ARTERIAL BLOOD GASES (ABGs) Imbalances for Nursing School & NCLEX | FEARLESSRN

By: FearlessRN

Hey guys! Welcome back, so here's the next video in the ABG series. So if you haven't watched the first video please take some time out to watch that and I hope that you find that video helpful. Today I will be talking about acid-base imbalances. So respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. I'll share with you some signs and symptoms, the pathophysiology or what's really going on - as well as the treatment. If you're interested then keep on watching.

And if you like this video, give it a thumbs up and subscribe! Thanks! =) Now let's begin! Keep in mind that when you are trying to identify differences between respiratory acidosis, respiratory alkalosis, metabolic acidosis and metabolic alkalosis; you want to have the normal values in mind. Respiratory acidosis: Here the patient is not breathing enough so the patient is - HyPOventilating! When you hypoventilate that means that you're retaining-- you're holding on to too much carbon dioxide or acid. And remember as I mentioned in the previous video, whenever you hold on to acid it causes the brain to mess up.

So what can be some causes of respiratory acidosis? It could be trauma, mid abdominal incision so maybe you know the patient has abdominal surgery and it hurts to breathe. So you're not going to breathe as much - they're in pain. Narcotics such as anesthetics.

Those will depress the respiration definitely! Even Neurological disease such as guillain-barre a and myasthenia gravis and of course there's many more causes so you know, do your research & figure that out or I'll leave some right here. So what are some signs and symptoms? So since there's a buildup of acid it's going to cause you to have a headache. The patient may also be confused and very drowsy or sleepy and hypoxia. So with respiratory acidosis the body needs to get rid of all this acid. So here, the compensation will occur via the kidneys! Because the lungs are messed up at this point.

ARTERIAL BLOOD GASES (ABGs) Imbalances for Nursing School & NCLEX | FEARLESSRN

Treatment for respiratory acidosis is to treat the patient with oxygen. They're not breathing as much, we want to fix that problem. Now let's get into Respiratory alkalosis: Here the patient is hyperventilating, they are breathing too much. So they blowing off all the acid and therefore they're retaining or keeping the base.

So what are some causes of hyperventilation? Anxiety, panic attack fear, acute aspirin overdose, excessiv mechanical ventilation. Some signs and symptoms will be headache, faintness, numbness and tingling sensations in your fingers and toes! Why? Because the body is having a lack of oxygen so if there's lack of oxygen there's no blood circulation to those body parts. So therefore you're going to fine those signs of symptoms to be occurring because the body is trying to tell you "hey there's something wrong" so you have to fix the problem. So hey? how will we fix this problem? The first thing we want to do is have the patient breathe into a brown paper bag and I'm sure you heard of that before. This forces the patient to breathe back in all the co2 because remember the patient is hyperventilating, they're breathing too much. So they blowing off too much co2 B acid and they're left with a lot of base. Remember whenever there is an imbalance meaning too high or too low the body does not like it. You can't eventually lead to death so that's why you would see someone breathing into a brown paper bag because you want them to trap that co2 or the acid and breathe it right back in.

And also another way if you want to keep the patient really calm because at this point if they're hyperventilating maybe they had a panic attack you know sometimes I have panic attacks when I'm driving up hills and it's really horrible. But you want to also try to find ways to keep that patient calm. You want to talk to the patient, you know, distract them a little bit so they can calm down and slow their breathing. Now we're going to begin to talk about Metabolic so obviously previously was the respiratory which dealt with the lungs and the lungs were the problem. Now we're going to talk about the kidneys so metabolic and here the kidneys are the problem. So in metabolic acidosis the kidneys are sick , so what would be the pH level here? Do you know comment below. Well the pH level is going to be very low, remember acidosis means its less than 7.35. So here the patient is retaining too much hydrogen.

Hydrogen is an acid! Maybe they don't have enough bicarb which is a base. So here the patient will hyperventilate to get rid of the acid! What are some causes of metabolic acidosis? Remember the patient is hyperventilating! It can be diabetic ketoacidosis that's DKA and that is when the patient has a very high blood glucose levels that causes the patient to have increased respirations and those respirations are called Kussmaul respirations. So they are very deep and rapid! Another cause would be aspirin or salicylic overdose, intoxication which we mentioned before. Also starvation like if a person has anorexia or bulimia and seizure activity and also severe diarrhea.

Remember diarrhea, when someone has diarrhea it contains a lot of acid so you are letting go of a lot of acid. So a trick that I learned and I've also heard all over is that when you think about metabolic acidosis you know, diarrhea it comes out the you-know-what so that's a good way to remember it. So some signs and symptoms would be hyperkalemia, so there is an increase of potassium. When there's an increase of potassium there's going to be muscle twitching, muscle weakness and arrhythmia.

Increase in respirations, so they're blowing off too much acid. So as for treatment you want to treat the cause. It can be any of the causes mentioned previously and you want to give the patient an IV push of bicarb or sodium bicarb. Now let's talk about Metabolic alkalosis: Patients retaining too much base and getting rid of too much hydrogen acid. So here the pH level is going to be high or low? It's going to be high because the patient has to be above 7.45 Right? Loss from upper GI tract so that means from the mouth it could be from vomiting or maybe or can be NG tube connected to suction. Also the person has a large intake of and acids that can also cause metabolic alkalosis because a lot of antacids contain bass.

Maybe the patient receives too much sodium bicarb (IV bicarb) or there's a depletion in Potassium. Diuretics such as thiazide diuretics so you're going to be you know urinating a lot more frequently and therefore you're going to be letting go of the potassium. Also depletion of Potassium can be due to laxative abuse and Cushing's syndrome.

So some signs & symptoms would be hypokalemia, cause remember there's a depletion so it's low potassium levels. Tachycardia because the body is sensing that something is wrong. Muscle cramps and arrhythmias.

So as for treatment you want to treat the cause which can be anything that we mentioned previously and you want to replace potassium because it's low. You wanna give oral potassium. It can be either through dietary measures such as eating a banana, raisins etc there's so much more.

Or can be given IV pump. Here is something you should remember!!! Metabolic acidosis is from the lower GI so it's going to be from diarrhea, so they're going to have HYPERKALEMIA! Whereas Metabolic alkalosis... Alkalosis,,, you're losing it from the upper GI.

So you're going to be vomiting and you're going to have HYPOKALEMIA. Now this concludes this video for the acid-base imbalances, signs and symptoms and treatments. I hope that this video was informative for you and helpful and you know easy to understand as best as I can make it .And if you do have any commentary or anything to say please leave it down below I'd love to hear your feedback and if you found it helpful this video, thumbs up and you know, join the FearlessRN family and subscribe today and do me a favor and share this video out! Somebody may need some help so if you think they do and share this video! Thank you so much for watching and stay tuned for the next video! Bye! Stay Blessed and good luck!!!.

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