acid and base Flashcards
1
Q
2nd line of defense to restore pH
A
respiratory mechanisms
2
Q
40% of buffering in an acute acid load takes place in
A
the bone
3
Q
A base or alkali is a compound that
A
combines with (accepts) hydrogen ions in solution
4
Q
A buffer system consists of
A
a weak acid and a weak base.
5
Q
a solid substance dissolved in body fluids.
A
A solute
6
Q
ABG is taken from _________ Interventions:
A
artery
so pressure after
get to lab quickly
be concerned/aware if on anticoagulant
7
Q
Acidity or alkalinity is determined by the concentration of ______, represented by the pH
A
H+ ions
8
Q
acidosis compensation problem
A
hyperkalemia and hypercalcemia
9
Q
Acidosis – pH < 7.35
Caused by an excess of _____ or _____ in bloodstream or a deficit of ______ in the blood stream
A
CO2 or H+ ions
HCO3
10
Q
alkalosis compensation complication
A
hypokalemia and hypocalcemia
11
Q
Alkalosis – pH > 7.45
Caused by an excess of _______ in the bloodstream or a deficit of _____ in the blood stream
A
HCO3
H+ ions
12
Q
An acid is any compound that contains _______ ____ that can be released. For this reason, acids are referred to as cation donors. A common strong acid is hydrochloric acid (HCl), which is present in ______ _______
A
hydrogen ions (H+)
gastric secretions.
13
Q
Balances are maintained by intake and output of ____ and _______ and their ________ in the body
A
H20
Electrolytes
Distribution
14
Q
bases are referred to as
A
cation acceptors
15
Q
Bicarb is produced in
A
kidneys and pancreas
16
Q
Buffer molecules keep strong acids or bases from altering the pH either by
A
absorbing or releasing free hydrogen ions.
17
Q
Buffers work against sudden and large changes in the pH of body fluids by doing one of these 2 things…..
A
- Releasing hydrogen ions (acting as acids) when the pH increases, and
- Binding hydrogen ions (acting as bases) when the pH decreases.
18
Q
cause of respiratory acidosis
A
retention of CO2
19
Q
causes of metabolic alkalosis
A
severe vomiting
excessive GI suctioning
diuretics
excessive NaCO3
20
Q
chemical reasons for metabolic alkalosis
A
excessive HCO3 intake or retention
loss of H+
21
Q
Decreased ability of the kidney to excrete acid or hold on to base is called
A
Metabolic Acidosis
22
Q
deep, rapid, and labored breathing
A
Kussmaul respirations
23
Q
Describe the difference between infiltration and extravasation as a complication of IV therapy.
A
Infiltration involves a nonvesicant solution.
• Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).
24
Q
examples of hypotonic solutions
A
D5W and 0.45% Sodium chloride (1/2 NS)
25
examples of isotonic solutions
```
normal saline (0.9% NaCl)
lactated ringers
```
26
First symptom of hypovolemia
thirst
27
for Ph to be acidosis the value must be what
below 7.35
28
for Ph to be alkalosis the value must be what
above 7.45
29
Function of bicarb
• Maintains acid–base balance by functioning as the primary buffer in the body
30
Function of Calcium
* Promotes transmission of nerve impulses
* Regulates muscle contractions
* Maintains cardiac automaticity
* Serves as an essential factor in the formation of blood clots
* Catalyzes many cellular activities
* Is a major component of bones and teeth
31
Function of Potassium
* Maintains osmolality of intracellular fluid
* Regulates conduction of cardiac rhythm
* Transmits electrical impulses in multiple body systems
* Assists with acid–base balance
32
Function of Sodium
* Regulates fluid volume
* Helps maintain blood volume
* Interacts with calcium to maintain muscle contraction
* Stimulates conduction of nerve impulses
33
how ill the respiratory system compensate for alkalosis metabolic imbalances
the lungs will decrease the attempt to eliminate CO2 from the system
34
how long do kidney buffers take to react
hours to days
35
How long do respiratory buffers take to react
rapidly
36
how will the metabolic system compensate for alkalosis respiratory imbalances?
the kidneys will decrease the excretion of H+ ions and will increase excretion of bicarb and make less bicarb
37
how will the metabolic system compensate for respiratory acidosis imbalances?
