酸堿平衡護理雙語

1、UNIT IIINursing Sciences,,UNIT III Nursing Sciences,Acid-Base Balance,Chapter 10,,,Pyramid terms,Allen’s test 艾倫實驗Compensation 補償，代償Metabolic acidosis 代謝酸中毒Respiratory acidosis 呼吸酸中毒Metabolic alkalosis代謝堿中毒Resp

2、iratory alkalosis呼吸堿中毒,CRITICAL THINKING,What Should You Do?The nurse performs an Allen’s test on a client scheduled for an arterial blood gas draw from the radial artery. On release of pressure from the ulnar artery, c

3、olor in the hand returns after 20 seconds. The nurse should take which action(s)?,Regulatory Systems for Hydrogen Ion Concentration in the Blood,BOX 10-1,Regulatory Systems for Hydrogen Ion Concentration in the Blood,Buf

4、fers血液緩沖系統(tǒng)Hemoglobin system血紅蛋白Plasma protein system血漿蛋白Carbonic acid-bicarbonate system碳酸及碳酸氫根緩沖系統(tǒng)Phosphate buffer system磷酸鹽緩沖系統(tǒng),Regulatory Systems for Hydrogen Ion Concentration in the Blood,Lungs肺Monitor the clie

5、nt’s respiratory status closely. In acidosis, the respiratory rate and depth increase in an attempt to exhale acids. In alkalosis, the respiratory rate and depth decrease; CO 2 is retained to neutralize and decrease the

6、strength of excess bicarbonate.,,Only for volatile acids,Regulatory Systems for Hydrogen Ion Concentration in the Blood,Kidneys腎排氫保堿Act slowly but compensation more thorough and selectiveActing by selective regulation

7、 of bicarbonate,排H+保HCO3—(bicarbonate retaining),Na+ + HCO3-,↓ H2CO3 ↓ CO2 + H2O,,磷酸鹽酸化 （phosphate acidifi

8、cation）,Na2HPO4,↓ NaH2PO4,氨的排泄 ( ammonia excretion),NH4+ ↓ NH4Cl,NH4+,Potassium exchange鉀離子的交換,H+,H+,acidosis,H+,H+,alkalosis,,When the client experiences an acid-bas

9、e imbalance, monitor the potassium level closely because the potassium moves in or out of the cells in an attempt to maintain acid-base balance.,pH,acidosis alkalosis,metabolic respiratory,原因,Simple acid-base disturban

10、ce,Ⅲ. Respiratory acidosis,Causes: Box 10-2Assessment: Table 10-1,Causes of respiratory acidosis,Asthma 哮喘Atelectasis 肺不張Brain trauma 腦外傷Bronchiectasis 支氣管擴張Bronchitis 支氣管炎Central nervous system depressants CNS抑制劑

11、Emphysema 肺氣腫Hypoventilation 通氣不足Pulmonary edema 肺水腫Pneumonia 肺炎Pulmonary emboli 肺栓塞,Box 10-2,Any condition that causes an obstruction of the airway or depresses the respiratory system can cause respiratory acidosis

12、.,Interventions,Administer oxygen as prescribedSemi-Fowler’s position半臥位Encourage and assist the client to turn, cough, and deep-breathe鼓勵并協(xié)助病人翻身、咳嗽及深呼吸Encourage hydration to thin secretions鼓勵病人多喝水Suction the client’

13、s airway, if necessary吸痰 Monitor electrolyte values, particularly the potassium level,Ⅳ. Respiratory Alkalosis,,Description: accumulation of base, orA loss of acid without a comparableLoss of base H2CO3 不足,pH,,

14、,Ⅳ. Respiratory Alkalosis,Causes: Overstimulation of respiratory systemFever發(fā)熱Hyperventilation 過度通氣Hypoxia 缺氧Hysteria癔病（歇斯底里）Overventilation by mechanical ventilatorPain,Ⅳ. Respiratory Alkalosis,Interventions:Ass

15、ist with breathing techniques and breathing acids as prescribed.a. Encourage voluntary holding of the breath if appropriateb. Provide use of a rebreathing mask as prescribedc. Provide carbon dioxide breaths as prescri

16、bed (rebreathing into a paper bag) Monitor electrolyte values, paticular potassium and calcium levels.Prepare to administer calcium gluconate for tetany（手足抽搐）as prescribed.,Ⅴ. Metabolic Acidosis,,Description: loss of

17、too much base or/and retention of retention of toomuch acid buffer base ,pH,,,,Causes of Metabolic Acidosis,Diabetes mellitus（糖尿?。﹐f diabetic ketoacidosis（酮癥酸中毒）Excessive ingestion of aspirin過度攝入阿司匹林High-f

18、at dietInsufficient metabolism of carbohydratesMalnutritionRenal insufficiency, acute kidney injury, or chronic kidney diseaseSevere diarrhea,Ⅴ. Metabolic Acidosis,Assessment:Hyperpnea(呼吸急促) with Kussmaul’s respira

