3. Acid: is any proton donor (a molecule that releases a
proton H+ in water).
e.g. hydrochloric acid(HCL), carbonic acid, lactic acid
Base: is a proton acceptor (a substance accept H+
often with the release of hydroxyl (OH-) ions).
e.g. Hydroxyl ion (OH-), Bicarbonate (HCO3)
4. Acid-base balance is very important for the
homeostasis of the body and almost all the
physiological activities depend upon the acid base
status of the body.
• Acids are constantly produced in the body.
• However, the acid production is balanced by the
production of bases so that the acid-base status of
the body is maintained
5. Hydrogen ion (H+) contains only a single proton
(positively charged particle).
• It is the smallest ionic particle, it is highly
reactive.
• The pH is another term for H+ concentration
that is generally used nowadays instead of
‘hydrogen ion concentration’
6. Power Of Hydrogen
pH is the negative logarithm of hydrogen ion
concentration in solution.
An increase in H+ ion concentration decreases the pH
(acidosis) and a reduction in H+ concentration increases
the pH (alkalosis).
• In a healthy person, pH value:
Arterial blood: 7.41
Venous blood: 7.35
pH of arterial blood gas is 7.35 - 7.45
7.
8. Effects of changes in pH scale
■ Changes in excitability of nerve and muscle cells
■ Influences enzymes activity
■ Influences k+ level
12. Acidosis
It refers to any pathological condition that causes a
relative excess of acid in the body
Acidosis is the reduction in pH (increase in H+
concentration) below normal range.
• Acidosis is produced by:
1. Increase in partial pressure of CO2 in the body fluids
particularly in arterial blood
2. Decrease in HCO3– concentration.
15. Respiratory acidosis
■ It is a state of relative excess of acid in the body fluid
resulting from retention or excessive production of
carbon dioxide.
■ It is an acid-base imbalance characterized by
increased partial pressure of carbon dioxide and
decreased blood ph.
18. Pathophysiology
Different contributing factor leads to alveolar hypoventilation.
During hypoventilation the lungs fail to expel CO2.
CO2 accumulates in blood where it reacts with water to form
carbonic acid
Carbonic acid dissociates into H+ and HCO3 –.
The increased H+ concentration in blood leads to decrease in pH
and acidosis.
21. Medical management
■ Increase ventilation via oxygen therapy.
■ Treat the underlying causes.
■ Correct electrolytes imbalance.
■ Mechanical ventilation adjusted to gradually decrease
carbon dioxide.
22. Nursing management
1. Assessment
■ Assess patients vitals signs especially respiratory
pattern, oxygen saturation.
■ Assess for the patient general condition, altered mental
status.
■ Assess for extremities for color, temperature, moisture.
■ Assess for laboratory findings.
■ Monitor intake and output.
23. 2. Nursing diagnosis
Impaired gas exchange related to different contributing
factors.
Ineffective breathing pattern related to different
contributing factors.
Ineffective tissue perfusion related to hypoventilation.
Acute confusion related to hypoxemia
Risk for injury related to dizziness, drowsiness
24. 3. Nursing intervention
■ Administer oxygen therapy, low flow rate in COPD
patient
■ Assist with positioning.
■ Maintain hydration (IV/PO) and provide
humidification.
■ Provide appropriate chest physiotherapy, including
postural drainage and breathing exercises.
25. Cont.…
■ Restrict use of hypnotic sedatives or tranquilizers
■ Administer Naloxone hydrochloride (Narcan), to over
counter effect of sedatives or opioids.
■ Monitor and graph serial ABGs, pulse oximetry
readings; Hb, serum electrolyte levels.
■ Sodium bicarbonate (NaHCO3) to correct acidosis
■ Administer IV solutions such as lactated Ringer’s
solution
27. Metabolic Acidosis
It is an acid base imbalance resulting from excessive
absorption or retention of acid or excessive excretion of
bicarbonate.
Metabolic acidosis is the acid-base imbalance characterized
by excess accumulation of organic acids in the body, which is
caused by abnormal metabolic processes.
Organic acids such as lactic acid, ketoacids and uric acid are
formed by normal metabolism.
32. Medical management
■ Treat the underlying condition
e.g.
– Administer insulin to control diabetes.
– Anti diarrheal drugs for diarrhea.
– Treat the poisoning by removing toxin.
33. Cont.…
■ Adequate hydration and electrolyte balance.
■ Restore tissue perfusion to the hypoxic tissue.
■ Intravenous sodium bicarbonate can be given in severe
acidosis.
34. Cont.…
■ Strict intake and output charting.
■ Frequent ABG analysis.
■ In case of not responding, dialysis is alternative
35. Nursing management
A. Assessment
• Monitor vitals signs, heart rate and rhythm
• Observe for altered respiratory excursion, rate, and
depth.
• Assess skin temperature, color, capillary refill.
• Monitor I&O closely and weigh daily.
36. Cont.…
• Assess Loss of consciousness and note progressive
changes in neuromuscular status. Note
neuromuscular strength, tone, movement.
• Monitor and graph serial ABGs.
• Monitor serum electrolytes, especially potassium.
37. B. Nursing diagnosis
■ Decreased cardiac output related to the acidosis
■ Risk for excess fluid volume related to correction
therapy
■ Risk for injury related to disease condition
38. C. Implementation
■ Replace fluids, as indicated depending on underlying
etiology:
D5W or saline solutions.
■ Intravenous Sodium bicarbonate infusion for severe
acidosis
■ Intravenous calcium phosphate 10% infusion slowly
over 10 mins to correct hyperkalemia
■ Dextrose insulin also can be given to correct lactic
acidosis and hyperkalemia.
39. Cont.…
■ Modify diet as indicated: low-protein, high-
carbohydrate diet in presence of renal failure or
Diabetes diet for the person with diabetes.
■ Maintain urine output, provide diuretic or assist with
dialysis as indicated
■ Provide seizure or coma precautions and bed in low
position, use of side rails, frequent observation.
■ Provide oral hygiene with chlorhexidine mouth wash,
lemon, glycerin swabs.
