Acid-Base Imbalances:

The acid-base levels are based on pH, CO2, PaCO2, O2, PaO2, HCO2 and H. Changes in these levels cause acid-base imbalances. ABGs must be obtained to determine accurate readings when a patient's respiratory status is impaired.

Normal blood gas values:

- pH: 7.35 – 7.45

- PaCO2: 35 – 45 mmHg

- PaO2: 80 – 100 mmHg

- HCO3: 22 – 26 mEq/L

Changes in acid-base balance:

Respiratory acidosis: can be caused by COPD, pneumonia, hypoventilation and asthma. Symptoms are rapid/ shallow respirations, confusion, and hypoxemia.

Nursing interventions are maintain oxygen saturation levels and airway and treat underlying cause.

- PaCO2 is increased above 45 mmHg.

- pH is decreased below 7.35.

respiratory alkalosis: caused by hyperventilation and stress. Symptoms are muscle twitching, deep/rapid breathing, dizziness, tingling of the fingers and difficulty breathing. Nursing interventions are treat the underlying cause and consider using a rebreathing mask, calm the patient and encourage slow breathing.

- PaCO2 is decreased below 35 mmHg

- pH is increased above 7.45

metabolic acidosis: caused by renal failure, diarrhoea, diabetes, vomiting and shock. Symptoms are fruit breath, nausea, vomiting, diarrhoea, headache and increased potassium.

Nursing interventions: administer IV sodium bicarbonate and maintain respiratory status, ensure proper nutrition and adequate hydration and monitor potassium levels. - Decreased pH <7.35

- Decreased HCO3 <22 mEq/L

Metabolic alkalosis: caused by vomiting and excessive intake of antacids and gastric suctioning. Symptoms are tingling, irritability, confusion, tetany, decreased respirations and muscle cramping, potassium is also decreased.

Nursing interventions are administer IV fluids, monitor electrolytes, increase potassium and treat the cause.

- Increased pH: >7.45

- Increased HCO3 >26 mEq/L