This condition does not occur in isolation but rather is a complication of a broader problem that may require inpatient care in a medical-surgical or subacute unit.
- Plans of care specific to predisposing factors
- Fluid and electrolyte imbalances
- Renal dialysis
- Respiratory acidosis (primary carbonic acid excess)
- Respiratory alkalosis (primary carbonic acid deficit)
- Patient Assessment Database (Dependent on Underlying Cause)
- Tachycardia, irregularities/dysrhythmias
- Diarrhea (with high chloride content)
- Use of potassium-losing diuretics (Diuril, Hygroton, Lasix, Edecrin)
- Laxative abuse
- Anorexia, nausea/prolonged vomiting
- High salt intake; excessive ingestion of licorice
- Recurrent indigestion/heartburn with frequent use of antacids/baking soda
- Tingling of fingers and toes; circumoral paresthesia
- Muscle twitching, weakness
- Hypertonicity of muscles, tetany, tremors, convulsions, loss of reflexes
- Confusion, irritability, restlessness, belligerence, apathy, coma
- Picking at bedclothes
Recent blood transfusions (citrated blood)
Hypoventilation (increases PCO2 and conserves carbonic acid), periods of apnea
- History of Cushing’s syndrome; corticosteroid therapy
- Discharge plan
- DRG projected mean length of inpatient stay depends on underlying cause
- May require change in therapy for underlying disease process/condition.
- Refer to section at end of plan for postdischarge considerations.
- Arterial pH: Increased, higher than 7.45.
- Bicarbonate (HCO3): Increased, higher than 26 mEq/L (primary).
- PaCO2: Slightly increased, higher than 45 mm Hg (compensatory).
- Base excess: Increased.
- Serum chloride: Decreased, less than 98 mEq/L, disproportionately to serum sodium decreases (if alkalosis is hypochloremia).
- Serum potassium: Decreased.
- Serum calcium: Usually decreased. Prolonged hypercalcemia (nonparathyroid) may be a predisposing factor.
- Urine pH: Increased, higher than 7.0.
- Urine chloride: Less than 10 mEq/L suggests chloride-responsive alkalosis, whereas levels higher than 20 mEq/L suggest chloride resistance.
- ECG: May show hypokalemic changes including peaked P waves, flat T waves, depressed ST segment, low T wave merging to P wave, and elevated U waves.
- Achieve homeostasis.
- Prevent/minimize complications.
- Provide information about condition/prognosis and treatment needs as appropriate.
- Physiological balance restored.
- Free of complications.
- Condition, prognosis, and treatment needs understood.
- Plan in place to meet needs after discharge.
Because no current nursing diagnosis speaks clearly to metabolic imbalances, the following interventions are presented in a general format for inclusion in the primary plan of care.