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Exam 4 > acid and base > Flashcards

acid and base Flashcards

1
Q

2nd line of defense to restore pH

A

respiratory mechanisms

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2
Q

40% of buffering in an acute acid load takes place in

A

the bone

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3
Q

A base or alkali is a compound that

A

combines with (accepts) hydrogen ions in solution

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4
Q

A buffer system consists of

A

a weak acid and a weak base.

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5
Q

a solid substance dissolved in body fluids.

A

A solute

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6
Q

ABG is taken from _________ Interventions:

A

artery
so pressure after
get to lab quickly
be concerned/aware if on anticoagulant

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7
Q

Acidity or alkalinity is determined by the concentration of ______, represented by the pH

A

H+ ions

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8
Q

acidosis compensation problem

A

hyperkalemia and hypercalcemia

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9
Q

Acidosis – pH < 7.35

Caused by an excess of _____ or _____ in bloodstream or a deficit of ______ in the blood stream

A

CO2 or H+ ions

HCO3

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10
Q

alkalosis compensation complication

A

hypokalemia and hypocalcemia

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11
Q

Alkalosis – pH > 7.45

Caused by an excess of _______ in the bloodstream or a deficit of _____ in the blood stream

A

HCO3

H+ ions

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12
Q

An acid is any compound that contains _______ ____ that can be released. For this reason, acids are referred to as cation donors. A common strong acid is hydrochloric acid (HCl), which is present in ______ _______

A

hydrogen ions (H+)

gastric secretions.

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13
Q

Balances are maintained by intake and output of ____ and _______ and their ________ in the body

A

H20
Electrolytes
Distribution

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14
Q

bases are referred to as

A

cation acceptors

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15
Q

Bicarb is produced in

A

kidneys and pancreas

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16
Q

Buffer molecules keep strong acids or bases from altering the pH either by

A

absorbing or releasing free hydrogen ions.

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17
Q

Buffers work against sudden and large changes in the pH of body fluids by doing one of these 2 things…..

A
  1. Releasing hydrogen ions (acting as acids) when the pH increases, and
  2. Binding hydrogen ions (acting as bases) when the pH decreases.
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18
Q

cause of respiratory acidosis

A

retention of CO2

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19
Q

causes of metabolic alkalosis

A

severe vomiting
excessive GI suctioning
diuretics
excessive NaCO3

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20
Q

chemical reasons for metabolic alkalosis

A

excessive HCO3 intake or retention

loss of H+

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21
Q

Decreased ability of the kidney to excrete acid or hold on to base is called

A

Metabolic Acidosis

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22
Q

deep, rapid, and labored breathing

A

Kussmaul respirations

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23
Q

Describe the difference between infiltration and extravasation as a complication of IV therapy.

A

Infiltration involves a nonvesicant solution.
• Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).

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24
Q

examples of hypotonic solutions

A

D5W and 0.45% Sodium chloride (1/2 NS)

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25
Q

examples of isotonic solutions

A 
normal saline (0.9% NaCl) 
lactated ringers
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26
Q

First symptom of hypovolemia

A

thirst

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27
Q

for Ph to be acidosis the value must be what

A

below 7.35

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28
Q

for Ph to be alkalosis the value must be what

A

above 7.45

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29
Q

Function of bicarb

A

• Maintains acid–base balance by functioning as the primary buffer in the body

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30
Q

Function of Calcium

A
  • Promotes transmission of nerve impulses
  • Regulates muscle contractions
  • Maintains cardiac automaticity
  • Serves as an essential factor in the formation of blood clots
  • Catalyzes many cellular activities
  • Is a major component of bones and teeth
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31
Q

Function of Potassium

A
  • Maintains osmolality of intracellular fluid
  • Regulates conduction of cardiac rhythm
  • Transmits electrical impulses in multiple body systems
  • Assists with acid–base balance
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32
Q

Function of Sodium

A
  • Regulates fluid volume
  • Helps maintain blood volume
  • Interacts with calcium to maintain muscle contraction
  • Stimulates conduction of nerve impulses
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33
Q

how ill the respiratory system compensate for alkalosis metabolic imbalances

A

the lungs will decrease the attempt to eliminate CO2 from the system

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34
Q

how long do kidney buffers take to react

A

hours to days

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35
Q

How long do respiratory buffers take to react

A

rapidly

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36
Q

how will the metabolic system compensate for alkalosis respiratory imbalances?

A

the kidneys will decrease the excretion of H+ ions and will increase excretion of bicarb and make less bicarb

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37
Q

how will the metabolic system compensate for respiratory acidosis imbalances?

