o Convulsions
Management:
o Provide emotional support.
o Encourage appropriate breathing patterns.
o Assist with techniques of breathing.
o Voluntary holding of breath.
o Re breathe exhaled co2.
o Re breathing mask.
o Carbon dioxide breaths.
o Provide caution care with ventilator client.
o Monitor electrolyte value particularly potassium and calcium.
o Administration medication as prescribed.
o Prepare to administer calcium gluconate for tetany.

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