Nursing 211

N211: Health Differences Across the Lifespan I Metabolic Acidosis (pH↓<7.35, HCO3 ↓<22) is anything which decreases HCO3, decreases the base and decreases the pH level. This condition is accompanied by other problems, such as starvation, chronic diarrhea, malnutrition, kidney failure, diabetic ketoacidosis, hyperthyroidism, trauma, shock, increased exercise, severe infection and fever. Nu sing Ass ssment Includes hypotension, dysrhythmias, peripheral vasodilation, cold clammy skin, Kussmaul’s respirations, drowsiness, headache, confusion, lethargy, weakness, coma, nausea, vomiting, diarrhea and abdominal pain. Diagnostics • pH less than 7.35 • HCO3 less than 22 mEq/L • Hyperkalemia • EKG may show changes related to potassium levels Compensation • Lungs eliminate carbon dioxide; kidneys conserve bicarbonate • Urine pH is less than 6 • PaCO2 decreases when compensation is occurring Nursing Interv ntions Include treating the underlying cause; provide hydration to restore water, nutrients and electrolytes. Mechanical ventilation is used only if other treatment modalities are ineffective. Monitor ABGs, I&O, measure daily weights, monitor serum electrolytes, monitor level of consciousness and protect from injury. Administer IV fluids and medications. Administer sodium bicarbonate only when the HCO3 levels are very low (below 16 to 18 mEq/L). Arterial Blood Gas (ABG’s) Values • pH 7.35-7.45 • PO2 80-100 mm hg • PCO2 35-45 mm hg • HCO3 22-26 mEq/L • SaO2 97-100% (also known as oxygen saturation) Sodium Bicarbonate (HCO3) acts as a base in the body. Therefore, if HCO3 is low it will cause metabolic acidosis. This can be caused by the body using up a lot of HCO3 (diabetics) or losing a lot of HCO3 in the urine.


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