Alteration in Acid/Base Balance

Question 1

How does the body repair a respiratory issue?

Answer 1

Kidneys

Question 2

How does the body repair a metabolic issue?

Answer 2

Lungs

Question 3

How is pH of the body maintained?

Answer 3

Buffers via elimination of acids through lungs and kidneys

Question 4

What are the chemical buffers of the body?

Answer 4

CO2 (acidic)

HCO3 (alkalotic)

Question 5

How do the lungs compensate?

Answer 5

By controlling the amount of CO2 in the blood

Immediate response

Question 6

How do the kidneys compensate?

Answer 6

By changing the rate of excretion or retention of H+ and HCO3- ions
“Slow” response

Question 7

What will happen if the metabolic side is too acidic?

Answer 7

Body will breathe faster and blow off CO2 (acid)

Question 8

What will happen if the metabolic side is too alkalotic?

Answer 8

Body will slow down breathing and hold on to CO2 (acidic)

Question 9

What happens when the body is too alkalotic?

Answer 9

At distal tubules (where reabsorption takes place), the body will reabsorb H+ and excrete HCO3 (alkalotic)

Question 10

What happens when the body is too acidic?

Answer 10

At distal tubules, the body will reabsorb HCO3 and excrete H+

Question 11

What is chemical regulation?

Answer 11

Plasma protein buffer where albumin, fibrinogen, prothrombin, and gamma globulin can bind with H+ to correct acidosis or alkalosis
(Limited binding capacity)

Question 12

What is biological regulation?

Answer 12

When H+ ions are absorbed or released by body cells

H+ must be changed with another + ion (often K+)

Question 13

When can biological regulation occur?

Answer 13

After short term chemical buffering

Takes 2-4 hours

Question 14

What are the physiological buffers?

Answer 14

Lungs - rapid adaptation

Kidneys - slower

Question 15

What is a normal pH?

Answer 15

7.35-7.45

Question 16

What is a normal paCO2?

Answer 16

35-45

Question 17

What is a normal HCO3-?

Answer 17

22-26

Question 18

What is a normal paO2?

Answer 18

80-100

Question 19

What is a normal saO2?

Answer 19

95-99%

Question 20

What values are acidotic?

Answer 20

pH <7.35
CO2 >45
HCO3 <22

Question 21

What values are alkalotic?

Answer 21

pH >7.45
CO2 <35
HCO3 >26

Question 22

What factors affects acid-base balance?

Answer 22

Age (old and young)
Chronic disease
Trauma
Therapies
GI losses

Question 23

What occurs in respiratory acidosis?

Answer 23

Decreased pH <7.35
Increased CO2 >45
Increase in H+ ions
Caused by hypoventilation or depressed ventilation
Results in hypoxemia
Compensation is a result of increased HCO-3
May be seen with an increased K+ > 5.0

Question 24

What does respiratory acidosis lead to?

Answer 24

Hypoxemia
CSF & brain cells become acidotic
- Change in LOC

Question 25

What is ROME?

Answer 25

Respiratory opposite | Metabolic equal

Question 26

High pH and low CO2 = ?

Answer 26

Respiratory problem

Question 27

Low pH and high CO2 = ?

Answer 27

Respiratory problem

Question 28

Low pH and low HCO3 = ?

Answer 28

Metabolic problem

Question 29

High pH and high HCO3 = ?

Answer 29

Metabolic problem

Question 30

What causes respiratory acidosis?

Answer 30

``` Pneumonia Renal failure Atelectasis Drug OD Paralysis of respiratory muscles Trauma Obstructive Sleep Apnea Airway obstruction Head injury Stroke (CVA) *things that make one breathe slowly ```

Question 31

What occurs in respiratory alkalosis?

Answer 31

Increased pH >7.45 Decreased CO2 <35 Decreased H+ ions Caused by HYPERventilation with excessive exhalation of CO2 Compensation is a result of a decrease in HCO-3 May be seen with a decreased K+ <3.5

Question 32

What causes respiratory alkalosis?

Answer 32

``` Anxiety Fear Anemia Increased metabolic states CNS injury Asthma *things that make one hyperventilate ```

Question 33

Why does anemia cause respiratory alkalosis?

Answer 33

Causes one to breathe quickly because there’s decreased RBC and HgB carries oxygen

Question 34

What occurs in metabolic acidosis?

Answer 34

``` Decreased pH <7.35 Decreased HCO-3 < 22 Increased H+ ions Compensation is a result of decrease in CO2 <35 May be seen with K+ >5.0 ```

Question 35

What causes metabolic acidosis?

Answer 35

``` Starvation DKA Renal failure Shock Diarrhea (main cause) ```

Question 36

What occurs in metabolic alkalosis?

Answer 36

Increased pH >7.45 Increased HCO-3 > 26 Decreased H+ ions Compensation is a result of increase in CO2 > 45

Question 37

What causes metabolic alkalosis?

Answer 37

``` Excessive use of antacids Prolonged gastric suctioning Loss of gastric acidic juices Excessive or prolonged vomiting Hypokalemia (< 3.5) Main cause: loss of upper GI fluids ```

Question 38

What is the nursing process for ABG stuff?

Answer 38

``` Assessment - Look at RR, O2 sat - Difficulty? Accessory muscles to breathe? Diaphragmatic breathing/nasal flaring? Nursing diagnoses Planning Implementing Evaluation ```

Question 39

How do you determine if the issue is with resp or metabolic?

Answer 39

Compare pH with CO2 and HCO3 If pH is acidotic, look for whichever value is also acidotic If pH is alkalotic, look for whichever value is also alkalotic