A

the kidneys will increase the excretion of H+ ions and will reduce the excretion of bicarb to make more

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38
Q

how will the respiratory system compensate for metabolic acidosis imbalances?

A

the lungs will increase the attempt to eliminate CO2 from the system

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39
Q

Hyperklemia = cell excitability - you will see

A

EKG changes, muscles will twitch/burn then numbness/weakness

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40
Q

Hypertonic fluids have a ________ osmolality than does
serum. When administered, they _____ fluids
and electrolytes from the intracellular and interstitial compartments into the _______ ________Hypertonic fluids can help _______, _________ and ________

A

higher
pull
intravascular compartment.
stabilize blood pressure, increase urine output, and reduce edema.

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41
Q

Hypertonic solutions also called

A

volume expanders

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42
Q

Hypotonic solution osmolality is ______ than that of serum. Infusion of these solutions ____ _____ _____ from the intravascular compartment into the interstitial fluid compartment. Hypotonic fluid is used for __________________, in which high serum glucose draws fluid out of the cells and into the vascular and interstitial compartments.

A

less
pulls body water
hyperglycemic conditions, such as diabetic ketoacidosis,

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43
Q

If bicarbonate is depleted while neutralizing a strong acid

A

the pH may drop below 7.35, resulting in a condition called acidosis.

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44
Q

If carbonic acid is depleted (by adding a strong base to extracellular fluid)

A

the pH may rise above 7.45, resulting in a condition called alkalosis.

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45
Q

In acidic environment there is more free calcium called _________ which allows what to form?

A

hypercalcemia

blood clots

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46
Q

In alkalosis you will see what electrolyte complications

A

hypocalcemia and hypokalemia

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47
Q

In extracellular fluid (ECF), the major cation is _______ and the major anions are _______ and _________

A

sodium (Na+)

chloride (Cl ̄) and bicarbonate (HCO3 ̄).

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48
Q

In general, how often are administration sets changed on peripheral IV lines?

A

For peripheral IV lines, the administration set is changed every 96 hours.

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49
Q

In intracellular fluid (ICF), the major cations are ____ and ____and the major anion is

A

potassium (K+) and magnesium (Mg2+)

phosphate (HPO42 ̄).

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50
Q

Increase in base (production, intake or lack of elimination) or decrease in acids ( getting rid of too much) in kidneys is called

A

Metabolic Alkalosis

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51
Q

Interventions for Metabolic Acidosis

A 
Correct underlying problem
Bicarb if low
insulin for DKA
antidiarrheal
remember we are worried about hyperkalemia
52
Q

Interventions for Metabolic Alkalosis

A

treat underlying problem (antiemetics)
stop diuretics
replace electrolytes
check calcium levels (heart and skeletal muscles)

53
Q

Interventions for Respiratory Acidosis

A

Treatment aimed at maintaining airway and improving gas exchange.
Pulmonary hygiene: TCDB, position changes, RT
O2
Drugs: bronchodialotors
maintain hydration

54
Q

Interventions of Respiratory Alkalosis

A 
aimed at stabilizing gas exchange:
paper bag
Encourage relax and deep breathing
correct lung problem
adjust vent settings
55
Q

involves excessive retention of sodium and water in the ECF. A synonym is hypervolemia. Fluid volume excess occurs as a result of excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.

A

Excess fluid volume

56
Q

is a measure of the percentage of

RBCs in whole blood.

A

Hematocrit

57
Q

is a measure of the solute concentration of the blood.

A

Serum osmolality

58
Q

is a substance that develops an elec-

trical charge when dissolved in water.

A

An electrolyte

59
Q

is fluid contained within the cells.

A

Intracellular fluid (ICF)

60
Q

is fluid outside the cells. ECF consists of three types of fluid: interstitial, intravascular, and transcellular fluid.

A

Extracellular fluid (ECF

61
Q

is the precipitation of carpal spasm by reduction of the blood supply to the hand with a tourniquet or blood pressure cuff inflated to 20 mm Hg above systolic blood pressure applied to the forearm for 3 minutes. Is seen in

A

Trousseau sign

hypocalcemia

62
Q

is the solute concentration of urine.

A

Urine osmolality

63
Q

Largest chemical buffer system

A

Carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3) buffer almost 90% of metabolic processes in the ECF.

64
Q

Last line of defense to restore pH

A

Renal Mechanism

65
Q

Lungs compensating for Metabolic Acidosis: When the serum pH is too acidic (pH is low), the lungs _______ carbon dioxide through ____ _____ _____ . This reduces the amount of carbon dioxide available to make carbonic acid.

