Management Of Diabetic Ketoacidosis In Adults
Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency. Nurses need to know how to identify and manage it and how to maintain electrolyte balance Continue reading >>
Metabolic Acidosis/alkalosis
-Gain of fixed acid ,inability to excrete acid, or loss of base. -Compensatory response of CO2 excretion by the lungs (Resp. Alkalosis) increase RR -Plasma pH increase -PaCO2 normal (uncompensated) -PaCO2 decrease (compensated) -HCO3 decrease -Urine pH <6 (compensated) Neuro Sign & Symptoms of Metabolic Acidosis? -Decrease BP -Dysrhythmias (related to hyperkalemia from compensation) -Warm, flushed skin (peripheral vasodilation) -Deep, rapid respiration (compensation by the lungs) a condition characterized by an excess of bicarbonate ions in the body in relation to the amount of carbonic acid in the body; the pH rises to greater than 7.45 -excessive vomiting -prolonged gastric suctioning -electrolyte disturbances (hypokalemia) -Cushings disease -excessive NaHCO3 intake -OD on baking soda -diuretics -excessive mineralocorticoids. -Compensatory response of CO2 retention by the lungs (Resp. Acidosis) decreased RR -Plasma pH increase -PaCO2 normal (uncompensated) -PaCO2 increase (compensated) -HCO3 increase -Urine pH >6 (compensated) -Dizziness -Irritability -Nervousness, confusion -Tachycardia -Dysrhythmias (related to hypokalemia from compensation) Neruomuscular S&S of Metabolic Alkalosis? -Tetany -Tremors -Tingling of finger and toes Muscle cramps , hypertonic muscle -Seizures -Hypoventilation (compensatory action by the lungs) Nursing interventions for Metabolic Acidosis? -Monitor VS -Neuro status -ABGs -K+ levels (elevated) -Make sure client has large-bore IV -Orient pt as needed -O2 as needed -position client to promote chest expansion -treat underlying cause -Resp. support (mechanical ventilation) -Give NaHCO3 Nursing intervention for Metabolic Alkalosis? -Assess I&O -LOC -HR & rhythm -VS -Assess neuro status -ABGs Continue reading >>
Metabolic Alkalosis | Kidney | Medical Specialties
METABOLIC ALKALOSIS (PRIMARY BASE BICARBONATE EXCESS) Metabolic alkalosis is characterized by a high pH (loss of hydrogen ions) and high plasma bicarbonate caused by excessive intake of sodium bicarbonate, loss of gastric/intestinal acid, renal excretion of hydrogen and chloride, prolonged hypercalcemia, hypokalemia, and hyperaldosteronism. Compensatory mechanisms include slow, shallow respirations to increase CO2 level and an increase of bicarbonate excretion and hydrogen reabsorption by the kidneys. This condition does not occur in isolation but rather is a complication of a broader problem that may require inpatient care in a medical-surgical or subacute unit. Plans of care specific to predisposing factors Respiratory acidosis (primary carbonic acid excess) Respiratory alkalosis (primary carbonic acid deficit) Patient Assessment Database (Dependent on Underlying Cause) May report: Diarrhea (with high chloride content) Use of potassium-losing diuretics (Diuril, Hygroton, Lasix, Edecrin) May report: Anorexia, nausea/prolonged vomiting High salt intake; excessive ingestion of licorice Recurrent indigestion/heartburn with frequent use of antacids/baking soda May report: Tingling of fingers and toes; circumoral paresthesia May exhibit: Hypertonicity of muscles, tetany, tremors, convulsions, loss of reflexes Confusion, irritability, restlessness, belligerence, apathy, coma May report: Recent blood transfusions (citrated blood) May exhibit: Hypoventilation (increases PCO2 and conserves carbonic acid), periods of apnea History of Cushings syndrome; corticosteroid therapy Discharge plan DRG projected mean length of inpatient stay depends on underlying cause considerations: May require change in therapy for underlying disease process/condition. Refer to section at end of plan Continue reading >>
Metabolic Acidosis From My Nursing Lab
Fatty acids are broken down into ____________, which are acidic. As the ____________level rises, ____________________develops. Substances such as __________________, _______________ and ____________cause a toxic increase in body acids either by breaking down into acidic byproducts or by stimulating metabolic acid production. An oversupply of metabolic acids _____________ the concentration of hydrogen ions in body fluids. To compensate, the body produces more of what? Intestinal suction, severe diarrhea, ileostomy drainage, or fistulas can lead to excessive loss of , ____________which causes ______________. In some cases, intravenous infusion of chloride can lead to what? excessive chloride in the blood (hyperchloremia). Some conditions (e.g., renal disease) and medications (e.g., carbonic anhydrase inhibitor diuretics) may prevent the body from excreting ______________, which can lead to ______________________. Some conditions such as __________ and medications such as_________ may prevent the body from excreting chloride, which can lead to hyperchloremia. Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease. such as Neurological manifestations of metabolic acidosis Cardiac manifestations of metabolic acidosis With Metabolic acidosis how does that affect Potassium and magnesium levels? an analysis of serum electrolytes may show an elevated serum potassium level and possibly a low magnesium level. With met acidosis what happens to the calcium? The total calcium level might be unchanged. The electrocardiogram may reflect changes. When it is mild- moderate acidosis how does it affect it? When it is severe how does it affect it? acidosis and hyperkalemia, such as a peaked T wave in mild to moderate hyperkalemia or absent Continue reading >>
