Acid-Base Imbalances

Disorder and Related Conditions	Assessment		Nursing Care Plan/Implementation	Evaluation/Outcome Criteria
Disorder and Related Conditions	Subjective Data	Objective Data	Nursing Care Plan/Implementation	Evaluation/Outcome Criteria
Respiratory Acidosis
Acute bronchitis Emphysema Respiratory obstruction Atelectasis Damage to respiratory center Pneumonia Asthmatic attack Drug overdose	Headache Irritability Disorientation Weakness Dyspnea on exertion Nausea	Hypoventilation: ↓ rate or rapid and shallow Cyanosis Tachycardia Diaphoresis Dehydration Coma (CO₂ narcosis) Hyperventilation to compensate if no pulmonary pathology present HCO₃, normal PaCO₂, elevated pH <7.35	Assist with normal breathing: encourage coughing; suction airway; postural drainage; pursed-lip breathing; raise HOB Protect from injury: oxygen as needed; encourage fluids; avoid sedation; medications as ordered—antibiotics, bronchial dilators Health teaching: identify cause, prevent future episodes; increase awareness regarding risk factors and early signs of impending imbalance; encourage compliance	Normal acid-base balance obtained Respiratory rate: 16–20 No signs of pulmonary infection (e.g., sputum colorless, breath sounds clear) Demonstrates breathing exercises (e.g., diaphragmatic breathing)
Metabolic Acidosis
Diabetic ketoacidosis Hyperthyroidism Severe infections Lactic acidosis in shock Renal failure → uremia Prolonged starvation diet; low-protein diet Diarrhea, dehydration Hepatitis Burns	Headache Restlessness Apathy, weakness Disorientation Thirst Nausea, abdominal pain	Kussmaul’s respirations: deep, rapid air hunger ↑ Temperature Vomiting, diarrhea Dehydration Stupor → convulsions → coma HCO₃ below normal PaCO₂ normal K⁺ >5 pH <7.35	Restore normal metabolism: correct underlying problem; sodium bicarbonate PO/IV; sodium lactate; fluid replacement, Ringer’s solution; diet: high calorie Prevent complications: regular insulin for ketoacidosis; hourly outputs; prepare for dialysis if in kidney failure Health teaching: identify signs and symptoms of primary illness, prevent complications, cardiac arrest; diet instructions	Normal acid-base balance obtained No rebound respiratory alkalosis following therapy No tetany following return of normal pH Alert, oriented No signs of K⁺ excess
Respiratory Alkalosis
Hyperventilation—CO₂ loss Hypoxia, high altitudes Fever Metabolic acidosis Increased ICP, encephalitis Salicylate poisoning After intensive exercise	Circumoral paresthesia Weakness Apprehension	Increased respirations Increased neuromuscular irritability; hypereflexia, muscle twitching, tetany, positive Chvostek’s sign Convulsions Unconsciousness Hypokalemia HCO₃ normal PaCO₂ decreased pH >7.45	Increase carbon dioxide level: rebreathing into a paper bag; adjusting respirator for CO₂ retention and oxygen inspired; correct hypoxia Prevent injury: safety measures for those who are unconscious; hypothermia for elevated temperature Health teaching: recognize stressful events; counseling if problem is hysteria	Normal acid-base balance obtained Recognizes psychological and environmental factors causing condition Respiratory rate returns to normal limits No cardiac arrhythmias Alert, oriented
Metabolic Alkalosis
Potassium deficiencies Vomiting GI suctioning Intestinal fistulas Inadequate electrolyte replacement Increased use of antacids Diuretic therapy, steroids Increased ingestion/injection of bicarbonates	Lethargy Irritability Disorientation Nausea	Respirations: shallow; apnea, decreased thoracic movement; cyanosis Pulse: irregular → cardiac arrest Muscles: twitching → tetany, convulsions GI: vomiting, diarrhea, paralytic ileus HCO₃ elevated above 26 PaCO₂ normal, K⁺ <3.5 pH >7.45	Obtain, maintain acid-base balance: irrigate NG tubes with saline; monitor I&O IV saline, potassium added; isotonic solutions PO; monitor vital signs Prevent physical injury: monitor for potassium loss, side effects of medications Health teaching: increase sodium when loss expected; instructions regarding self-administration of medications (e.g., baking soda)	Normal acid-base balance obtained No signs of potassium deficit Respiratory rate: 16–20 No arrhythmias—pulse regular Lists food sources high in potassium

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Table 6-8