Test 1

Question 1

what is the definition of acid-base balance?

Answer 1

the process of regulating the pH, bicarbonate concentration, and partial pressure of carbon dioxide of body fluids

Question 2

What are the acid-base balancing processes?

Answer 2

• acid production (consistent)
• acid buffering (maintains ratio between bicarb and carbonic acid)
• acid excretion (through lungs and through kidneys)

Question 3

acid-base imbalance characteristics

Answer 3

• develops as a complication of another underlying condition
• never considered “normal” but may be “expected” if a chronic condition is present
• ex respiratory acidosis d/t COPD

Question 4

how does the body maintain optimal acid-base balance?

Answer 4

• acid excretion keeps up with production
• if too much acid is produced the buffers can become overwhelmed

Question 5

what is acidosis caused by?

Answer 5

too much acid or loss of too much base

Question 6

characteristics of respiratory acidosis

Answer 6

• too much carbonic acid
• buffers cannot maintain balance

Question 7

what causes respiratory acidosis?

Answer 7

• COPD
• asthma
• pneumonia
• pulmonary edema
• narcotic overdose
• Guillan Barre

Question 8

What is metabolic acidosis?

Answer 8

• metabolic acid (H+) retention/ingestion or bicarb loss

Question 9

What can cause metabolic acidosis?

Answer 9

• DKA
• diarrhea (bicarb loss through intestinal tract)
• renal disease
• thyroid storm
• starvation ketoacidosis
• build up of lactic acid
• acid ingestion, aspirin overdose

Question 10

what is alkalosis caused by?

Answer 10

too much base or loss of too much acid

Question 11

what is respiratory alkalosis?

Answer 11

carbonic acid loss

Question 12

what causes respiratory alkalosis

Answer 12

hyperventilation (pain, anxiety, hypoxia, head injury)

Question 13

what is metabolic alkalosis

Answer 13

• excess of bicarb or metabolic acid loss

Question 14

what causes metabolic alkalosis

Answer 14

• emesis
• continuous NG tube suction
• tums (excess antacids)
• IV sodium bicarb
• diuretics (decreases fluid volume which can increase bicarb excretion)

Question 15

what does the body do to prevent these acid base imbalances?

Answer 15

can attempt to correct it with compensation

Question 16

How long does it take for the lungs to compensate

Answer 16

happens very quickly, breathing is adjusted

Question 17

how long does it take for the kidneys to compensate?

Answer 17

• happens in 2-3 days to make a clinically significant difference

Question 18

expected ABG values for metabolic alkalosis and compensation

Answer 18

HIGH pH and HIGH HCO3
compensation- low RR

Question 19

expected ABG values for metabolic acidosis and compensation

Answer 19

LOW pH and LOW HCO3
compensation- high RR

Question 20

expected ABG values for respiratory acidosis

Answer 20

LOW pH and HIGH CO2

Question 21

expected ABG values for respiratory alkalosis

Answer 21

HIGH pH and LOW CO2

Question 22

how do you know if compensation is partial or full?

Answer 22

if the pH is normal it is full compensation, if the pH is still abnormal it is partial compensation

Question 23

what are some teaching points to prevent acid base imbalance

Answer 23

• Diet: safe weight loss, safe food handling to avoid food poisoning
• smoking cessation/prevention
• preventing overdose of meds at home (antacids, aspirin)

Question 24

What clients are at risk for DKA?

Answer 24

• type 1 diabetics due to their complete lack of insulin
• pts who are noncompliant with their insulin
• undiagnosed diabetics (young children)

Question 25

what are the assessment findings for a client with DKA

Answer 25

- decrease in LOC - polyuria - polydipsia - fatigue - nausea - anorexia - abdominal pain - dehydration - orthostatic hypotension - tachycardia - Kussmaul's breathing - acetone breath

Question 26

what are the treatments/management priorities for DKA

Answer 26

- IV fluids: infuse fast to improve dehydration (1 L/hour) - IV regular insulin drip: infuse slow to reverse acidosis and prevent hypoglycemia - avoid activities that increase intracranial pressure

Question 27

what are the expected lab values/diagnostics for a pt with DKA?

Answer 27

- BG 250-800 - ketones and glucose in urine - positive ketones in blood - metabolic acidosis on an ABG (pH low, HCO3 low, CO2 low)

Question 28

what would indicate decline in client status in a client with DKA

Answer 28

- decreased LOC - low BP - tachycardia - decreased urine output

Question 29

should 0.9% normal saline be the IV fluid infused for the entire time the client is on an insulin drip?

Answer 29

no, when blood glucose is 250-300 we switch to a dextrose drip to avoid hypoglycemia

Question 30

what are complications associated with the treatments of DKA?

Answer 30

- cerebral edema - hypoglycemia - hypokalemia - fluid overload

Question 31

What are the sick day rules?

Answer 31

- take insulin agents as usual - test blood glucose and urine ketones every 3-4 hours - report elevated glucose levels or urine ketones to primary provider - take supplemental doses of doses of regular insulin every 3-4 hours if needed - substitute soft foods six to eight times a day if you cannot follow your usual meal plan - take liquids every 1/2 to 1 hour to prevent dehydration and to provide calories, if vomiting, diarrhea, or fever persists report nausea, vomiting, and diarrhea to your primary provider because extreme fluid loss may be dangerous - be aware that if you are unable to retain oral fluids you may require hospitalization to avoid DKA and possibly coma

Question 32

why is an insulin drip started for a client in DKA?

Answer 32

to reverse the acidosis

Question 33

what are expected patient outcomes for DKA

Answer 33

- achieves fluid and electrolyte balance - demonstrates knowledge about DKA - decreased anxiety - absence of compliance

Question 34

when should potassium replacement start for DKA?

Answer 34

- once potassium levels are NORMAL - hold replacement if hyperkalemia or no urination