Perfecting Your Acid-base Balancing Act
When it comes to acids and bases, the difference between life and death is balance. The body’s acid-base balance depends on some delicately balanced chemical reactions. The hydrogen ion (H+) affects pH, and pH regulation influences the speed of cellular reactions, cell function, cell permeability, and the very integrity of cell structure. When an imbalance develops, you can detect it quickly by knowing how to assess your patient and interpret arterial blood gas (ABG) values. And you can restore the balance by targeting your interventions to the specific acid-base disorder you find. Basics of acid-base balance Before assessing a patient’s acid-base balance, you need to understand how the H+ affects acids, bases, and pH. An acid is a substance that can donate H+ to a base. Examples include hydrochloric acid, nitric acid, ammonium ion, lactic acid, acetic acid, and carbonic acid (H2CO3). A base is a substance that can accept or bind H+. Examples include ammonia, lactate, acetate, and bicarbonate (HCO3-). pH reflects the overall H+ concentration in body fluids. The higher the number of H+ in the blood, the lower the pH; and the lower the number of H+, the higher the pH. A solution containing more base than acid has fewer H+ and a higher pH. A solution containing more acid than base has more H+ and a lower pH. The pH of water (H2O), 7.4, is considered neutral. The pH of blood is slightly alkaline and has a normal range of 7.35 to 7.45. For normal enzyme and cell function and normal metabolism, the blood’s pH must remain in this narrow range. If the blood is acidic, the force of cardiac contractions diminishes. If the blood is alkaline, neuromuscular function becomes impaired. A blood pH below 6.8 or above 7.8 is usually fatal. pH also reflects the balance between the p Continue reading >>
Using The Abg To Identify Acidosis
March/April 2016, Volume :14 Number 2 , page 6 - 9 [Free] Join NursingCenter to get uninterrupted access to this Article Acidosis is an acid-base imbalance that's characterized by an abnormal accumulation of acid in the blood. It can also be caused by a loss of alkali in the blood, leading to an acid-base mismatch in which there's more acid than base. Regardless of the cause, acidosis will lead to a serum pH level below 7.35. An acidic environment can be very dangerous because it alters cellular function, which in turn affects all body systems. Additionally, acidosis can alter a patient's oxygenation by making it more difficult for hemoglobin to bind with available oxygen. Acidosis is either respiratory or metabolic in nature. In this article, you'll learn about both disorders, including recognition, causes, and nursing care. As the name implies, respiratory acidosis is caused by problems with the respiratory system. In order to understand respiratory acidosis, you'll need to have a generalized understanding of anatomy and physiology as it relates to the respiratory system, which takes oxygen from the air and transports it to the blood. Once oxygen is in the blood, it's transported throughout the body. In addition to taking in oxygen, the lungs also remove carbon dioxide from the blood by exhaling it into the environment. When the lungs aren't able to remove carbon dioxide effectively, the carbon dioxide that remains in the body will form an acid. This acid accumulates in the blood, causing a low serum pH and corresponding respiratory acidosis. Respiratory acidosis can develop quickly over a short period of time or slowly over a prolonged amount of time. The speed with which respiratory acidosis develops will depend on the underlying condition causing it. Respiratory a Continue reading >>
Metabolic Acidosis Treatment & Management: Approach Considerations, Type 1 Renal Tubular Acidosis, Type 2 Renal Tubular Acidosis