the kidneys will increase the excretion of H+ ions and will reduce the excretion of bicarb to make more
38
how will the respiratory system compensate for metabolic acidosis imbalances?
the lungs will increase the attempt to eliminate CO2 from the system
39
Hyperklemia = cell excitability - you will see
EKG changes, muscles will twitch/burn then numbness/weakness
40
Hypertonic fluids have a ________ osmolality than does
serum. When administered, they _____ fluids
and electrolytes from the intracellular and interstitial compartments into the _______ ________Hypertonic fluids can help _______, _________ and ________
higher
pull
intravascular compartment.
stabilize blood pressure, increase urine output, and reduce edema.
41
Hypertonic solutions also called
volume expanders
42
Hypotonic solution osmolality is ______ than that of serum. Infusion of these solutions ____ _____ _____ from the intravascular compartment into the interstitial fluid compartment. Hypotonic fluid is used for __________________, in which high serum glucose draws fluid out of the cells and into the vascular and interstitial compartments.
less
pulls body water
hyperglycemic conditions, such as diabetic ketoacidosis,
43
If bicarbonate is depleted while neutralizing a strong acid
the pH may drop below 7.35, resulting in a condition called acidosis.
44
If carbonic acid is depleted (by adding a strong base to extracellular fluid)
the pH may rise above 7.45, resulting in a condition called alkalosis.
45
In acidic environment there is more free calcium called _________ which allows what to form?
hypercalcemia
| blood clots
46
In alkalosis you will see what electrolyte complications
hypocalcemia and hypokalemia
47
In extracellular fluid (ECF), the major cation is _______ and the major anions are _______ and _________
sodium (Na+)
| chloride (Cl ̄) and bicarbonate (HCO3 ̄).
48
In general, how often are administration sets changed on peripheral IV lines?
For peripheral IV lines, the administration set is changed every 96 hours.
49
In intracellular fluid (ICF), the major cations are ____ and ____and the major anion is
potassium (K+) and magnesium (Mg2+)
| phosphate (HPO42 ̄).
50
Increase in base (production, intake or lack of elimination) or decrease in acids ( getting rid of too much) in kidneys is called
Metabolic Alkalosis
51
Interventions for Metabolic Acidosis
```
Correct underlying problem
Bicarb if low
insulin for DKA
antidiarrheal
remember we are worried about hyperkalemia
```
52
Interventions for Metabolic Alkalosis
treat underlying problem (antiemetics)
stop diuretics
replace electrolytes
check calcium levels (heart and skeletal muscles)
53
Interventions for Respiratory Acidosis
Treatment aimed at maintaining airway and improving gas exchange.
Pulmonary hygiene: TCDB, position changes, RT
O2
Drugs: bronchodialotors
maintain hydration
54
Interventions of Respiratory Alkalosis
```
aimed at stabilizing gas exchange:
paper bag
Encourage relax and deep breathing
correct lung problem
adjust vent settings
```
55
involves excessive retention of sodium and water in the ECF. A synonym is hypervolemia. Fluid volume excess occurs as a result of excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.
Excess fluid volume
56
is a measure of the percentage of
| RBCs in whole blood.
Hematocrit
57
is a measure of the solute concentration of the blood.
Serum osmolality
58
is a substance that develops an elec-
| trical charge when dissolved in water.
An electrolyte
59
is fluid contained within the cells.
Intracellular fluid (ICF)
60
is fluid outside the cells. ECF consists of three types of fluid: interstitial, intravascular, and transcellular fluid.
Extracellular fluid (ECF
61
is the precipitation of carpal spasm by reduction of the blood supply to the hand with a tourniquet or blood pressure cuff inflated to 20 mm Hg above systolic blood pressure applied to the forearm for 3 minutes. Is seen in
Trousseau sign
hypocalcemia
62
is the solute concentration of urine.
Urine osmolality
63
Largest chemical buffer system
Carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3) buffer almost 90% of metabolic processes in the ECF.
64
Last line of defense to restore pH
Renal Mechanism
65
Lungs compensating for Metabolic Acidosis: When the serum pH is too acidic (pH is low), the lungs _______ carbon dioxide through ____ _____ _____ . This reduces the amount of carbon dioxide available to make carbonic acid.
remove
rapid, deep breathing
66
Lungs compensating for Metabolic Alkalosis:When the serum pH is too alkaline (pH is high), the lungs try to _______ carbon dioxide through ______ ______
conserve
| shallow respirations.
