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NURSING113 > ACID/BASE > Flashcards

ACID/BASE Flashcards

1
Q

ACID / BASE OBJECTIVES

A
  1. Explain the mechanisms that help individuals maintain homeostasis for acid-base
  2. Distinguish the etiology, clinical manifestations, management, and nursing interventions for the exemplars.
  3. Describe the role of dietary modification, modification of fluid intake, medication administration, IV therapy, in resolving acid-base imbalances.
  4. Apply the nursing process in providing culturally competent care to a client with each exemplar.
  5. Correlate diagnostic tests and therapies/interventions, in the care of a client with each exemplar.
  6. Compose nursing documentation related to each exemplar
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2
Q

________ keep pH within a normal range (7.35 to 7.45)

A

Homeostasis Mechanisms

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3
Q

__________ prevent major changes in the pH of body fluids by removing or releasing H+

ng or releasing H

A

Buffer systems

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4
Q

The major extracellular buffer system is the ____________

A

bicarbonate–carbonic acid buffer system

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5
Q

The ______ regulate the bicarbonate level in the ECF

A

Kidneys

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6
Q

The _____, under the control of the medulla, regulate the CO2 and the carbonic acid content of the ECF

A

Lungs

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7
Q

What is Acid-Base Balance & Imbalance?

A
  • Hydrogen ion (H+) determines acidity or alkalinity of body fluids
  • Occur when acid or base levels become disproportionate
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8
Q

Acidosis PH level

A

Less than 7.35

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9
Q

Alkalosis PH level

A

Greater than 7.45

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10
Q

Three systems work together to maintain pH

A
  • Chemical Buffers
  • Respiratory system
  • Renal system
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11
Q

Respiratory System

A
  • Starts working QUICKLY
  • Regulates carbonic acid by eliminating or retaining CO2
  • Increase in CO2 or H+ stimulates the respiratory center
  • Increasing rate and depth of respiration
  • Eliminates CO2
  • Increases pH to normal range
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12
Q

Renal System

A
  • Long-term regulation of acid-base balance
  • Slower
  • Selectively excrete or retain H+ to maintain pH
  • Form or excrete bicarbonate to maintain pH
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13
Q

Arterial blood gas

A

An arterial blood gases (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to find out how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

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14
Q

PaCO2

A

Carbon dioxide

normal range 35-45

ACID >45

BASE <35

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15
Q

PH

A

Normal range 7.35–7.45

ACID <7.35

BASE >7.45

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16
Q

HCO3

A

Bicarbonate

Normal range 22-26

ACID <22

BASE >26

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17
Q

Two Major Categories

A

Acidosis: H+ increases above normal (pH below 7.35)

Alkalosis: H+ decreases below normal

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18
Q

Metabolic ACIDosis risk factors

A

Diarrhea

Intestinal fistulas

Parenteral nutrition

Excessive intake of acids, such as salicylates

Diabetic ketoacidosis

Renal failure

Starvational ketoacidosis

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19
Q

Metabolic ACIDosis assessment

A

Headache

Confusion

Drowsiness

Increased respiratory rate and depth

Nausea and vomiting

Peripheral vasodilation

ABGs

pH <7.35

HCO3− <22 mEq/L (primary)

PaCO2 <35 mm Hg

Hyperkalemia frequently present

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20
Q

Metabolic ACIDosis Nursing Interventions

A

Treatment is directed toward correcting the metabolic deficit. If the cause of the problem is excessive intake of chloride, treatment obviously focuses on eliminating the source. When necessary, bicarbonate is administered.

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21
Q

Metabolic ALKalosis risk factors

A

Vomiting or gastric suction

Hypokalemia

Potassium-wasting diuretics

Alkali ingestion (bicarbonate-containing antacids)

Renal loss of H+ (e.g., from steroid or diuretic use)

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22
Q

Metabolic ALKalosis assessment

A

Dizziness

Tingling of fingers and toes

Hypertonic muscles

Depressed respirations (compensatory)

ABGs

pH >7.45

HCO3− >26 mEq/L (primary)

PaCO2 >45 mm Hg (compensatory)

Hypokalemia may be present

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23
Q

Metabolic ALKalosis Nursing Interventions

A

Treatment is aimed at reversal of the underlying disorder. Sufficient chloride must be supplied for the kidney to absorb sodium with chloride (allowing the excretion of excess bicarbonate). Treatment also includes administration of NaCl fluids to restore normal fluid volume.