Metabolic AcidosisTreatment & Management Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN more... Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise healthy young individual is approximately 15 mm Hg. With increasing age and other complicating illnesses, the limit of compensation is likely to be less. A further small drop in HCO3- at this point thus is not matched by a corresponding fall in PaCO2, and rapid decompensation can occur. For example, in a patient with metabolic acidosis with a serum HCO3- level of 9 mEq/L and a maximally compensated PCO2 of 20 mm Hg, a drop in the serum HCO3- level to 7 mEq/L results in a change in pH from 7.28 to 7.16. A second situation in which HCO3- correction should be considered is in well-compensated metabolic acidosis with impending respiratory failure. As metabolic acidosis continues in some patients, the increased ventilatory drive to lower the PaCO2 may not be sustainable because of respiratory muscle fatigue. In this situation, a PaCO2 that starts to rise may change the plasma pH dramatically even without a significant further fall in HCO3-. For example, in a patient with metabolic acidosis with a serum HCO3- level of 15 and a compensated PaCO2 of 27 mm Hg, a rise in PaCO2 to 37 mm Hg results in a change in pH from 7.33 to 7.20. A further rise of the PaCO2 to 43 mm Hg drops the pH to 7.14. All of this would have occurred whi Continue reading >>
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Anion Gap Acidosis | Allnurses
Can someone please explain the difference btwn non-anion and anion met acidosis, why it's important to know the difference and how do we treat/manage this? I just started in ICU and I have been hearing this a lot here. Have you researched this at all on the internet or in your textbooks? If you're a nurse, then you really should know how to research anything you're confused about. Rather than ask someone to take the time to teach you the basics, why not read up on the basics and then come with specific questions? Moved to our Critical Care forum for more replies. It depends on how messed up your electrolytes and bicarb are. There's a formula out there. A wide gap is bad. By correcting the acidoses and dehydration and fixing electrolyte issues you close the gap and balance the equation. Anion gap is a further step to figure out why a person has for instance, in this case, metabolic acidosis. I like to pretend it's a mystery obtain objective and subjective information. Patient is a 65 year old male admitted with moderate dehydration, and complaint of diarrhea for the last 3 days. Okay lets draw labs, and get a blood gas Na+ 134, K+ 2.9, Cl- 108, HCO3- 16, BUN 31, First figure out your blood gas/ ph = 7.32, CO2 = 34 HCO3= 15 (metabolic acidosis) I am thinking this is due to his history of diarrhea and the loss of bicarbonate because, the most common etiology of normal anion gap acidosis is diarrhea with renal tubular acidosis being a distant second Know your parameters Normal is 6-12 mEq/L (non anion is another way of saying it) Get familiar with what they could indicate Low (< 6) Hypoalbuminemia, Plasma cell dyscrasia, Monoclonal protein, Bromide intoxication Normal (6-12) Hyperalimentation, Acetazolamide and other carbonic anhydrase inhibitors, Renal tubular acidosis, D Continue reading >>
1 Perfusion 2 Cognition 3 Communication 4 Fluid And Electrolytes 9 The Nurse Is | Course Hero
1 Perfusion 2 Cognition 3 Communication 4 Fluid and electrolytes 9 The nurse is 1 perfusion 2 cognition 3 communication 4 fluid and 100% (46) 46 out of 46 people found this document helpful This preview shows page 2 - 4 out of 19 pages. 1)Perfusion2)Cognition3)Communication4)Fluid and electrolytes____9.The nurse is caring for a comatose patient with respiratory acidosis. For which intervention will the nurse need to collaborate when caring for this patient?1)Monitoring vital signs2)Measuring intake and output3)Determining recent eating behaviors4)Identifying current oxygen saturation level____10.The nurse is analyzing the patient's arterial blood gas report, which reveals a pH of 7.15. The patient has just suffered a cardiac arrest. Which consequences of this pH value does the nurse consider for this patient?1)Decreased cardiac output2)Decreased potassium levels3)Increased magnesium levels4)Decreased free calcium in the ECF____11.The nurse is caring for a patient admitted with renal failure and metabolic acidosis. Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective?1)Tachypnea2)Palpitations3)Increased deep tendon reflexes4)Decreased depth of respirations____12.A patient with metabolic acidosis has been admitted to the unit from the emergency department (ED). The patient is experiencing confusion and weakness. Which independent nursing intervention is the priority?1)Protecting the patient from injury2)Placing the patient in a high-Fowler's position3)Administering sodium bicarbonate to the patient4)Providing the patient with appropriate skin care____13.The nurse is reviewing new orders provided by the health-care provider for a critical care patient with metabolic acidosis. Which prescr Continue reading >>
Metabolic Acidosis Nursing Care Plan
