Nursing 211

N211: Health Differences Across the Lifespan I Includes increased heart rate, hypotension, hypokalemia, PVCs, hypoventilation, respiratory failure, dizziness, irritability, nervousness, confusion, tremors, muscle cramps, tetany, hyper-reflexia, paresthesias in fingers and toes and seizures. Diagnostic • pH greater than 7.45 • HCO3 above 26 mEq/L • hypokalemia • hypocalcemia • hyponatremia • hypochloremia • urine chloride levels reveal whether client is chloride responsive (under 10mEq/L) or chloride resistant (over 10mEq/L) Compensation • Lungs retain CO2 due to reduced respiration which allows carbon dioxide to accumulate in the body fluids. • Carbon dioxide reacts with water to produce carbonic acid. If metabolic alkalosis persists for several hours, and if the kidneys are functional, the kidneys reduce the rate of hydrogen ion secretion to help reverse alkalosis. kidneys conserve hydrogen and excrete HCO3 • PaCO2 increases with compensation • Urine pH is greater than 6 Nursing I terventions Include treatment aimed at correcting underlying problem, provide sufficient chloride to enhance renal absorption of sodium and excretion of HCO3, restore normal fluid balance; monitor level of consciousness, monitor vital signs, especially respiratory rate and depth. Administer normal saline based IV fluid replacement, potassium supplement if hypokalemic, histamine-2 receptor antagonists such as ranitidine (Zantac) or famotidine (Pepcid) to reduce secretion of hydrogen ions and loss of hydrogen ions from GI drainage. If client is chloride responsive, administer acetazolamide (Diamox) to increase renal bicarbonate excretion. Monitor I&O, prevent from injury, and monitor EKG and ABGs.

2.5 Metabolic Acidosis


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