A

remove

rapid, deep breathing

66
Q

Lungs compensating for Metabolic Alkalosis:When the serum pH is too alkaline (pH is high), the lungs try to _______ carbon dioxide through ______ ______

A

conserve

shallow respirations.

67
Q

measure acid–base balance and oxygen status.

A

ABGs

68
Q

measures sodium, potassium, chloride, and bicarbonate levels. The test often includes blood urea nitrogen (BUN), creatinine, and glucose.

A

Serum electrolytes

69
Q

measures the kidney’s ability to con- centrate or dilute urine in relation to the plasma.

A

Specific gravity

70
Q

Metabolic disorders produce an alteration in the plasma _______ concentration

A

HCO3-

71
Q

Normal blood plasma is slightly

A

alkaline

72
Q

occurs when there is a proportional loss of water and electrolytes from the ECF. It may occur as a result of insufficient intake of isotonic fluid; bleeding; excessive loss through urine, skin, insensible losses, or the gastrointestinal tract; or loss of fluid into a third space.

A

Deficient fluid volume

73
Q

over the elimination of HCO3 ions in metabolic acidosis causes what

A

diarrhea

74
Q

overproduction of H+ions in metabolic acidosis causes what

A

diabetic ketoacidosis

75
Q

Pa02 value

A

80-100

76
Q

Ph acidosis could be caused by

A

excess C02
excess H+ ions in the bloodstream
the deficit of HC03 in the bloodstream

77
Q

Ph alkalosis could be caused by what

A

excess HCO3 in the bloodstream

a deficit of H+ ions in the bloodstream

78
Q

pH represents the______ ______ of the H+ concentration, that is a pH of 7.0 implies a concentration of 10-7

A

negative logarithm
meaning it’s inverse:the higher the H+ ion concentration the lower the pH. The lower the H+ ion concentration the higher the pH

79
Q

Protein are amphoteric - meaning

A

can function as acids (releasing H+ ions) or bases (bind H+ ions)

80
Q

Rank in order the acid–base balance mechanisms from most rapidly acting to the slowest acting.

A

The three acid–base balance mechanisms are ranked as follows:
• Buffers act the most rapidly.
• Respiratory mechanisms are intermediate. • Renal mechanisms act the slowest.

81
Q

Renal system buffer acts on bicarb HCO3 how?

A

reabsorbs or produces

82
Q

Renal system buffer acts on H+ ions how?

A

conserves or excretes

83
Q

Renal system buffer is

A

slow - can take hours to days

84
Q

respiratory alkalosis cause

A

hyperventilation

85
Q

Respiratory buffer mechanism is

A

fast - rapid changes in H+

86
Q

Respiratory disorders involve an alteration in the ______, reflecting an increase or decrease in ______ ________

A

pCO2

alveolar ventilation

87
Q

Respiratory mechanism control the body’s carbonic acid supply via

A

carbon dioxide retention or removal to maintain the 20:1 ratio of base to acid.

88
Q

Retention of CO2 in lungs is what disorder

A

Respiratory Acidosis

89
Q

S/S of hypervolemia

A 
inc BO
bounding pulse
inc shallow, respirations
distended neck veins
dependent edema
skin is pale and cool
UO is dilute and inc
rapid weight gain
Dec BUN
may develop crackles dyspnea, ascites
90
Q

S/S of Metabolic Acidosis

A 
Changes in LOC - confusion drowsiness
headache
decreased BP
muscle twitching 
vasodilation - warm, flushed skin
N/V/D
91
Q

S/S of Metabolic Alkalosis

A 
hypoventilation (compensatory - trying to hold on to CO2
restless then lethargy
dysrhythmias (tachycardia)
dizziness
N/V/D
Tingling of extremities ( fingers, toes)
92
Q

S/S of progressing hypovolemia is

A

As fluid volume decreases:
rapid, weak pulse and a low blood pressure (starts high)
dry skin and mucus membranes, decreased skin turgor and UO
Temp rist d/t body not able to cool
Inc BUN - less water in proportion to solids

93
Q

S/S of Respiratory Acidosis

A 
hypoventilation - leading to hypoxia
rapid shallow respirations
dec BP d/t vasodilatation
hyperkalemia
dysrhythmias - d/t inc K+
drowsiness, dizzy, disoriented
muscle weakness/hyperrelexia
94
Q

s/s of Respiratory alkalosis

A 
hyperventilating (deep rapid breathing)
tachycardia
numbers/tingling
confusion
light headedness
95
Q

So pH, a measure of acidity and alkalinity, is a

A

characteristic of blood

96
Q

The amount of acid or base present in a solution is measured as

A

pH

97
Q

The body’s precise regulation of the H+ ions is necessary to maintain what

A

cell integrity
membrane excitability
the speed of enzymatic reactions

98
Q

The body’s precise regulation of H+ ions is necessary to

A

maintain cell integrity, membrane excitability and the speed of enzymatic reactions

99
Q

The Chvostek sign (/ˈkvɒstɪk/) is a clinical sign of _________. It is evidenced by the ____ ____ ______innervated by the facial nerve (CNVII).

