LESSON ¹ 18
(PRACTICAL – 6 HOURS)
Theme: Acid-Based
Balance.
Aim: To be able to perform nursing interventions according to nursing care
plan and needs of the patient, to learn how properly evaluate the quality of
care and outcomes for the patient.
Professional orientation
of students: Acid-base balance within the body is necessary to
maintain health and function in all body systems. This balance is maintained by
the intake and output of water and electrolytes and regulation by the renal and
pulmonary systems. Imbalances may result from many factors, including
illnesses, altered fluid intake, or prolonged episodes of vomiting or diarrhea.
Acid-base balance is necessary for many physiological processes, and unbalances
can alter respiration, metabolism, and the function of central nervous system.
Knowledge and understanding of the mechanisms that contribute acid-base balance
are essential.
Methodology of Practical Class: 9:00-12:00
Algorithm of students’ communication
with patients with pathology in subject (communication skills)
During
examination of the patient students have to use such communicative algorithm.
Complaints
and anamnesis taking in patients.
1. Friendly facial expression
and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Take complaints and
anamnesis in a patient.
5. Explain to the patient
results of his/her lab tests correctly and accessibly.
6. Explain to the patient your
actions concerning him/her (the necessity of hospitalization, certain
examinations and manipulations), which are planned in future.
7. Conversation
accomplishment.
Objective examination:
Physical methods of
examination of patients with internal diseases
1. Friendly facial expression
and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient, what
examinations will be carried out and get his/her informed consent.
5. Find a contact with the
patient and make an attempt to gain his/her trust.
6. Inform about the
possibility of appearing of unpleasant feelings during the examination.
7. Prepare for the examination
(clean warm hands, cut nails, warm phonendoscope,
etc.).
8. Examination (demonstration
of clinical skill).
9. Explain to the patient
results of his/her lab tests correctly and accessibly.
10. Conversation
accomplishment.
Estimation of laboratory and instrumental investigations
Informing about the results of
examination of patients with internal diseases
1. Friendly facial expression
and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient
results of his/her lab tests correctly and clearly.
5. Involve the patient into
the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly
understood).
Planning and prognosis the
results of the conservative treatment
Friendly
facial expression and smile.
1. Gentle tone of speech.
2. Greeting and introducing.
3. Correct and clear
explanation of necessary treatment directions.
4. Discuss with a patient the
peculiarities of taking medicines, duration of their usage, possible side
effects; find out whether your explanations are clear for him/her or not.
5. Conversation accomplishment.
Work 1. Master the next practical skills
Practical Skill Preparing
an IV Solution
Practical
Skill Starting
an IV
Practical
Skill Inserting a Butterfly Needle
Practical
Skill Preparing the IV Bag and Tubing
Practical
Skill Setting the IV Flow Rate
Practical
Skill Assessing and Maintaining an IV Insertion
Site
Practical
Skill Changing the IV Solution
Practical
Skill Discontinuing the IV and Changing to a
Heparin Lock
Practical
Skill Administering a Blood Transfusion
Work 2:
Write a NCP for the following situational
task:
Bobby Warder, 54 years old, is being admitted
with Congestive Heart Failure (CHF). Upon assessment, the nurse finds the
following data: has gained five pounds in the last two days, a bounding pulse
rate of 110 and blood pressure of 160/100, and distended neck veins. Upon
auscultation, the nurse discovers his lungs have crackles (rales)
in the bases. Develop a nursing care plan for Mr. Warder.
Seminar discussion
of theoretical
issues: 12:30-14:00
1.
Identify
the variables affecting normal acid-based balance.
2.
Discuss
the clinical assessment for the client for acid-based balance.
Initial level of knowledge and skills are checked by
solving situational tasks for each topic, answers in test evaluations and
constructive questions.
(the instructor has tests & situational tasks)
1. What is the best explanation for why
changes in blood pH reflect the adequacy of acid-base homeostatic mechanisms?
A.
Body fluid pH is a measure
of the blood hydrogen ion concentration, and the acid-base homeostatic
mechanisms control this concentration.
B.
Body fluid pH is a
measure of the blood bicarbonate concentration, and the acid-base homeostatic
mechanisms control this concentration.
C.
When homeostatic
mechanisms are functioning properly, the blood electrolyte concentrations are
normal, as measured by pH.
D.
When body fluid pH is
normal, acid-base homeostatic mechanisms are not needed.
2. What
is the most correct description of normal arterial blood pH with regard to
acid-base balance?
A.
Arterial blood has a
neutral pH.
B.
Arterial blood is
slightly acidic.
C.
Arterial blood is
slightly alkaline.
D.
Arterial blood maintains electroneutrality.
3. When
a client has an arterial blood pH of 7.48, what action by a buffer will bring
the pH back to normal?
A.
Absorb bicarbonate ions
from the blood
B.
Release bicarbonate ions
into the blood
C.
Absorb hydrogen ions from
the blood
D.
Release hydrogen ions
into the blood
4. Which
statement most accurately describes the relationship between the hydrogen ion
concentration and carbon dioxide concentration in extracellular fluids?
A.
Because carbon dioxide is
a gas and hydrogen ions are electrolytes, these two substances have no relationship
in extracellular fluids.
B.
The concentrations of
hydrogen ions and carbon dioxide are directly related, with an increase or
decrease in one always resulting in a corresponding increase or decrease in the
other.
C.