19、tion occurs (see Table 10-1),Ⅴ. Metabolic Acidosis,Interventions:Assess level of consciousness for central nervous system depressionMonitor intake and output and assist with fluid and electrolyte replacement as presc

20、ribedPrepare to administer solutions intravenously as prescribed to increase the buffer base..Initiate safety and seizure precautions.Monitor the serum potassium level closely.Interventions in diabetes mellitus and

21、diabetic ketoacidosis.Give insulin as prescribed,Monitor the client experiencing severe diarrhea for manifestations of metabolic acidosis.,Ⅵ. Metabolic Alkalosis,,Description: accumulation of base orA loss of acid wit

22、hout a comparableloss of base H2CO3 deficit ,pH,,,Causes of Metabolic Alkalosis,Dysfunction of metabolism代謝功能障礙Diuretics利尿劑Excessive vomiting or gastrointestinal suctioningHyperaldosteronismIngestion of and/

23、or infusion of excess sodium bicarbonateMassive transfusion of whole blood,Ⅵ. Metabolic Alkalosis,,Assessment:Respiratory rate and depth decrease toconserve CO2(see Table 10-2),Ⅵ. Metabolic Alkalosis,Interventions:

24、Monitor potassium and calcium serum levels. Prepare to administer medications to promote the kidney excretion of bicarbonate. Prepare to replace potassium chloride as prescribed.,Ⅶ. Arterial Blood Gases動脈血氣,,A: Coll

25、ection of an arterial blood gasSpecimen,1. Obtain vital signs.2. Determine whether the client has an arterial line in place (allows for arterial blood sampling without further puncture to the client).3. Perform the A

26、llen’s test to determine the presence of collateral circulation 4. Assess factors that may affect the accuracy of the results, such as changes in the O 2 settings, suctioning within the past 20 minutes, and client’s act

27、ivities.5. Provide emotional support to the client.6. Assist with the specimen draw by preparing a heparinized syringe (if not already prepackaged).7. Apply pressure immediately to the puncture site following the bloo

28、d draw; maintain pressure for 5 minutes or for 10 minutes if the client is taking an anticoagulant.8. Appropriately label the specimen and transport it on ice to the laboratory.9. On the laboratory form, record the cli

29、ent’s temperature and the type of supplemental oxygen that the client is receiving.,Allen’s Test,1. Explain the procedure to the client.2. Apply pressure over the ulnar and radial arteries simultaneously.3. Ask the cli

30、ent to open and close the hand repeatedly.4. Release pressure from the ulnar artery while compressing the radial artery.5. Assess the color of the extremity distal to the pressure point.6. Document the findings.,4-ste

31、p,Step 1pH↑→alkalosis堿中毒pH↓→acidosis酸中毒Step 2 Pco2 ↑ +pH↓ respiratory acidosis呼吸性酸中毒Pco2 ↓ +pH↑respiratory alkalosis呼吸性堿中毒Step 3 HCO3- ↑ +pH ↑ metabolic alkalosis代謝性堿中毒HCO3- ↓ +pH↓ metabolic acidosis代謝性酸中毒Step 4

32、 Compensation,,,CRITICAL THINKING,What Should You Do?The nurse performs an Allen’s test on a client scheduled for an arterial blood gas draw from the radial artery. On release of pressure from the ulnar artery, color i

33、n the hand returns after 20 seconds. The nurse should take which action(s)?,,Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial

34、 artery occurs with arterial puncture. Upon release of pressure on the ulnar artery, if pinkness fails to return within 6 to 7 seconds, the ulnar artery is insufficient, indicating that the radial artery should not be us

35、ed for obtaining a blood specimen. Another site needs to be selected for the arterial puncture and the health care provider needs to be notified of the finding.,,The nurse reviews the arterial blood gas results of a clie

36、nt and notes the following: pH 7.45, Pco 2 of 30 mm Hg, and HCO3- of 20 mEq/L. The nurse analyzes these results as indicating which condition?1. Metabolic acidosis, compensated2. Respiratory alkalosis, compensated3. M

37、etabolic alkalosis, uncompensated4. Respiratory acidosis, uncompensated,2,,The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client

38、 is at risk for which acid-base disorder?1. Metabolic acidosis2. Metabolic alkalosis3. Respiratory acidosis4. Respiratory alkalosis,2,,A client who is found unresponsive has arterial blood gases drawn and the results

39、 indicate the following: pH is 7.12, Pco 2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition?1. Metabolic acidosis with compensation2. Respiratory acidosis with compens

40、ation3. Metabolic acidosis without compensation4. Respiratory acidosis without compensation,4,,The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that th

41、e client is experiencing respiratory acidosis. Which result validates the nurse’s findings?1. pH 7.25, Pco 2 50 mm Hg2. pH 7.35, Pco 2 40 mm Hg3. pH 7.50, Pco 2 52 mm Hg4. pH 7.52, Pco 2 28 mm Hg,1,,The nurse plans c

42、are for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-base imbalance?1. Metabolic acidosis2. Metabolic alkalosis3. Respiratory