67
measure acid–base balance and oxygen status.
ABGs
68
measures sodium, potassium, chloride, and bicarbonate levels. The test often includes blood urea nitrogen (BUN), creatinine, and glucose.
Serum electrolytes
69
measures the kidney’s ability to con- centrate or dilute urine in relation to the plasma.
Specific gravity
70
Metabolic disorders produce an alteration in the plasma _______ concentration
HCO3-
71
Normal blood plasma is slightly
alkaline
72
occurs when there is a proportional loss of water and electrolytes from the ECF. It may occur as a result of insufficient intake of isotonic fluid; bleeding; excessive loss through urine, skin, insensible losses, or the gastrointestinal tract; or loss of fluid into a third space.
Deficient fluid volume
73
over the elimination of HCO3 ions in metabolic acidosis causes what
diarrhea
74
overproduction of H+ions in metabolic acidosis causes what
diabetic ketoacidosis
75
Pa02 value
80-100
76
Ph acidosis could be caused by
excess C02
excess H+ ions in the bloodstream
the deficit of HC03 in the bloodstream
77
Ph alkalosis could be caused by what
excess HCO3 in the bloodstream
| a deficit of H+ ions in the bloodstream
78
pH represents the______ ______ of the H+ concentration, that is a pH of 7.0 implies a concentration of 10-7
negative logarithm
meaning it's inverse:the higher the H+ ion concentration the lower the pH. The lower the H+ ion concentration the higher the pH
79
Protein are amphoteric - meaning
can function as acids (releasing H+ ions) or bases (bind H+ ions)
80
Rank in order the acid–base balance mechanisms from most rapidly acting to the slowest acting.
The three acid–base balance mechanisms are ranked as follows:
• Buffers act the most rapidly.
• Respiratory mechanisms are intermediate. • Renal mechanisms act the slowest.
81
Renal system buffer acts on bicarb HCO3 how?
reabsorbs or produces
82
Renal system buffer acts on H+ ions how?
conserves or excretes
83
Renal system buffer is
slow - can take hours to days
84
respiratory alkalosis cause
hyperventilation
85
Respiratory buffer mechanism is
fast - rapid changes in H+
86
Respiratory disorders involve an alteration in the ______, reflecting an increase or decrease in ______ ________
pCO2
| alveolar ventilation
87
Respiratory mechanism control the body’s carbonic acid supply via
carbon dioxide retention or removal to maintain the 20:1 ratio of base to acid.
88
Retention of CO2 in lungs is what disorder
Respiratory Acidosis
89
S/S of hypervolemia
```
inc BO
bounding pulse
inc shallow, respirations
distended neck veins
dependent edema
skin is pale and cool
UO is dilute and inc
rapid weight gain
Dec BUN
may develop crackles dyspnea, ascites
```
90
S/S of Metabolic Acidosis
```
Changes in LOC - confusion drowsiness
headache
decreased BP
muscle twitching
vasodilation - warm, flushed skin
N/V/D
```
91
S/S of Metabolic Alkalosis
```
hypoventilation (compensatory - trying to hold on to CO2
restless then lethargy
dysrhythmias (tachycardia)
dizziness
N/V/D
Tingling of extremities ( fingers, toes)
```
92
S/S of progressing hypovolemia is
As fluid volume decreases:
rapid, weak pulse and a low blood pressure (starts high)
dry skin and mucus membranes, decreased skin turgor and UO
Temp rist d/t body not able to cool
Inc BUN - less water in proportion to solids
93
S/S of Respiratory Acidosis
```
hypoventilation - leading to hypoxia
rapid shallow respirations
dec BP d/t vasodilatation
hyperkalemia
dysrhythmias - d/t inc K+
drowsiness, dizzy, disoriented
muscle weakness/hyperrelexia
```
94
s/s of Respiratory alkalosis
```
hyperventilating (deep rapid breathing)
tachycardia
numbers/tingling
confusion
light headedness
```
95
So pH, a measure of acidity and alkalinity, is a
characteristic of blood
96
The amount of acid or base present in a solution is measured as
pH
97
The body's precise regulation of the H+ ions is necessary to maintain what
cell integrity
membrane excitability
the speed of enzymatic reactions
98
The body’s precise regulation of H+ ions is necessary to
maintain cell integrity, membrane excitability and the speed of enzymatic reactions
99
The Chvostek sign (/ˈkvɒstɪk/) is a clinical sign of _________. It is evidenced by the ____ ____ ______innervated by the facial nerve (CNVII).
