Acid–Base Balance, ABG Interpretation, and Clinical Nursing Care | Chapter 9 from Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition)

Acid–Base Balance, ABG Interpretation, and Clinical Nursing Care | Chapter 9 from Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition)

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Welcome to Chapter 9 of the Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri. Acid–base balance is a cornerstone of clinical nursing, affecting every body system and requiring sharp lab interpretation and critical thinking skills. This chapter provides all the tools you need for success on the NCLEX-PN and safe, effective patient care.

Watch the comprehensive video summary below, and subscribe to Last Minute Lecture for every NCLEX-PN chapter review:

Understanding Acid–Base Balance: The Foundations

  • Hydrogen ions (H+): Central to acid–base balance and pH regulation.
  • Acids and bases: Acids donate H+; bases accept H+ in the body’s chemical reactions.
  • Buffer systems: Hemoglobin, bicarbonate, phosphate, and plasma proteins minimize pH fluctuations.
  • Potassium’s role: Shifts in/out of cells to help maintain acid–base homeostasis, affecting serum levels during imbalances.

Body Systems: Respiratory and Renal Regulation

  • Respiratory system: Adjusts carbon dioxide (CO₂) exhalation to control acid levels. Hypoventilation → acidosis; hyperventilation → alkalosis.
  • Renal system: Excretes or retains H+ and HCO₃⁻ (bicarbonate) for long-term pH regulation.

ABG Interpretation: Normal Values and the “Pyramid Steps”

  • pH: 7.35–7.45
  • PaCO₂: 35–45 mmHg (respiratory component)
  • HCO₃⁻: 22–26 mEq/L (metabolic component)

Apply the “Pyramid Steps” to quickly diagnose acid–base disorders:

  1. Check pH: Acidotic or alkalotic?
  2. Assess PaCO₂ and HCO₃⁻: Which matches the pH (respiratory or metabolic)?
  3. Is there compensation by the other system?

Types of Acid–Base Imbalances: Causes, Symptoms, and Nursing Care

  • Respiratory Acidosis:
    • Causes: COPD, hypoventilation, airway obstruction
    • Symptoms: confusion, headache, hypoxia, tachycardia
    • Interventions: airway support, improve ventilation, monitor ABGs
  • Respiratory Alkalosis:
    • Causes: hyperventilation, anxiety, pain
    • Symptoms: lightheadedness, numbness, tetany, palpitations
    • Interventions: slow breathing, manage anxiety, monitor for hypokalemia
  • Metabolic Acidosis:
    • Causes: DKA, diarrhea, renal failure, shock
    • Symptoms: Kussmaul’s respirations, drowsiness, hypotension
    • Interventions: treat cause, monitor potassium, sodium bicarbonate if needed
  • Metabolic Alkalosis:
    • Causes: vomiting, NG suction, diuretics
    • Symptoms: muscle cramps, irritability, hypokalemia, arrhythmias
    • Interventions: correct underlying cause, monitor electrolytes, administer fluids/electrolytes

Arterial Blood Gas Collection and Allen’s Test

  • Always perform Allen’s test before a radial artery ABG to ensure collateral circulation.
  • Follow strict infection control and documentation protocols during sample collection.

Electrolytes and Acid–Base Disorders

Imbalances often impact potassium and calcium levels—watch for hyperkalemia in acidosis and hypokalemia in alkalosis. Recognize the interplay between electrolyte disturbances and pH for comprehensive client care.

Clinical Scenarios and NCLEX Practice

Chapter 9 presents real-world examples like diabetic ketoacidosis, renal failure, COPD, and prolonged vomiting—linking them to their characteristic acid–base imbalances. Apply your ABG interpretation skills with NCLEX-style questions and critical thinking exercises for mastery.

Want step-by-step walkthroughs? Watch the video above and subscribe to Last Minute Lecture for more clinical examples and Pyramid Steps explanations!

Conclusion: Confidently Interpret Acid–Base Imbalances on the NCLEX-PN

Chapter 9 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) provides the stepwise approach, lab interpretation, and clinical judgment you need for acid–base success. Use the Pyramid Steps, know your ABG norms, and link clinical scenarios to their imbalances for safe, evidence-based care.

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Explore the full YouTube playlist for Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) here: Complete Playlist

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