Carbon dioxide buffers
hydrogen ions; thus, these two concentrations are inversely related to each
other. The higher the carbon dioxide concentration, the fewer hydrogen ions are
present in that fluid.
D.
Hydrogen ions and carbon
dioxide ions exist in a balanced relationship as a result of their charges. The
positively charged hydrogen ions are attracted to the negatively charged carbon
dioxide ions, forming an electrically neutral substance.
5. In
what ways do changes in oxygen concentration affect acid-base balance?
a.
Oxygen deficiency results
in increased carbon dioxide production and acidosis.
b.
Oxygen deficiency results
in increased carbon dioxide production and alkalosis.
c.
Oxygen excess results in
decreased carbon dioxide production and acidosis.
d.
Oxygen excess results in decreased
carbon dioxide production and alkalosis.
6. How
would acid-base balance be affected in a person who has low levels of
hemoglobin?
A.
Acid-base balance would
be unaffected, because hemoglobin has no role in acid-base balance.
B.
Low levels of hemoglobin
would reduce the amount of oxygen available to tissues and increase the
formation of hydrogen ions.
C.
Because hemoglobin and
bicarbonate have opposite actions, low levels of hemoglobin would result in a
slightly more alkaline environment of the blood.
D.
Because hemoglobin serves
as a major intracellular protein buffer, the person with low hemoglobin levels
would be less able to compensate for mild acidosis.
7. The
client has an arterial blood gas pH of 7.42. How should the nurse interpret
this client’s acid-base status?
A. The client has no blood hydrogen ions.
B. The client has a normal blood hydrogen ion concentration.
C. The client has a deficit in the blood hydrogen ion concentration.
D. The client has an excess in the blood hydrogen ion concentration.
8. What
type of acid-base imbalance should the nurse be most alert for in the client
who has hypoxemia?
A.
Reduced carbon dioxide
production, alkalosis
B.
Reduced carbon dioxide
retention, alkalosis
C.
Excess carbon dioxide
production, acidosis
D.
Excess carbon dioxide retention,
acidosis
9. Which
client is at greatest risk for acidosis?
A. The 78-year-old client on diuretic therapy with furosemide
(Lasix, Furoside)
B. The 62-year-old client with moderate hypertension
C. The 75-year-old client with peptic ulcer disease
D. The 45-year-old client with pneumonia
10. Which
acid-base imbalance should the nurse be prepared for
in a client who has acute pancreatitis?
A.
Metabolic acidosis
B.
Metabolic alkalosis
C.
Respiratory acidosis
D.
Respiratory alkalosis
Student should
know:
1. Differences between:
2. What type of nursing interventions to perform for
particular patient with acid-based imbalance.
Student should be able to:
1.
Describe the regulation
of acid–base balance in the body, including the roles of the lungs, the
kidneys, and buffers.
2.
Identify factors
affecting normal body acid–base balance.
3.
Discuss the risk factors
for and the causes and effects of acid–base imbalance.
4.
Collect assessment data related
to the client’s acid–base balance.
5.
Identify examples of
nursing diagnoses, outcomes, and interventions for clients with altered
acid–base balance.
6.
Implement measures to
correct imbalances of acids and bases such as enteral
or parenteral replacements and blood transfusions.
7.
Evaluate the effect of
nursing and collaborative interventions on the client’s acid–base balance.
Correct answers of
test evaluations and situational tasks:
1. A
2. C
3. D
4. B
5. A
6. D
7. B
8. C
9. D
10.
A
References:
Basic:
1.
Ternopil State
Medical University http://intranet.tdmu.edu.ua/data/kafedra/internal/i_nurse/classes_stud/en/BSN-%284y%29/3%20year/1%20sem/Foundations%20of%20Nursing%20Practicum/18.%20Acid-Base%20Balance.htm
2.
Potter & Perry, Chapter 38, pp. 959-999.
3.
Study Guide: Chapter 38Altman G.
Delmar’s fundamental and advanced nursing skills book, pp. 121-234.
4.
Kozier
& Erb's Fundamentals Of Nursing: Concepts,
Process, And Practice Eighth Edition Audrey Berman, Shirlee
Snyder, Barbara Kozier, Glenora
Erb,
Additional:
1.
Potter and Perry.
Fundamentals of Nursing. – 6th edition.
– Mosby, Inc.
2.
Study Guide and Skills Performance
Checklist to Accompany Potter and Perry’s Fundamentals of Nursing. – 6th edition. – Mosby, Inc.
3.
Altman G. Delmar’s
fundamental and advanced nursing skills book / G.Altman, P. Buschel, V.Coxon. – Thomson Learning ©
WEB
RESOURCES
National Health
Information Center http://nhic-nt.health.org
American Nurses
Association http://www.nursingworld.org
Certification
Board of Infection Control and Epidemiology www.cbic.org
HealthCare Report
Cards www.healthcarereportcards.com
Hospital
Infections Program, Centres for Disease Control and Prevention www.cdc.gov
Methodical instruction has
been worked out by: T. Yu. Rybalka
Methodical
instruction was discussed and adopted at the
Department sitting
11 June 2012. Minute ¹ 13
Methodical
instruction was adopted and reviewed at the
Department sitting
12 June 2013. Minute ¹ 13
The Head of
Clinical Immunology,
Alergology and General Patients Care Prof. I. Ya.
The Head of
Assistant of Clinical Immunology,
Alergology and General Patients Care Department T.Yu.
Rybalka BSN, MSN