24
Q

Metabolic Acidosis

A

•Characterized by low pH (<7.35)•Low bicarbonate (<22 mEq/L)•May be caused by:•Excess acid in body•Loss of bicarbonate from body•Respiratory system attempts to return pH to normal

25
Q

Metabolic Acidosis Manifestions

A

General manifestations: weakness, fatigue, headache, malaise

GI manifestations → N&V

Neurological manifestations → Decreased LOC

Cardiac manifestations → ↑HR, ↓BP, dysrhythmias

Integumentary manifestations→ Warm & flush

Kussmaul respiration →Deep and rapid

26
Q

Treatment for all

A

Focus on treating primary disorder

Diagnostic tests

Pharmacologic therapy

27
Q

Metabolic Acidosis Interventions

A

Nursing interventions may include the following tasks:

Monitor cardiac status

Monitor for potential excess fluid volume

28
Q

Metabolic Alkalosis

A
  • Characterized by high pH (>7.45)
  • High bicarbonate (>26 mEq/L)
  • May be caused by loss of acid or excess bicarbonate in body
  • Respiratory system attempts to compensate•

PaCO2 increases (>45 mmHg)

29
Q
  • Metabolic*
  • Alkalosis:*
  • Clinical Manifestations*
A

Result of decreased calcium

•Numbness/tingling around mouth, fingers, toes•

Dizziness•

Trousseau sign•

Muscle spasms•

Respirations depressed•

Respiratory failure with hypoxemia•

Respiratory acidosis

30
Q
  • Metabolic Alkalosis*
  • Interventions*
A
  • Teach risks of using sodium bicarbonate
  • Availability of other antacid preparations
  • Seek medical evaluations for persistent gastric symptoms
31
Q

Respiratory Alterations

A
  • Respiratory à retention of CO2, increasing carbonic acid
  • Respiratory acidosis
  • Retention of carbon dioxide
  • Increase CO2•Respiratory alkalosis
  • Excess loss of carbon dioxide
  • Decrease CO2

Taylor Fundamentals 1566-1567

Honan Adult Health 88-90

Respiratory is OPPOSITE pH and PaCO2 will be opposite!!

32
Q

Respiratory Acidosis

A

Risk factors

Acute respiratory disease

Pulmonary edema

Aspiration of a foreign body

Atelectasis

Overdose of sedative or anesthetic

Cardiac arrest

Chronic respiratory disease

Emphysema

Bronchial asthma

Cystic fibrosis

Inadequate mechanical ventilation

CNS depression

Neuromuscular disease

Assesment

Acute respiratory acidosis

Mental cloudiness

Dizziness

Muscular twitching

Unconsciousness

ABGs

pH <7.35

PaCO2 >45 mm Hg (primary)

HCO3− normal or only slightly elevated

Chronic respiratory acidosis

Weakness

Dull headache

ABGs

pH <7.35 or low N

PaCO2 >45 mm Hg (primary)

HCO3− >26 mEq/L (compensatory)

Nursing interventions

Treatment is directed at improving ventilation

Pharmacologic measures

Pulmonary hygiene measures

Adequate hydration

Supplemental oxygen

Mechanical ventilation may be necessary to correct disorder but must be used cautiously to decrease PaCO2 slowly.

33
Q

Respiratory Alkalosis

A

Risk factors

Hyperventilation

Extreme anxiety (most common cause)

Hypoxemia

High fever

Early sepsis

Excessive ventilation by mechanical ventilator

CNS lesion involving the respiratory center

Assessment

Lightheadedness

Inability to concentrate

Hyperventilation syndrome

Tinnitus

Palpitations

Sweating

Dry mouth

Tremulousness

Convulsions and loss of consciousness

ABGs

pH >7.45

PaCO2 <35 mm Hg (primary)

HCO3− <22 mEq/L (compensatory)

Nursing Interventions

If anxiety is the cause, encourage the patient to breathe more slowly (causes accumulation of CO2) or breathe into a closed system (paper bag). Sedative may also be necessary in extreme anxiety.

Treatment of other causes is directed at correcting the underlying problem.

34
Q

Respiratory Acidosis

A
  • Caused by excess of carbonic acid
  • Characterized by a pH < 7.35
  • PaCO2 > 45 mmHg
  • May be acute or chronic
  • Kidneys compensate by retaining bicarbonate
35
Q
  • Acute*
  • Respiratory Acidosis*
A
  • Results from sudden failure of ventilation
  • Acute pneumonia
  • Overdose of sedatives or narcotics
  • Trauma
  • Aspiration
  • PaCO2 rises rapidly
  • pH falls markedly
  • pH of 7 or lower can occur
36
Q
  • Chronic*
  • Respiratory Acidosis*
A
  • Associated with chronic respiratory (Cystic Fibrosis) or neuromuscular conditions (ALS, Guillain Barre)
  • Affects alveolar ventilation
  • Majority have COPD à bronchitis, emphysema
  • PaCO2 increases over time, remains high
  • Kidneys retain bicarbonate
  • pH often close to normal
  • Hypercapnia
  • Carbon dioxide narcosis
37
Q

Safety Alert

A

Carefully monitor the neurological and respiratory status in clients with chronic respiratory acidosis who are receiving oxygen therapy. Immediately report a decrease in LOC or depressed respirations.

