ACID BASE IMBALANCES

Download
Share  Add to  Flag Embed
Views:
 
Category: Education
     
 
License:   All Rights Reserved

Presentation Description

No description available.

Comments

Presentation Transcript

Slide 1:

PRESENTED BY: KIRAN RANDHAWA ACID BASE IMBALANCES

INTRODUCTION:

INTRODUCTION Body normally maintains a steady balance between acids produced during metabolism and base that neutralize & promote excretion of acids. Patients with DM,COPD,& kidney diseases frequently develop acid base imbalances.

TERMINOLOGY:

TERMINOLOGY Acid:Donor of H + ,separation of an acid into H+ and its accompanying anion in solution. Acidosis:process that adds acid or eliminate base from body fluids.

CONTD…:

CONTD… Alkali:acceptor of H+,chemical combining of acid & base when H+ are added to a solution containing a base. Alkalosis:process that adds baseor eliminates acid from body fluids

CONTD…:

CONTD… Buffer:substance that reacts with an acid or base to prevent a large change in pH. pH:negative logarithm of H+ concentration.

HYDROGEN ION CONCENTRATION:

HYDROGEN ION CONCENTRATION Vital to life Expressed as p H . Circulate in the body two forms: -volatile hydrogen of carbonic acid -non volatile form of hydrogen & organic acids

REGULATORY SYSTEMS FOR H+ CONCENTRATION:

REGULATORY SYSTEMS FOR H+ CONCENTRATION Buffer systems Respiratory system Urinary system

BUFFER SYSTEMS:

BUFFER SYSTEMS Carbonic acid-bicarbonate buffer system Phosphate buffer system Plasma protein buffer system Hemoglobin system

RESPIRATORY SYSTEM:

RESPIRATORY SYSTEM In acidosis: pH increases,respiratory rate depth Decreases H 2 CO 3 is carried to lungs Reduced to CO 2 & H 2 O & exhaled H+are inactivated & excreted

CONTD…:

CONTD… In alkalosis: pH increases,respiratory rate & depth decreases CO 2 is retained,H 2 CO 3 is built up Neutralizes & decreases excess bicarbonate

URINARY SYSTEM:

URINARY SYSTEM In acidosis pH decreases,H+ are secreted into tubules & combines with buffers For excretion in urine

CONTD…:

CONTD… In alkalosis: pH increases & bicarbonate ions move into tubules & combine with sodium & excreted in the urine

Slide 13:

ALTERATIONS

Slide 14:

METABOLIC ACIDOSIS

DEFINITION:

DEFINITION It is a state of relative acid excess in the body fluids resulting from a gain of fixed acid or loss of bicarbonate.

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Due to gain of fixed acid,inability to excrete acid,loss of base Compensatory response of CO 2 excretion by lungs

COMPENSATORY MECHANISM:

COMPENSATORY MECHANISM Lungs eliminate CO 2 & conserve HCO 3 -

ETIOLOGY:

ETIOLOGY Diabetes mellitus/diabetic ketoacidosis Renal insufficiency/failure Insufficient metabolism of carbohydrates Excessive ingestion of acetylsalicylic acid

CONTD…:

CONTD… Severe diarrhoea Malnutrition High fat diet

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS Increased respiratory rate Headache Nausea,vomiting & diarrhea Fruity smell breath CNS:mental dullness,drowsiness, stupor & coma

CONTD…:

CONTD… Twitching & convulsions Increased blood pressure Cold, clammy skin Dysarrythmias

ASSESSMENT & DIAGNOSTIC FINDINGS:

ASSESSMENT & DIAGNOSTIC FINDINGS Complete health history Physical examination Arterial Blood gas analysis Hyperkalemia / Hypokalemia ECG

MANAGEMENT:

MANAGEMENT Alkalizing agent(if serum bicarbonate level is less than 12mEq/l Assess level of consciousness Monitor intake & output,assist with fluids & electrolyte

CONTD…:

CONTD… Initiate safety & seizure precautions Monitor serum potassium level Administer insulin carefully in case of DM Monitor for circulatory collapse

CONTD…:

CONTD… Dietary modifications Dialysis

Slide 26:

METABOLIC ALKALOSIS

DEFINITION:

DEFINITION Metabolic alkalosis is clinical Disturbance characterized by a high pH(increased H+ concentration) & a High plasma HCO 3 - concentration.