Arteriolar dilation or decreased cardiac contractility and hypovolemia occur, resulting in systemic shock, evidenced by hypotension and tissue hypoxia. Assess LOC and note progressive changes in neuromuscular status. Note neuromuscular strength, tone, movement. Decreased mental function, confusion , seizures, weakness, flaccid paralysis can occur because of hypoxia, hyperkalemia , and decreased pH of CNS fluid. Provide seizure or coma precautions and bed in low position, use of side rails, frequent observation. Protects patient from injury resulting from decreased mentation and convulsions. Acidemia may be manifested by changes in ECG configuration and presence of brady dysrhythmias as well as increased ventricular irritability such as fibrillation (signs of hyperkalemia ). Life-threatening cardiovascular collapse may also occur because of vasodilation and decreased cardiac contractility. Note: Hypokalemia can occur as acidosis is corrected, resulting in premature ventricular contractions (PVCs) and/or ventricular tachycardia. Observe for altered respiratory excursion, rate, and depth. Deep, rapid respirations (Kussmauls) may be noted as a compensatory mechanism to eliminate excess acid; however, as potassium shifts out of cell in an attempt to correct acidosis, respirations may become depressed. Transient respiratory depression may be the result of overcorrection of metabolic acidosis with sodium bicarbonate. Assess skin temperature, color, capillary refill. Evaluates circulatory status, tissue perfusion , effects of hypotension . Auscultate bowel sounds, measure abdominal girth as indicated. In the presence of coexisting hyperkalemia , GI distress (distension, diarrhea , and colic) may occur. Marked dehydration may be present because of vomiting, diarrhea . Therapy n Continue reading >>
Acid-base Management: Metabolic Acidosis | Definition Of Acid-base Management: Metabolic Acidosis By Medical Dictionary
Acid-base management: metabolic acidosis | definition of acid-base management: metabolic acidosis by Medical dictionary the process of controlling how something is done or used. acid-base management in the nursing interventions classification, a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from acid-base imbalance. acid-base management: metabolic acidosis in the nursing interventions classification, a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from serum bicarbonate levels lower than desired. See also metabolic acidosis . acid-base management: metabolic alkalosis in the nursing interventions classification, a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from serum bicarbonate levels higher than desired. See also metabolic alkalosis. acid-base management: respiratory acidosis in the nursing interventions classification, a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from serum pCO2 levels higher than desired. See also respiratory acidosis . acid-base management: respiratory alkalosis in the nursing interventions classification, a nursing intervention defined as the promotion of acid-base balance and prevention of complications resulting from serum pCO2 levels lower than desired. See also respiratory alkalosis. airway management in the nursing interventions classification, a nursing intervention defined as insertion or assisting with insertion and stabilization of an artificial airway . See also artificial airway management . allergy management in the nursing interventions classification, a nursing intervention define Continue reading >>
Acid-base Imbalances: Metabolic Acidosis And Alkalosis; Respiratory Acidosis And Alkalosis
Type your tag names separated by a space and hit enter Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis is a topic covered in the Diseases and Disorders. To view the entire topic, please sign in or purchase a subscription . Nursing Central is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Explore these free sample topics: -- The first section of this topic is shown below -- Description MEDICAL: Miscellaneous Disorders of Nutrition, Metabolism, Fluids/Electrolytes With Major CC -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Description MEDICAL: Miscellaneous Disorders of Nutrition, Metabolism, Fluids/Electrolytes With Major CC There's more to see -- the rest of this entry is available only to subscribers. Sommers, Marilyn Sawyer.. "Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis." Diseases and Disorders, 6th ed., F.A. Davis Company, 2019. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Diseases-and-Disorders/73505/all/Acid_Base_Imbalances:_Metabolic_Acidosis_and_Alkalosis. Sommers MS. Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis. Diseases and Disorders. 6th ed. F.A. Davis Company; 2019. Accessed February 1, 2020. Sommers, M. S. (2019). Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis. In Diseases and Disorders. Available from Sommers MS. Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Continue reading >>
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Etiology And Clinical Manifestations ::