38
Q
  • Respiratory Acidosis*
  • Clinical Manifestations*
A

Acute respiratory acidosis

•PaCO2 levels rise rapidly•Cause manifestations of hypercapnia•Cerebral vasodilation•LOC progressively decreases•Rapid changes in ABGs•Skin warm, flushed•Pulse elevated

39
Q
  • Respiratory*
  • Acidosis*
  • Interventions*
A

Nursing interventions may include the following tasks:

Monitor cardiac status

Monitor respiratory status

40
Q

Respiratory Alkalosis

A
  • Always caused by hyperventilation, leading to carbon dioxide deficit
  • Characterized by a pH > 7.45
  • PaCO2 < 35 mmHg
41
Q
  • Respiratory*
  • Alkalosis*
  • Clinical*
  • Manifestations*
  • Clinical*
  • Manifestations*
A

Light-headedness

The feeling of panic and difficulty concentrating

Circumoral and distal extremity paresthesias

Tremors

Positive Chvostek sign

Trousseau sign

42
Q
  • Respiratory*
  • Alkalosis*
  • Interventions*
A

Management focuses on correcting the imbalance and treating the underlying cause.

Create calm environmental

Quiet, low stimulation

Reduce anxiety or panic

ABGs prior to meds or O2 therapy

43
Q

Interventions and therapyand Therapy

A

Goal of treatment: Restore or maintain normal body balance

  • Identify the underlying cause
  • Collaborative care

Health history

Daily weight

Monitoring of intake and output

Assessing respiratory and renal function

Maintenance of patent airway

Oxygen saturation monitoring

44
Q

Ask these 3 questions when answering ABG’S

A
  1. Is it a respiratory or a metabolic problem?
  2. Is this alkalosis or acidosis?
  3. Is this uncompensated or compensated?
45
Q

Steps for interpreting ABGs

A

1 Look at pH

  1. Look at PaCO2
  2. Look at HCO3-
  3. Look at the PaCO2 or the HCO3- and match either with the pH.
  4. Look at the total picture and determine if compensated.
  5. Look at PaO2 and SaO2
46
Q

Examples for ABG’S

A
  • Respiratory Acidosis•pH ↓•PaCO2 ↑•HCO3: WNL
  • Respiratory Alkalosis•pH ↑•PaCO2↓•HCO3: WNL
  • Metabolic Acidosis•pH ↓•PaCO2: WNL•HCO3 ↓
  • Metabolic Alkalosis•pH ↑•PaCO2: WNL•HCO3 ↑
47
Q

Is it compensated or uncompensated?

A

5. Look at the total picture and determine whether compensation has occurred.

Determine whether the body is compensating for the pH change. Complete compensation occurs when the body’s ability to compensate is so effective that the pH falls within the normal range. Partial compensation occurs when the pH remains outside the normal range. Compensation involves opposites: for example, in primary metabolic acidosis, compensation involves respiratory alkalosis; in primary respiratory acidosis, compensation involves metabolic alkalosis. Determine which level more closely corresponds with the pH, indicating the primary cause of the problem. The other level reflects the compensation.

Example:

pH ↓7.29

PaCO2 ↓17 mm Hg

HC ↓19 mEq/L

The low pH indicates acidosis; the PaCO2 is low, which normally leads to alkalosis, and the bicarbonate level is low, which normally leads to acidosis. In this example, the bicarbonate level more closely corresponds with the pH, making the primary cause of the problem metabolic. The resultant decrease in PaCO2 reflects partial respiratory compensation—metabolic acidosis with partial respiratory compensation (Willis, 2015). When compensation occurs, the PaCO2 and the HCO3− will always point in the same direction.

48
Q

PaO2 and SaO2 indicate the oxygenation status

A
  • PaO2 < 80% - hypoxemia
  • SaO2 < 95% - hypoxemia
  • Hypoxemia – low O2 in blood
  • Hypoxia – low O2 to tissues
  • Low Saturation – less O2 on hemoglobin

SaO2 is that there are some things that will affect its accuracy or reliability. Because of these things, you may see a high SpO2 but actually the patient is not oxygenating well at all. Remember that the SaO2 measures the saturation of hemoglobin.

