NURSING SCIENCES

ACID-BASE BALANCE
 HYDROGEN IONS, ACIDS,
AND BASES
 HYDROGEN IONS (H+)

 ACIDS

 BASES

 PH
Normal arterial pH is 7.35 – 7.45
ACID-BASE BALANCES
 Acidosis – pH < 7.35

 Alkalosis – pH > 7.45

 Buffers
PRIMARY BUFFER SYSTEMS
IN EXTRACELLULAR FLUID
 REGULATION OF ACIDS
AND BASES
 THE BIG THREE ACID-BASE
REGULATORS

 Chemical regulation
 Biological regulation
 Physiological regulation
 PHYSIOLOGICAL
REGULATION

 Alkalosis

 Acidosis
ACID – BASE IMBALANCES
 RESPIRATORY
ACIDOSIS
 RESPIRATORY

ALKALOSIS
 METABOLIC ACIDOSIS

 METABOLIC ALKALOSIS
ARTERIAL BLOOD GASES
 NORMAL BLOOD GAS
VALUES
 pH 7.35-7.45
 PCO 35-45
2
mmHg
 HCO 22-27
3
mEq/L
 PO 80-100
2
mmHg
ARTERIAL BLOOD GASES
 RESPIRATORY IMBALANCES
 Respiratory function indicator is

PCO2
 Opposite response between the

pH and PCO2
 pH is down in an acidotic

condition and is elevated in an

alkalotic condition
 pH and PCO determines if the

condition is a respiratory
ARTERIAL BLOOD GASES
 METABOLIC IMBALANCES
 HCO3 is indicator for metabolic

function
 A corresponding response

between the pH and the HCO3

 pH is down in an acidotic

condition and is elevated in an

alkalotic condition
 The pH and the HCO determines
3
ANALYZING ARTERIAL
BLOOD GAS RESULTS
 PYRAMID STEPS
 Look at the blood gas report
 PYRAMID STEP 1
 Look at the pH. Is it up or down? If it is up,
it reflects alkalosis. If it is down, it reflects
acidosis.
 PYRAMID STEP 2
 Look at the PCO2. Is it up or down? If it
reflects an opposite response as the pH
then you know that the condition is a
respiratory imbalance. If it does not reflect
an opposite response as the pH, then move
ANALYZING ARTERIAL
BLOOD GAS RESULTS
 PYRAMID STEP 3
 Look at the HCO3. Does the HCO3 reflect a
corresponding response with the pH? If it
does, then the condition is a metabolic
imbalance.
 PYRAMID STEP 4
 Remember, compensation has occurred if
the pH is in a normal range of 7.35-7.45.
 If the pH is not within normal range, look at
the respiratory or metabolic function
indicators.
FLUID, ELECTROLYTE &
ACID -BASE
 REMEMBER~~~~

 NORMAL CHEMISTRY LABORATORY VALUES

 Serum electrolyte levels

 CBC (changes in Hct related to FVD & FVE)
 BUN & Blood Creatinine Levels (kidney
functions)
 Urine Specific gravity (normal 1.003 –
1.023)
 ABG’s
LUID, ELECTROLYTE &
ACID -BASE
 OVERALL GOALS/EVALUATION

 NORMAL FLUID, ELECTROLYTE AND ACID

BASE BALANCE

 CAUSES OF IMBALANCES IDENTIFIED OR

CORRECTED

 NO COMPLICATIONS FROM THERAPIES

NEEDED TO RESTORE BALANCE

 INCLUDE FAMILY IN PROCESS