Etiology and Clinical Manifestations :: Metabolic Acidosis Etiology: Loss of base: such as in cases of severe diarrhea or Gain of metabolic acids: Anaerobic metabolism; Drug overdose (e.g.salicylates); Renal failure; Diabetic ketoacidosis Manifestations: headache and lethargy are early symptoms; warm flushed skin; seizures; mental confusion; muscle twitching; agitation; coma (severe acidosis); anorexia, nausea, vomiting and diarrhea; deep and rapid respirations (Kussmaul respirations); hyperkalemia (shift of acid to the ICF and K+ to the ECF); cardiac dysrhythmias. Decreased blood pH; decreased HCO3; normal PaCO2 or decreased if compensation is occurring. (The "nursing interventions" button on the homepage will lead the user to these nursing interventions listed under each problem. It would be nice to have a pull-down menu under "nursing interventions" for metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis) on the homepage). Nursing Interventions: Assess the clinical symptoms, health history, and lab results. Identify the underlying cause to intervene appropriately. When there is sever acidosis (pH < 7.1), sodium bicarbonate is necessary to bring the pH to a safe level. Correct the sodium and water deficits, as well. Metabolic Alkalosis Etiology: Loss of metabolic acids: such as in cases of prolonged vomiting or gastrointestinal suctioning. Hyperaldosteronism can cause sodium retention and loss of hydrogen ions and potassium. or Gain of Base: an increased intake of bicarbonate. Diuretics (e.g. furosemide) can cause sodium, potassium, and chloride excretion more than bicarbonate excretion. Manifestations: general weakness, muscle cramps, hyperactive reflexes, tetany (due to a decrease in calcium); shallow and slow respirations; confu Continue reading >>
Acid-base Imbalances Nursing Care Plan & Management
Acid-Base Imbalances Nursing Care Plan & Management Acidbase imbalance is an abnormality of the human bodys normal balance of acids and bases that causes the plasmapH to deviate out of the normal range (7.35 to 7.45). Respiratory Alkalosis is an acid-base imbalance characterized by decreased partial pressure of arterial carbon dioxide and increased blood pH Signs and Symptoms/ Clinical Manifestations: positive Chvosteks sign nausea and vomiting Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH above 7.45 and partial pressure of carbon dioxide below 35 mmHg. Institute safety measures for the patient with vertigo or the unconscious patient. Encourage the anxious patient to verbalize fears Administer sedation as ordered to relax the patient Encourage the patient to take deep, slow breaths or breathe into a brown paper bag (inspire CO2). Monitor ABGs, primarily PaCO2; a value less than 35 mmHg indicates too little CO2 (carbonic acid) Respiratory Acidos is is an acid-base imbalance characterized by increased partial pressure of arterialcarbon dioxide and decreased blood pH. chest wall trauma, pulmonary edema, atelactasis, pneumothorax, drug overdose, pneumonia, Guillain-Barre syndrome any condition that results in hypoventilation Signs and Symptoms/ Clinical Manifestations: mental cloudiness and feeling of fullness in head Labs indicated: arterial blood gas (ABG) studies reveal abnormal values: pH below 7.35 and partial pressure of carbon dioxide above 45 mmHg. Monitor I&O and administer fluids as ordered Administer oxygen and medications for order; monitor hourly vital signs and respiratory status (may requires mechanical ventilation) Monitor arterial blood gases (ABGs); pH, PaCO2, HCO3 Metabolic Alkalosis is an acid-base imbalance characterized b Continue reading >>
Metabolic Acidosis Nclex Review Notes
Are you studying metabolic acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic acidosis from metabolic alkalosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. This article will cover: Metabolic acidosis simplified Lab values expected with metabolic acidosis Causes of metabolic acidosis Signs and symptoms of metabolic acidosis Nursing interventions for metabolic acidosis Lecture on Metabolic Acidosis Metabolic Acidosis Metabolic Acidosis in Simple Terms: a metabolic problem due to the buildup of acid in the body fluids which affects the bicarbonate (HCO3 levels) either from: increased acid production (ex: DKA where ketones (acids) increase in the body which decreases bicarbonate) decreased acid excretion (ex: renal failure where there is high amount of waste left in the body which causes the acids to increase and bicarb can’t control imbalance) loss of too much bicarb (diarrhea) When this acidic phenomena is taking place in the body other systems will try to compensate to increase the bicarb back to normal. One system that tries to compensate is the respiratory system. In order to compensate, the respiratory system will cause the body to hyperventilate by increasing breathing through Kussmaul’s respirations. Kussmaul respirations are deep, rapid breathes. The body hopes this will help expel CO2 (an acid) which will “hopefully” increase the pH back to normal. Lab values expected in Metabolic Acidosis: HCO3: decreased <22 Blood pH: decreased <7.35 CO2: <35 or normal (may be normal b Continue reading >>
