"Alteration in acid base balance".pptx..

It's a very useful ppt regarding acid base balance alterations

1. Alteration in acid base balance

2. RESPIRATORY ACIDOSIS Increase in Partial pressure of CO2( above 45mmHg) Respiratory acidosis ( carbonic acid excess) occurs whenever there is hypoventilation Hypoventilation results in build up of CO2 and subsequently carbonic acid accumulates in the body

3. CAUSES FOR RESPIRATORY ACIDOSIS COPD Barbiturates/ sedative overdose (Central nervous system depressants) Obesity( Respiration difficulty) Severe Pneumonia Atelectasis Respiratory Muscle weakness These problems will cause difficulty to breathe and CO2 cannot move out of lungs so there will be accumulation and increase in the CO2 level in the blood and causes Respiratory acidosis

4. COPD, Barbiturates/ Sedatives, Obesity, Pneumonia, Atelectasis, Respiratory muscle weakness or paralysis Difficulty in breathing Lungs cannot exhale out CO2 from the body CO2 cannot move out, will accumulate in the blood Increase in CO2 in blood leads to respiratory acidosis Pathophysiology

5. PATHOPHYSIOLOGY CO2 retention from hypoventilation To compensate, the kidney conserve or save bicarbonates in the body and excrete out Hydrogen ion from the body through urine In acute stage, the renal compensation starts within 2-3 days RESPIRATORY ACIDOSIS METABOLIC ALKALOSIS( increase in HCO3 level COMPENSATION

6. Lab findings of respiratory acidosis pH -----Low…below 7.35 PaCO2----Increased…..above 45 mmHg HCO3-----Normal ( uncompensated ) HCO3----Increased ( compensated )

7. CLINICAL FEATURES CNS Drowsiness Disorientation Dizziness Head ache Coma Seizure CVS Hypotension Ventricular fibrillation Peripheral vasodilation Warm and flushed skin Respiratory System Hypoventilation hypoxia

8. TREATMENT Identification and correction of cause IV therapy----Inj. Soda Bicarbonate Oxygen therapy Non invasive Mechanical Ventilation/ Invasive mechanical ventilation( CPAP Mode) Bronchodilators (Nebulization)--- Levolin , Ipratropium Bromide

9. NURSING MANAGEMENT History and P.E----to identify and treat the cause Monitor SpO2 and ABG values Provide semi-fowlers position Adm Oxygen therapy Connect the patient to mechanical ventilator (Invasive/ non invasive)

10. METABOLIC ACIDOSIS Decrease in HCO3 level in the blood (less than 22 mEq/L Metabolic acidosis will occur when carbonic acid, Keto -acids and lactic acids accumulates in the body and when bicarbonate is lost from the body or when the body fails to reabsorb HCO3 Severe Diarrhoea leads to loss of bicarbonate from the body In renal failure there will be decrease in the reabsorption of bicarbonates

11. CAUSES OF METABOLIC ACIDOSIS Diabetic keto -acidosis Lactic Acidosis Starvation Diarrhoea Renal failure Gastrointestinal Disease Shock

12. PATHOPHYSIOLOGY Increase in the carbonic acid, keto -acids and lactic acids Loss of bicarbonate from the body Decrease in the reabsorption of Bicarbonate by the kidney Compensation—increase in the CO2 excretion by the lungs( deep and rapid breathing)

13. COMPENSATORY MECHANISM METABOLIC ACIDOSIS RESPIRATORY ALKALOSIS( DECREASE IN CO2 Level COMPENSATION

14. CLINICAL FEATURES CNS Drowsiness Disorientation Dizziness Head ache Coma Seizure CVS Hypotension Dysrhythmias Ventricular fibrillation Peripheral vasodilation Warm and flushed skin

15. CLINICAL FEATURES ( Cont …) GIS Nausea Vomiting Diarrhoea Abdominal pain Respiratory system Kussmaul respiration---Deep and rapid respiration ( Compensation)

16. Lab Finding

17. Management Bicarbonate supplements (oral/ IV soda bicarbonate) Treatment of the cause IV fluids Insulin to correct Diabetic Keto Acidosis Oxygen therapy

18. RESPIRATORY ALKALOSIS Respiratory alkalosis occurs when there is decrease in the partial pressure of CO2 Respiratory alkalosis occurs with decrease in carbonic acid Occurs in hyperventilation

19. CAUSES Hyperventilation caused by- -- Hypoxia Pulmonary emboli Anxiety Pain Fear Exercise Fever Stimulated respiratory center caused by— Septicaemia( serious blood stream infection) Encephalitis( inflammation of the brain) Brain injury Salicylate drug overdose or poisoning

20. PATHOGENESIS Increased carbon dioxide excretion from hyperventilation Compensatory response Decrease in rapid hyperventilation by controlling the cause HCO3 excretion by the kidney—low HCO3(metabolic acidosis)

21. COMPENSATORY MECHANISM RESPIRATORY ALKALOSIS METABOLIC ACIDOSIS( DECREASE IN HCO3 Level COMPENSATION

22. CLINICAL MANIFESTATIONS CNS Lethargy Light headedness Confusion Tetany Numbness Hyper- reflexia Seizure CVS Tachycardia Dysrhythmias GIT Nausea Vomiting Epigastric pain RESP Hyperventilation

23. Lab Finding

24. MANAGEMENT Depends on the identification of the cause and correct the causation Patient is instructed to breathe more slowly to allow CO2 to accumulate Patient can be provided with Closed rebreathing mask Sedative may be used to relieve hyperventilation in anxious patient

25. Closed Re-breather Mask

26. NURSING MANAGEMENT Identify the causes for hyperventilation Reassurance to the anxious patients Treatment of pain and fever Advice to breathe slowly Provide rebreathing mask and advice to breathe into it –so as to pick up CO2 which is exhaled Inj. Midaz / Inj Lorazepam to sedate the anxious patients

27. METABOLIC ALKALOSIS Occurs when there is increase in the HCO3 level ( Bicarbonate excess)

28. CAUSES OF METABOLIC ALKALOSIS Severe vomiting Excess gastric suction Diuretic therapy Potassium deficit Excess NaHCO3 intake/ administration Excessive Steroids use

29. PATHOPHYSIOLOGY Severe vomiting. NG suction, Potassium deficit, Diuretic therapy Increase administration of Steroids and Sodium Bicarbonates Loss of Acids from the body Increase in the HCO3 level Compensation mechanism is by retaining or saving CO2 in the body, thereby increasing the acid level in the body( Respiratory Acidosis)

30. COMPENSATORY MECHANISM METABOLIC ALKALOSIS RESPIRATORY ACIDOSIS( Increase in CO2 Level COMPENSATION

31. CLINICAL MANIFESTATIONS CNS Dizziness Irritability Confusion Tetany Tremors Numbness Muscle cramps Seizure CVS Tachycardia Dysrhythmias GIT Nausea Vomiting Epigastric pain RESP Hypoventilation

32. Lab Finding

33. MANAGEMENT Identification and correction of the cause Monitor for dehydration Correct the fluid loss Intake –Output monitoring IV fluids---IV N ormal Saline Antacids/ PPI for patients having gastric suction

34. NURSING MANAGEMENT Assess for signs of dehydration or shock Monitor Intake and Output Adm.. Anti-emetic---for severe vomiting Antacids/ PPI----patients having NG suction Correction of hypokalemia ( Inj KCL) IV fluids ---Normal saline