A

hypocalcemia

twitching of muscles

100
Q

The kidneys are _______ to compensate than the lungs, but renal physiology has several powerful mechanisms to control pH by the _______ of excess acid or base.

A

slower

excretion

101
Q

The major, homeostatic control point for maintaining a stable pH balance is

A

renal excretion

102
Q

The osmolality of isotonic fluids is similar to that of ____ _____. When infused, isotonic solutions remain ______the intravascular compartment. As a result, they are useful for clients with _______ or __________

A

blood serum
inside
hypotension or hypovolemia.

103
Q

the ratio of carbonic acid ions to bicarbonate ions is

A

1:20

104
Q

the respiratory system compensates for _______ and metabolic (renal) compensates for ______

A

metabolic

respiratory

105
Q

The usual ratio of NaHCO3 to H2CO3 is

A

20:1

106
Q

Things that create acid in our body

A

breathing, digestion, sustained muscle moment

107
Q

Three complex mechanisms maintain acid–base balance:

A

(1) buffers, (2) respiratory control of carbon dioxide, and (3) renal regulation of bicarbonate (HCO3–).

108
Q

Three major chemical buffer systems in the body are the:

A

Carbonic acid-bicarbonate buffer system

Phosphate buffer system

Protein buffer system

109
Q

to be fully compensated the Ph must be what

A

normal

110
Q

under the elimination of H+ ions in metabolic acidosis causes what

A

kidney failure

111
Q

What 2 electrolyte imbalances do you see with Metabolic Acidosis

A

hyperkalemia and hypercalcemia

112
Q

What are the major concerns associated with sodium and potassium intake?

A

The major concerns are excessive sodium intake and inadequate potassium intake, which could lead to the following:
• For sodium: weight gain (edema), hypertension (high blood pressure)
• For potassium: cardiac dysrhythmias (bradycardias, heart block, asystole), potential for acid–base imbalance (metabolic acidosis)

113
Q

What could cause Metabolic Acidois (keeping/making too much acid or getting rid of too much base?

A

DKA - Diabetic Keto Acidosis overproduction of H+ions - making too much
Aspirin OD
starvation - making too much (braking down fats)
heavy exercise - making too much (lactic acid)
shock -
Severe Diarrhea - losing too much base
Real/Kidney failure - Keeping too much acid or not making base

114
Q

What could cause Metabolic Alkalosis

A

severe vomiting (getting rid of acid)
excessive GI suctioning (getting rid of acid)
Potassium wasting diuretics (lassie, fuorisomide)
Excessive NaHCO3 (sodium bicarb - antacids)

115
Q

what disorder causes too much loss of CO2

A

Metabolic Alkalosis

116
Q

What electrolyte disorder is associated with Metabolic Alkalosis

A

hypokalcemia

117
Q

what electrolytes would you see with respiratory alkalosis

A

hypocalcemia, hypokalemia

118
Q

What is a cation

A

a positively charged particle

119
Q

what is the balancing mechanism for acid-base imbalances

A

carbonic

120
Q

What is the body trying to do with Kussmaul respirations

A

get rid of acid through the lungs

121
Q

What kind of patients will you see with Metabolic alkalosis

A 
excessive ventilation from mechanical vent
hyperventilating from :
fear
anxiety
fever
sepsis
122
Q

What kind of patients would you see with Respiratory Acidosis - who keeps/can’t get rid of CO2?

A

COPD - decreased exhale of CO2
Pneumonia -
Atelectasis - decrease lung expansion
people with decreased respiratory stimuli - like those who have been under anesthesia or drug overdose - decrease respirations

123
Q

What patient do you associate Kussmaul reparations with

A

diabetic Ketoacidosis

124
Q

What systems regulate acid-base balance

A

renal and pulmonary

125
Q

where is bicarbonate produced?

A

kidneys and pancreas

126
Q

who is at risk for acid/base imbalances

A

elderly
people on multiple meds
people with chronic health problems
people with mental status changes

127
Q

Who is at risk for pH imbalances

A

elderly
poly pharmacy - lots of meds
chronic health problems
mental status changes - dehydration or fluid overload

Exam 4 (14 decks)

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