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Due to loss of strong acid or gain of base Compensatory response of CO 2 retention by lungs

COMPENSATORY MECHANISM:

COMPENSATORY MECHANISM Lungs decrease ventilation to increase PaCO 2 & Kidney conserve H+ to excrete HCO 3 -

ETIOLOGY:

ETIOLOGY Malfunction of metabolism Ingestion of excess sodium bicarbonate Excessive vomiting or gastrointestinal suctioning Diuretics

CONTD…:

CONTD… Hyperaldosteronism Massive transfusion of whole blood

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS Decreased respiratory rate Nausea,vomiting & diarrhea Restlessness Numbness & tingling sensation in extremities Twitching Dysrhythmias:tachycardia

ASSESMENT & DIAGNOSTIC FINDINGS:

ASSESMENT & DIAGNOSTIC FINDINGS Arterial blood gas analysis:increased pH,decreased HCO 3 - ,Increased PaCO 2 Hypokalemia,hypochloremia Increased urinary chloride level

MANAGEMENT:

MANAGEMENT Potassium chloride NaCl Histamine-2-receptor antagonists Carbonic anhydrase inhibitors Monitor potassium & calcium serum blood levels

CONTD…:

CONTD… Obtain history to identify etiology of imbalance Monitor vital signs,skin integrity,& body temperature Intake & output Lab investigations

Slide 36:

RESPIRATORY ACIDOSIS

DEFINITION:

DEFINITION It is a clinical disturbance which is characterized by decreased pH & increased PaCO 2

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Due to CO 2 retention from hyperventilation Compensatory response of HCO 3 - retention by kidney

COMPENSATORY MECHANISM:

COMPENSATORY MECHANISM Kidneys eliminate H+ & retain HCO 3 -

ETIOLOGY:

ETIOLOGY Inadequate ventilation Respiratory obstruction Medications:sedatives,narcotics Bronchitis Atelectasis Brain trauma

CONTD…:

CONTD… Emphysema Asthma Pulmonary edema Brochiectasis

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS Increased vital signs Mental cloudiness,feeling of fullness in head Increased ICP Cyanosis Hypercapnia

ASSESMENT & DIAGNOSTIC FINDINGS:

ASSESMENT & DIAGNOSTIC FINDINGS ABG Analysis:decreased pH,increased PaCO 2 & varying HCO 3 - Serum electrolyte level Chest X ray ECG

MANAGEMENT:

MANAGEMENT Bonchodilators Antibiotics Thrombolytics Adequate hydration:23litres/day Supplemental O 2 Mechanical ventilation

CONTD…:

CONTD… Monitor for signs of respiratory distress Semi-fowler’s position Encourage turning,coughing & breathing Suctioning

CONTD…:

CONTD… Reduce restlessness by improving ventilation rather than by sedatives Monitor electrolyte level (potassium)

Slide 47:

RESPIRATORY ALKALOSIS

DEFINITION:

DEFINITION It is a clinical disturbance which is characterized by increase pH & decreased PaCO 2 .

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Due to increased CO 2 excretion from hyperventilation Compensatory response of HCO 3 - excretion by kidney

COMPENSATORY MECHANISM:

COMPENSATORY MECHANISM Kidney conserve H+ & excrete HCO 3 -

ETIOLOGY:

ETIOLOGY Hyperventilation Hysteria Overventilation by mechanical ventilation Fever Pain or brain trauma

CONTD…:

CONTD… Salicylates hypoxia

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS Hyperventilation & tachypnea Headache,lightheadedness & vertigo Mental status changes Paresthesias Hypokalemia,Hypocalcemia Tetany,Convulsions

ASSESMENT & DIAGNOSTIC FINDINGS:

ASSESMENT & DIAGNOSTIC FINDINGS ABG Analysis:increased pH & decreased PaCO 2 Serum electrolytes Toxicology screen

MANAGEMENT:

MANAGEMENT Treat the underlying causes Respiratory support: -O 2 therapy -encourage appropriate breathing pattern -Assist with breathing techniques & breathing aids as prescribed

CONTD…:

CONTD… Cautious care with ventilator clients Monitor electrolyte values Prepare to administer calcium gluconate Provide emotional support & reassurance

SUMMARY:

SUMMARY Introduction Terminology Hydrogen ion concentration Regulatory systems for H+ concentration Buffer system Respiratory system Urinary system

CONTD…:

CONTD… ALTERATIONS Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

BIBLIOGRAPHY:

BIBLIOGRAPHY Brunner & Suddharth’s;”medical surgical nursing”;10 th edition;Pp:281-285 Hargrove Ray.A et al;”medical surgical nursing”;4 th edition:lippincott’s Williams & Wilkins publication:Pp:

CONTD…:

CONTD… Black J.M,Hawk’s J.H;”Medical surgical nursing”;7 th edition;vol:I;Elseiver’s publication;Pp:285-293

Slide 61:

THANKS