M1 Acid Base Flashcards by Josh Kotov

Three mechanisms of regulating acid base balance

Buffering system
Respiratory compensation
Metabolic/renal compensation

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Resp reguation of acid base 101

Lungs regulate CO2 that combines with H2O which forms H2CO3 - carbonic acid

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H2 CO3

Carbonic acid

regulated by resp A/B system

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What part of brain regulates Resp A/B balance

Medulla chemo receptors

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Breathing faster/deeper - hyperventilation =

Breathing slower/shallower - hypoventilation =

CO2 elimination, increases pH

CO2 accumulation, decrease pH

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Renal regulation of A/B balance

KIDNEYS key player

reabsorb or excrete acids or bases

can produce HCO3 bicarbonate

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Carbonic acid

Bicarbonate

H2CO3 - acidic

HCO3 - basic

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1 part carbonic acid =

20 parts bicarbonate

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Kidney pH adjustments take ___ …

TIME

days to weeks

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Normal Acid Base values
pH
PaCO2
HCO3
Pao2
Sao2

pH 7.35-7.45
PaCO2 45-35
HCO3 22-28

Pao2 80-100
Sao2 greater than %95

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SpO2 -

Sao2 -

Pao2 -

SpO2 = oxygen saturation as measured by pulse oximeter

Sao2 = oxygen saturation as measured by blood analysis (e.g. a blood gas)

Pao2 = partial pressure of oxygen in the blood

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ABG interpretation steps

classify pH
assess PaCO2
assess HCO3

determine compensation
total, partial, uncompensated

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Respiratory acidosis

Decrease in rate of alveolar ventilation

pH less than 7.35
PaCO2 greater than 45mmHg

compensation = increase in HCO3

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Respiratory acidosis causes

respiratory center depression
drug sedation/anesthesia
resp arrest
impaired ventilation/airway obstruction

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Acidosis S/S CNS

Decrease in excitability
Drowsiness
Disorientation
Coma

restlessness
headache

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Acidosis S/S cardiovascuar

Dysrhythmia
Decreased contractility
Hypotension

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Resp alkalosis causes

Hypoxemia
Anemia
Fever
Dyspnea
Anger

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S/S of alkalosis CNS/lytes/cardio

Increased excitability

numbness
tingling
confusion
blurred vision

Hypokalemia
Hypocalcemia

hypertension

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Respiratory alkalosis renal compensation

HCO3 reabsorption drops

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Metabolic acidosis 101

lab values

primary decrease in plasma bicarbonate

pH less than 7.35

HCO3 less than 22

Compensation = decrease in PaCO2

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Metabolic acidosis causes

Loss of HCO3 - diarrhea

Decreased acid elimination - renal failure

Excess acid production -
Starvation
Diabetic/alcoholic ketoacidosis
Cardiac arrest
Sepsis
Shock

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Metabolic alkalosis 101

lab values

Increase in bicarbonate in ECF (extracellular fluid)

pH greater than 7.45

HCO3 greater than 28

Compensatory increase in PaCO2

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Metabolic alkalosis causes

Excess of base/loss of acid
Vomiting
GI suction

Alkali intake increase
med or diet

Furosemide diuretic

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Methazolamide/acetazolamide and A/B balance

Carbonic anhydrase inhibitor

causes increase in metabolic acidity

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Calcium carbonate antacids and A/B balance

Used to treat GERD will lower pH may result in metabolic alkalosis

Myasthenia gravis (MG)

Chronic autoimmune disorder Antibodies destroy communication between nerves and muscle

Potassium and Acid Base Balance

Acidosis causes decreased K(+) secretion and increased reabsorption. SO, MORE K+ Alkalosis has the opposite effects, often leading to hypokalemia. SO, LESS K+

Increased anion gap indicates Decreased anion gap indicates

Metabolic acidosis Metabolic alkalosis

Normal anion gap range

8-12

Only thing the lungs control

CO2

Simple nursing intervention for hyperventilation

paperbag

CO2 is high CO2 is low

Breathing slow and low, retaining Breathing fast, blowing off

What is the anion gap What does it represent Values

Difference between all positively charged and negatively charged electrolytes represents unmeasured phosphate sulfate and proteins that act as Acid Base buffers 8 to 12mEq/L

Reverse metabolic acidosis by giving

Sodium bicarbonate

When giving sodium bicarb to correct metabolic acidosis pt will become at risk of why

cardiac arrest potassium will shift back into cells resulting in hypokalemia

Diuretics like thiazide and furosemide can cause This is due to

Metabolic alkalosis Urination of lytes (potassium) and acids

Hypocalcemia symptoms

tingling in fingers/toes dizziness tetany

Why does metabolic alkalosis cause hypocalcemia

loss of H+ creates excess (-) ions, Ca++ binds to those and gets used up, creating hypocalcemia

Hypokalemia symptoms

heart palpitations muscle weakness prominent U waves

Why does metabolic alkalosis cause hypokalemia

Body holds on to H+ to correct issue. Excess H+ replaces K+ and K+ gets excreted This results in hypokalemia

Best way to narrow down cause of metabolic alkalosis

Urine chloride level

Carbonic anhydrase inhibitor med MOA

Acetazolamide enhance bicarbonate exertion used for metabolic alkalosis

atelectasis

lung collapse

COPD causes

resp acidosis

When CO2 combines with water it becomes

Acidic

Acidic pt behavior = alkalotic pt behavior =

lethargic excitable

PT with Pulmonary embolism will first have resp alkalosis then acidosis why

first they hyperventilate due to panic, then the clot blocks off CO2 exchange sites

Only way to rid of CO2

exhalation

Can lungs fix them selves

NO, need kidneys to adjust

Kidneys control both

Hydrogen and bicarb

High anion gap =

accumulation of fixed acid

basic cause for metabolic acidosis

kidney failure

Atropine?