1.Oxygenation Values on an ABG1.PaO2 – Partial Pressure of Oxygen1.Amount of oxygen dissolved in arterial blood2.How well the lungs are working to get O2 INTO the arterial blood2.SaO2 – Arterial Oxygen Saturation1.Percentage of hemoglobin molecules fully saturated with oxygen in arterial blood2.How well is the blood carrying/transporting O2 to the tissues2.Pulse Oximetry1.An indirect, peripheral measurement of oxygen saturation2.Affected by peripheral perfusion and temperature

Nursing Points

General

1.Normal Values1.PaO2 → 80-100 mmHg1.On Room Air (21% FiO2)2.SaO2 → 95-100%2.Oxyhemoglobin Dissociation Curve1.Patient conditions affect ‘affinity’ of Hgb for O22.Same SaO2, different PaO2

Assessment

1.Low PaO2 or SaO21.Cyanosis2.Dyspnea3.Tachypnea4.Cool skin2.Low PaO2 but high SaO21.Limitations of SaO21.Anemias2.Carbon Monoxide poisoning1.Headache, dizziness, dyspnea, no cyanosis3.P/F Ratio1.Normal PaO2, but on supplemental oxygen = something’s still wrong2.PaO2 ÷ FiO2 → Normal is >4003.Example1.PaO2 1202.FiO2 60%3.P/F Ratio = 120 / 0.60 = 2001.Indicates moderate to severe ARDS

Therapeutic Management

1.Give supplemental O22.Blood transfusions as needed3.May require mechanical ventilation if respiratory effort is not sufficient

Nursing Concepts

1.Oxygenation2.Gas Exchange

Patient Education

1.May need to help family understand the numbers, if they are anxious

49
Q

ROME METHOD

A

1 Determine the PH

  1. Look at the PaCO2.
    Remember, carbon dioxide is produced by cellular metabolism and is excreted by the lungs through exhalation. It represents the respiratory component of the blood gas. Normal levels range from 35 to 45 mm Hg. Changes in the PaCO2 reflect lung function. A PaCO2 level below 35 mm Hg can be caused by hyperventilation, resulting in alkalosis. When the patient retains CO2, as a result of hypoventilation, for example, the PaCO2 level rises above 45 mm Hg, resulting in acidosis.
  2. Look at the HCO3−.
    Remember, bicarbonate is produced by the kidneys. It represents the metabolic component of the blood gas. Normal levels range from 22 to 26 mEq/L. Changes in the HCO3− reflect kidney function. A HCO3−level below 22 mEq/L indicates acidosis and above 26 mEq/L indicates alkalosis.
    4. Look at the PaCO2 or the HCO3- and match either with the pH.

If the pH is low and the PaCO2 is high, the patient has respiratory acidosis. If the pH is high and the PaCO2 is low, the patient has respiratory alkalosis. If the pH and HCO3−are high but the PaCO2 is normal, the patient has metabolic alkalosis. The patient has metabolic acidosis if the pH and HCO3−are low and the PaCO2 is normal (Woodruff, 2006).

5. Look at the total picture and determine whether compensation has occurred.

Determine whether the body is compensating for the pH change. Complete compensation occurs when the body’s ability to compensate is so effective that the pH falls within the normal range. Partial compensation occurs when the pH remains outside the normal range. Compensation involves opposites: for example, in primary metabolic acidosis, compensation involves respiratory alkalosis; in primary respiratory acidosis, compensation involves metabolic alkalosis. Determine which level more closely corresponds with the pH, indicating the primary cause of the problem. The other level reflects the compensation.

Example:

pH ↓7.29

PaCO2 ↓17 mm Hg

HC ↓19 mEq/L

The low pH indicates acidosis; the PaCO2 is low, which normally leads to alkalosis, and the bicarbonate level is low, which normally leads to acidosis. In this example, the bicarbonate level more closely corresponds with the pH, making the primary cause of the problem metabolic. The resultant decrease in PaCO2 reflects partial respiratory compensation—metabolic acidosis with partial respiratory compensation (Willis, 2015). When compensation occurs, the PaCO2 and the HCO3− will always point in the same direction.

50
Q

Ph is the measurement of ___ ions

A

Hydrogen

51
Q

When you think CO2, think ___

A

Lung / respiratory

52
Q

When you think Hc03, think ______

A

Kidneys / metabolic

53
Q

A patient losing all of their co2 will have a __________ PH

A

High

54
Q

A patient who is retaining all of their co2 will have a ______ ph

A

Low

55
Q

A patient who is retaining/re aborbsion all their Hc03 will have a ________ PH

A

High

56
Q

A patient who is losing all of their HC03 will have a _____ Ph

A

Low

NURSING113 (4 decks)

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