Diseases & Disorders - A Nursing Therapeutic Manual : a by Marilyn Sommers

By Marilyn Sommers

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2). Sodium bicarbonate may be administered by intravenous drip or by intravenous push. Overmedication of sodium bicarbonate may cause metabolic alkalosis, fluid volume overload, hypokalemia, and worsened acidosis. qxd 11/7/06 10:49 AM Page 24 PMAC-291 PMAC-291:Books:DAMS/DART/ARCHIVE 24 Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis large quantities of isotonic saline solutions should not be administered to patients with suspected renal failure. These drugs may contribute to the development of metabolic acidosis.

Determine if the patient has experienced headache, lethargy, blurred vision, confusion, or nausea. Respiratory Alkalosis. Establish a history of hyperventilation from anxiety or mechanical overventilation. Early manifestations involve changes in neurological and neuromuscular status due to decreased PaCO2 levels (hypocapnia), which may lead to decreased cerebral perfusion. Determine if the patient has experienced lightheadedness, anxiety, the inability to concentrate, or confusion. Elicit a patient history of muscle cramps, spasms, tingling (paresthesia) of the extremities, and circumoral (around the mouth) numbness.

Note cardiovascular abnormalities, such as tachycardia, hypertension, and atrial and ventricular dysrhythmias. During periods of acute respiratory acidosis, monitor the cardiac rhythm continuously. Take the patient’s pulse, noting a bounding quality characteristic of hypercapnia. If the cause of the respiratory acidosis is respiratory center depression or respiratory muscle paralysis, respirations are slow and shallow. As respiratory acidosis worsens and respiratory muscles fail, the rate of respirations decreases.

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