Do you even leave an unstable client?

NO, call rapid response.

do you ever push or mix potassium

Common causes of metabolic acidosis

DKA Renal Failure Diarrhea

Resp acidosis S/S

confusion, disorientation, drop in LOC

Potassium and Resp Acidosis

Increase in K+

Treatment for resp acidosis

Oxygen vent or supplemental bronchodilators, nebulizers hydration

Respiratory acidosis and headaches resp alkalosis and loc

Increase in CO2 dilates brain blood vessels in resp alkalosis CO2 will drop which is why pt passes out

Resp alkalosis S/S

numbness tingling tinnitis due to low calcium loss of consciousness

Salicylate intoxication causes which AB problem

Aspirin poisoning Resp alkalosis

PaO2 normal range

Partial pressure or oxygen in arterial blood How much PRESSURE oxygen exerts in blood 80-100mmHg

SaO2

Arterial oxygen SATURATION measured by pulse oximetry 95-100%

Allen test

Do PRIOR or taking blood gas check radial and ulnar arterial flow before draw

In partial compensation, both CO2 and HCO3 levels are

Abnormal

In full compensation pH is

Normal

Biggest characteristics of ARDS

Ventilation problems Refractory Hypoxemia

Surfactant

Liquid produced by alveoli to maintain function No surfactant, no function

Most worrisome alarm on a ventilator

Low pressure Drop in oxygenation

Basic assessment for ventilation

Auscultate all lobes for noise

If you cant fix the vent

Face mask pt and provide O2 Call for help

ARDS CXR will appear

White

ARDS ABGs will show a decrease in

O2 sat

Initial ABGs for ARDS will reveal resp then

Alkalosis Acidosis

FiO2

Fraction of inspired O2 Concentration of oxygen in gas mixture room air is 21%

Best position for ARDS

Prone or up right

PEEP = _ = _

Vent = DECREASE IN CARDIAC OUTPUT

Due to ventilation and peep Cardiac output will drop this results in

Drop in BP Drop in perfusion Drop in urine output Drop in LOC

Normal Cardiac output in L

4-6L/m

95% of all PE come from

Deep veins of legs

Different types of Thrombus

Blood clot Lipid Tumor Amniotic sac (from baby)

Lipid thrombus is concern for first _h after long bone break

Other MAJOR site contributing to Thrombus development

Heart A FIB specifically

If DVT suspected never do _ test

Homans

PLURAL FRICTION RUB =

Pulmonary Embolism

Cholesterol meds kill what organ

Liver

HIV tests

Elissa Westernblot

PE can lead to right side heart failure T/F

True

D-dimers indicates only that not

there is a clot not a particular location

Best treatment for Hypoglycemia

DEXTROCE 50%

Anemia due to drop in kidney function v in kidney function = _ = _

v in bone marrow = v in erythropoietin

Erythropoietin

Glycoprotein hormone Produced by peritubular cells of kidney Stimulates RBC production

v in RBC production can happen due to (GI)

Lack of iron Lack of nutrition Lack of erythropoietin

Livers major functions 4 of em

Detoxify body Clotting Metabolizes drugs Synthesizes albumin

Aplastic anemia is also known as

Bone marrow aplasia

Aplastic anemia 101

body stops producing enough blood cells due to BONE MARROW damage

Aplastic anemia can happen due to

Birth defect Poisoning - radiation, infection, medication

Diagnosing Aplastic anemia

Bone marrow biopsy CBC WBC HnH

Treatment for aplastic anemia

Antithymocyte globulin ATG Cyclosporins - immunosuppressant

Hemolytic anemia 101

RBC deformity

Intrinsic vs acquired hemolytic anemia

Something inside Due to meds, treatment, developed condition

GI organ most impacted by CF

Pancreas will become blocked and literally digest self

CF genome is autosomal

recessive

For tissue repair you need _ and _

Protein and Vit C

B1 = B2 =

targets heart targets lungs 1 heart 2 lungs

AKI = v in GFR = HF = fluid overload =

Hyperkalemia Hypokalemia

When not to give isotonic fluids 3 situations

HF Renal failure ^BP

GFR numbers

90-100 idea hospital wants greater than 60

Best Lab indicator of Renal Failure

Creatinine

Treating prerenal failure

Increase volume give meds

Heart EF numbers

Want it to be greater than 50 less than 40 is HF

Mycin vancomycin tobramycin S/S or toxicity

Ototoxicity Nephrotoxicity

Peaks and trophs with mycin drugs

Check troph before giving check peak 1h after

rhabdomyolysis 101 S/S

Kidney toxicity related to myoglobulin release from muscle injury Dark urine (tea colored)

Glomerulonephritis big cause moa treat with

4 weeks after strep PROTEINURIA steroids

can bun and creatinine drop

NO only normal or elevated

Big S/S of fat embolism

Petechia

NY Heart function classification

1-4 ok - worst

2-3lb increase in a week

HF prevention BIGGEST MONITORING intervention

MONITOR WEIGHT DAILY

Right HF basic S/S

JVD Liver pain Clear breath sounds

Beta blockers block what system what chemicals

Sympathetic Epi Norepi

RAAS system most potent constrictor converted at

ANGIOTENSIN II Lungs

Nitro Directions

q5m for 3 doses CALL EMS

B Blocker contraindications

COPD Asthma DIABETES - will mask symptoms

PT arrives at hospital first 4 interventions AONM

Aspirin O2 Nitro Morphine

Normal hematocrit M F

42-52 37-47

M1 Acid Base Flashcards

(128 cards)