hypocalcemia
| twitching of muscles
100
The kidneys are _______ to compensate than the lungs, but renal physiology has several powerful mechanisms to control pH by the _______ of excess acid or base.
slower
| excretion
101
The major, homeostatic control point for maintaining a stable pH balance is
renal excretion
102
The osmolality of isotonic fluids is similar to that of ____ _____. When infused, isotonic solutions remain ______the intravascular compartment. As a result, they are useful for clients with _______ or __________
blood serum
inside
hypotension or hypovolemia.
103
the ratio of carbonic acid ions to bicarbonate ions is
1:20
104
the respiratory system compensates for _______ and metabolic (renal) compensates for ______
metabolic
| respiratory
105
The usual ratio of NaHCO3 to H2CO3 is
20:1
106
Things that create acid in our body
breathing, digestion, sustained muscle moment
107
Three complex mechanisms maintain acid–base balance:
(1) buffers, (2) respiratory control of carbon dioxide, and (3) renal regulation of bicarbonate (HCO3–).
108
Three major chemical buffer systems in the body are the:
Carbonic acid-bicarbonate buffer system
Phosphate buffer system
Protein buffer system
109
to be fully compensated the Ph must be what
normal
110
under the elimination of H+ ions in metabolic acidosis causes what
kidney failure
111
What 2 electrolyte imbalances do you see with Metabolic Acidosis
hyperkalemia and hypercalcemia
112
What are the major concerns associated with sodium and potassium intake?
The major concerns are excessive sodium intake and inadequate potassium intake, which could lead to the following:
• For sodium: weight gain (edema), hypertension (high blood pressure)
• For potassium: cardiac dysrhythmias (bradycardias, heart block, asystole), potential for acid–base imbalance (metabolic acidosis)
113
What could cause Metabolic Acidois (keeping/making too much acid or getting rid of too much base?
DKA - Diabetic Keto Acidosis overproduction of H+ions - making too much
Aspirin OD
starvation - making too much (braking down fats)
heavy exercise - making too much (lactic acid)
shock -
Severe Diarrhea - losing too much base
Real/Kidney failure - Keeping too much acid or not making base
114
What could cause Metabolic Alkalosis
severe vomiting (getting rid of acid)
excessive GI suctioning (getting rid of acid)
Potassium wasting diuretics (lassie, fuorisomide)
Excessive NaHCO3 (sodium bicarb - antacids)
115
what disorder causes too much loss of CO2
Metabolic Alkalosis
116
What electrolyte disorder is associated with Metabolic Alkalosis
hypokalcemia
117
what electrolytes would you see with respiratory alkalosis
hypocalcemia, hypokalemia
118
What is a cation
a positively charged particle
119
what is the balancing mechanism for acid-base imbalances
carbonic
120
What is the body trying to do with Kussmaul respirations
get rid of acid through the lungs
121
What kind of patients will you see with Metabolic alkalosis
```
excessive ventilation from mechanical vent
hyperventilating from :
fear
anxiety
fever
sepsis
```
122
What kind of patients would you see with Respiratory Acidosis - who keeps/can't get rid of CO2?
COPD - decreased exhale of CO2
Pneumonia -
Atelectasis - decrease lung expansion
people with decreased respiratory stimuli - like those who have been under anesthesia or drug overdose - decrease respirations
123
What patient do you associate Kussmaul reparations with
diabetic Ketoacidosis
124
What systems regulate acid-base balance
renal and pulmonary
125
where is bicarbonate produced?
kidneys and pancreas
126
who is at risk for acid/base imbalances
elderly
people on multiple meds
people with chronic health problems
people with mental status changes
127
Who is at risk for pH imbalances
elderly
poly pharmacy - lots of meds
chronic health problems
mental status changes - dehydration or fluid overload
