1. PH: - 7.35-7.45 2. Co2: - 35-45 (this is an acid) (higher the number more acidic) 3. HCO3- - 22-26 (bicarb, more is more basic) 4. Uncompensated: - pH and one other value is abnormal 5. Partial Compensation - some compensation occurs but pH remains abnormal 6. Fully-compensated: - A pH level that has returned to normal. 7. Metabolic acidosis causes: - DKA, renal disease, starvation, diarrhea, ileostomy, hyperthyroidism, pancreatitis, liver failure, dehydration, seizure activity, ethanol intoxication, and aspirin toxicity. 8. Metabolic acidosis Lab Assessment: - pH<7.35, bicarbonate <21mEq/L, PaO2 normal, PaCo2 normal or slightly decreased, and serum potassium high 9. Metabolic acidosis Clinical manifestations: - Kussmaul's breathing RR>20, weak, confused, hypotension, cardiac changes (due to hyperkalemia), N/V 10. Metabolic acidosis nursing interventions: - hydration, antidiarrheal medication, monitor electrolytes (potassium), --Renal failure: strict I&O, monitor diet, may need dialysis, --Neuro status: seizure precautions, --DKA: Patient will need insulin drip, bicarbonate (only with low serum levels), and watch for respiratory depression: patient may need to be ventilated 11. Respiratory acidosis causes: - respiratory depression, inadequate chest expansion, airway obstruction or aspiration of a foreign object, opioids, anesthetics, ascites, pulmonary embolism, pulmonary edema, hypoventilation, rib fractures, tuberculosis, emphysema, drowning, acute respiratory distress syndrome, pneumonia, COPD, severe asthma, and decreased alveolar-capillary diffusion. 12. Respiratory acidosis Lab assessment: - pH <7.35, PaO2 low, PaCO2 high, Serum bicarbonate variable, serum potassium levels elevated, and serum levels normal or low (if renal compensation present) 13. Respiratory acidosis clinical manifestations - CNS changes (lethargy, confusion, stupor, coma), neuromuscular changes (decreased muscle tone, deep tendon reflexes, facial paralysis, skeletal muscle weakness), respiratory changes (Kussmaul's breathing), skin changes (warm, dry pink=vasodilation), cardiovascular changes: early- elevated HR and cardiac output changes; worsening: hyperkalemia, decreased HR, T wave peaked and QRS widened, peripheral pulses weak, and hypotension. 14. Respiratory acidosis nursing interventions - Focus on improving gas exchange, administer oxygen, if severe pt may need to be put on ventilator, drug therapies (administer bronchodilators, mucolytics, and antiinflammatories=tramadol/naproxen), and encourage breathing techniques (turn, cough, deep breath/incentive spirometer use) 15. Metabolic Alkalosis Causes: - base excess-excess intake of bicarbonates, carbonates, acetates, and citrates; acid deficit- prolonged vomiting, excess cortisol, hyperaldosteronism, thiazide diuretics, prolonged NG suction, and loss of gastric acid. -- Ingestion of antacids, TPN, blood transfusion, diuretic therapy 16. Metabolic Alkalosis Lab Assessment: - ph>7.45, HCO3->26, and normal O2/CO2 levels 17. Metabolic Alkalosis Clinical Manifestations: