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Med-Surg Nursing > objective 4 (2) > Flashcards

objective 4 (2) Flashcards

1
Q

produced with normal metabolic processes

A

acids

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2
Q

what is the organ that plays an essential role in acid/base balance?

A

kidneys

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3
Q

what conditions can lead to acid base imbalances?

A

diabetes, COPD, kidney disease, vomiting and diarrhea

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4
Q

what is the normal blood pH?

A

7.35-7.45

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5
Q

pH less than 7.35

A

acidosis

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6
Q

pH greater than 7.45

A

alkalosis

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7
Q

an increased in H+ concentration lead to…

A

acidity

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8
Q

a decrease in H+ concentration leads to…

A

alkalinity

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9
Q

the higher the pH…

A

the lower the H+ concentration

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10
Q

the lower the pH…

A

the higher the H+ concentration

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11
Q

1

A

most ACIDIC

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12
Q

14

A

most BASIC

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13
Q

ADDITION of H+ will…

A

increase ACIDITY and lower pH

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14
Q

ELIMINATION of H+ will…

A

promote ALKALINITY and rise pH

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15
Q

what are the 4 mechanisms that the body will use to maintain normal balance of acids and bases in the blood?

A

buffer system
respiratory system
renal system

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16
Q

is the fastest-acting system and the primary
regulator of acid–base balance

A

buffer system

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17
Q

act chemically to change
strong acids into weaker acids or to bind to acids and neutralize
their effect

A

buffers

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18
Q

what is the major buffer system for acid base balance?

A

bicarbonate-carbonic acid system

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19
Q

carbonic acid

A

chief acid

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20
Q

bicarbonate

A

chief base

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21
Q
  • The amount of CO2 in the blood directly relates to carbonic acid concentration
    and subsequently to H+ concentration
  • CO2 is a potential acid; when dissolved in water, it becomes carbonic acid (CO2
    + H2O = H2CO3). Increase in CO2 = increase in acid in bloodstream (LOWER
    pH) & decrease in CO2 = decrease in acid in bloodstream (HIGHER pH).
  • As a compensatory mechanism, the respiratory system acts on the CO2 + H2O
    side of the reaction by altering the rate and depth of breathing to “blow off”
    (through hyperventilation) or “retain” (through hypoventilation) CO2.
  • will respond within couple minutes to change in pH, maximal
    effectiveness seen within hours.
A

respiratory response

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22
Q
  • Under normal conditions, the kidneys reabsorb and conserve all of
    the bicarbonate they filter. The kidneys can generate additional
    bicarbonate and eliminate excess H+ as compensation for acidosis.
  • The body depends on the kidneys to excrete a portion of the acid
    produced by cellular metabolism. Thus the kidneys normally excrete
    an acidic urine (average pH is 6).
    *is relatively slow (hours or days), but in chronic
    conditions (COPD) can maintain balance indefinitely
A

renal response

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23
Q

what are the normal plasma pH levels?

A

7.35-7.45

24
Q

acidosis

A

6.8-7.35

25
Q

alkalosis

A

7.45-7.8

26
Q

when will death occur?

A

<6.8 >7.8

27
Q

what is normal HCO3?

A

21-28

28
Q

what is the normal CO2?

A

35-45

29
Q

is how we can measure
the acidity/alkalinity of
blood
* Used to determine acid
base imbalances, their
cause, if there is any
compensation
happening, and the
severity
* Usually drawn through
radial artery by
respiratory therapist

A

arterial blood gas

30
Q

occurs with
hypoventilation – retention of CO2
* Hypoventilation results in a buildup of
CO2; subsequently, carbonic acid
accumulates in the blood. Carbonic
acid dissociates, causing liberation of
H−, and the pH decreases

A

respiratory acidosis

31
Q

what are the causes of respiratory acidosis?

A

asthma, pneumonia, COPD, overdose, pulmonary edema

32
Q

what are the S&S of respiratory acidosis?

A
  • Extreme respiratory insufficiency
    (Hypoventilation)
  • Cyanosis
  • Dizziness / drowsiness
  • Increased pulse / Decreased BP
  • Warm flushed skin
  • Possible Seizures
  • Cardiac arrythmias (Due to subsequent
    Hyperkalemia    )
33
Q

how do we manage respiratory acidosis>

A

Individualized treatment dependent upon cause, acute or chronic.
Treatment aimed at improving ventilation - o2 admin, hydration,
BiPAP, bronchodilators, steroids, possible mechanical ventilation

34
Q

occurs with hyperventilation – loss of CO2
* The decrease in the arterial CO2 level leads to a decrease in carbonic
acid concentration in the blood and an increase in pH
* Always caused by hyperventilation; blowing off CO2 and so lowering
carbonic acid concentrations

A

respiratory alkalosis

35
Q

what are the causes of respiratory alkalosis?

A

Pneumonia, Pulmonary Embolus, Pain, Anxiety

36
Q

what are the S&S of respiratory alkalosis?

A

increased respiratory rate
lightheadedness
numbness/tingling of hands and feet
sweating
panic
tinnitus
tachycardia
dysthymias

37
Q

how do we manage respiratory alkalosis?

A

Treatment varies, dependent upon cause
If temporary anxiety is the issue, the patient is
instructed to breathe into a paper bag to allow
rebreathing of expired air (CO2)
Sedation if the patient is very anxious.
Kidneys compensate by retaining
H+ and excreting HCO3-

38
Q

occurs when
an acid other than carbonic acid accumulates in the body
or when bicarbonate is lost from body fluids. In both
cases, a bicarbonate deficit results.
* pH decreased
* HcO3 decreased

A

metabolic acidosis

39
Q

what are the causes of metabolic acidosis?

A

Shock, cardiac arrest, starvation, DKA, renal failure
(chronic metabolic acidosis), severe diarrhea, diuretic
overuse, lactic acidosis (working out too much!)

40
Q

what are the S&S of metabolic acidosis?

A
  • Kussmaul’s breathing (increased rate and
    depth)
  • N/V
  • Headache / confusion / lethargy
  • Dangerous cardiac dysrhythmias
  • Cold clammy skin
  • Hyperkalemia (shift of K+ out of cells)
  • If DKA is cause – Will have fruity smelling
    breath
41
Q

how do we manage metabolic acidosis?

A
  • Eliminating the cause, if possible
  • Replacing lost fluids and electrolytes
  • Severe: IV bicarbonate
  • Insulin if cause is DKA
42
Q

occurs when
acid is lost (as a result of prolonged vomiting or gastric
suction) or when bicarbonate increases (from ingestion of
things like baking soda) occurs
* Increased pH
* Increased HCO3

A

metabolic alkalosis

43
Q

what are the causes of metabolic alkalosis?

A

: Diuretic therapy, prolonged gastric suctioning,
pyloric stenosis with emesis, vomiting, hypokalemia,
antacids, sodium bicarb administration, steroid use

44
Q

what are the S&S of metabolic alkalosis?

A
  • Depressed respirations to retain CO2 may
    cause hypoxemia in patients with
    decreased LOC
  • Dizziness
  • Confusion
  • Tachycardia
  • Dysrhythmia (caused by hypokalemia)
  • Tetany
  • Muscle cramps
45
Q

how do we manage metabolic alkalosis?

A

Monitor I&O carefully
Restore fluid balance
Administer chloride (IV
fluids with K+ if necessary)
to aid in elimination of
bicarbonate.

46
Q

what is ROME?

A

respiratory
opposite
metabolic
equal

47
Q

low pH, high PaCO2

A

respiratory acidosis

48
Q

high pH, low PaCO2

A

respiratory alkalosis

49
Q

low pH, low HCO3

A

metabolic acidosis

50
Q

high pH, high HCO3

A

metabolic alkalosis

51
Q

Returning the bicarbonate/carbolic acid ratio back to 20:1

A

compensation

52
Q

KIDNEYS: Increased renal acid (H+) excretion and HCO3 is
retained in the blood serum

A

respiratory acidosis compensation

53
Q

KIDNEYS: Increased renal HCO3 excretion and H+ is
retained in the blood serum.

A

respiratory alkalosis compensation

54
Q

LUNGS: Increased ventilation expels CO2 and renal retention of
HCO3.

A

metabolic acidosis compensation

55
Q

LUNGS: Decreased ventilation to retain CO2.

A

metabolic alkalosis compensation

Med-Surg Nursing (9 decks)

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