acid and base Flashcards
2nd line of defense to restore pH
respiratory mechanisms
40% of buffering in an acute acid load takes place in
the bone
A base or alkali is a compound that
combines with (accepts) hydrogen ions in solution
A buffer system consists of
a weak acid and a weak base.
a solid substance dissolved in body fluids.
A solute
ABG is taken from _________ Interventions:
artery
so pressure after
get to lab quickly
be concerned/aware if on anticoagulant
Acidity or alkalinity is determined by the concentration of ______, represented by the pH
H+ ions
acidosis compensation problem
hyperkalemia and hypercalcemia
Acidosis – pH < 7.35
Caused by an excess of _____ or _____ in bloodstream or a deficit of ______ in the blood stream
CO2 or H+ ions
HCO3
alkalosis compensation complication
hypokalemia and hypocalcemia
Alkalosis – pH > 7.45
Caused by an excess of _______ in the bloodstream or a deficit of _____ in the blood stream
HCO3
H+ ions
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 ______ _______
hydrogen ions (H+)
gastric secretions.
Balances are maintained by intake and output of ____ and _______ and their ________ in the body
H20
Electrolytes
Distribution
bases are referred to as
cation acceptors
Bicarb is produced in
kidneys and pancreas
Buffer molecules keep strong acids or bases from altering the pH either by
absorbing or releasing free hydrogen ions.
Buffers work against sudden and large changes in the pH of body fluids by doing one of these 2 things…..
- Releasing hydrogen ions (acting as acids) when the pH increases, and
- Binding hydrogen ions (acting as bases) when the pH decreases.
cause of respiratory acidosis
retention of CO2
causes of metabolic alkalosis
severe vomiting
excessive GI suctioning
diuretics
excessive NaCO3
chemical reasons for metabolic alkalosis
excessive HCO3 intake or retention
loss of H+
Decreased ability of the kidney to excrete acid or hold on to base is called
Metabolic Acidosis
deep, rapid, and labored breathing
Kussmaul respirations
Describe the difference between infiltration and extravasation as a complication of IV therapy.
Infiltration involves a nonvesicant solution.
• Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).
examples of hypotonic solutions
D5W and 0.45% Sodium chloride (1/2 NS)
examples of isotonic solutions
normal saline (0.9% NaCl) lactated ringers
First symptom of hypovolemia
thirst
for Ph to be acidosis the value must be what
below 7.35
for Ph to be alkalosis the value must be what
above 7.45
Function of bicarb
• Maintains acid–base balance by functioning as the primary buffer in the body
Function of Calcium
- 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
Function of Potassium
- Maintains osmolality of intracellular fluid
- Regulates conduction of cardiac rhythm
- Transmits electrical impulses in multiple body systems
- Assists with acid–base balance
Function of Sodium
- Regulates fluid volume
- Helps maintain blood volume
- Interacts with calcium to maintain muscle contraction
- Stimulates conduction of nerve impulses
how ill the respiratory system compensate for alkalosis metabolic imbalances
the lungs will decrease the attempt to eliminate CO2 from the system
how long do kidney buffers take to react
hours to days
How long do respiratory buffers take to react
rapidly
how will the metabolic system compensate for alkalosis respiratory imbalances?
the kidneys will decrease the excretion of H+ ions and will increase excretion of bicarb and make less bicarb
how will the metabolic system compensate for respiratory acidosis imbalances?
the kidneys will increase the excretion of H+ ions and will reduce the excretion of bicarb to make more
how will the respiratory system compensate for metabolic acidosis imbalances?
the lungs will increase the attempt to eliminate CO2 from the system
Hyperklemia = cell excitability - you will see
EKG changes, muscles will twitch/burn then numbness/weakness
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 ________
higher
pull
intravascular compartment.
stabilize blood pressure, increase urine output, and reduce edema.
Hypertonic solutions also called
volume expanders
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.
less
pulls body water
hyperglycemic conditions, such as diabetic ketoacidosis,
If bicarbonate is depleted while neutralizing a strong acid
the pH may drop below 7.35, resulting in a condition called acidosis.
If carbonic acid is depleted (by adding a strong base to extracellular fluid)
the pH may rise above 7.45, resulting in a condition called alkalosis.
In acidic environment there is more free calcium called _________ which allows what to form?
hypercalcemia
blood clots
In alkalosis you will see what electrolyte complications
hypocalcemia and hypokalemia
In extracellular fluid (ECF), the major cation is _______ and the major anions are _______ and _________
sodium (Na+)
chloride (Cl ̄) and bicarbonate (HCO3 ̄).
In general, how often are administration sets changed on peripheral IV lines?
For peripheral IV lines, the administration set is changed every 96 hours.
In intracellular fluid (ICF), the major cations are ____ and ____and the major anion is
potassium (K+) and magnesium (Mg2+)
phosphate (HPO42 ̄).
Increase in base (production, intake or lack of elimination) or decrease in acids ( getting rid of too much) in kidneys is called
Metabolic Alkalosis
Interventions for Metabolic Acidosis
Correct underlying problem Bicarb if low insulin for DKA antidiarrheal remember we are worried about hyperkalemia
Interventions for Metabolic Alkalosis
treat underlying problem (antiemetics)
stop diuretics
replace electrolytes
check calcium levels (heart and skeletal muscles)
Interventions for Respiratory Acidosis
Treatment aimed at maintaining airway and improving gas exchange.
Pulmonary hygiene: TCDB, position changes, RT
O2
Drugs: bronchodialotors
maintain hydration
Interventions of Respiratory Alkalosis
aimed at stabilizing gas exchange: paper bag Encourage relax and deep breathing correct lung problem adjust vent settings
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.
Excess fluid volume
is a measure of the percentage of
RBCs in whole blood.
Hematocrit
is a measure of the solute concentration of the blood.
Serum osmolality
is a substance that develops an elec-
trical charge when dissolved in water.
An electrolyte
is fluid contained within the cells.
Intracellular fluid (ICF)
is fluid outside the cells. ECF consists of three types of fluid: interstitial, intravascular, and transcellular fluid.
Extracellular fluid (ECF
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
Trousseau sign
hypocalcemia
is the solute concentration of urine.
Urine osmolality
Largest chemical buffer system
Carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3) buffer almost 90% of metabolic processes in the ECF.
Last line of defense to restore pH
Renal Mechanism
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.
remove
rapid, deep breathing
Lungs compensating for Metabolic Alkalosis:When the serum pH is too alkaline (pH is high), the lungs try to _______ carbon dioxide through ______ ______
conserve
shallow respirations.
measure acid–base balance and oxygen status.
ABGs
measures sodium, potassium, chloride, and bicarbonate levels. The test often includes blood urea nitrogen (BUN), creatinine, and glucose.
Serum electrolytes
measures the kidney’s ability to con- centrate or dilute urine in relation to the plasma.
Specific gravity
Metabolic disorders produce an alteration in the plasma _______ concentration
HCO3-
Normal blood plasma is slightly
alkaline
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.
Deficient fluid volume
over the elimination of HCO3 ions in metabolic acidosis causes what
diarrhea
overproduction of H+ions in metabolic acidosis causes what
diabetic ketoacidosis
Pa02 value
80-100
Ph acidosis could be caused by
excess C02
excess H+ ions in the bloodstream
the deficit of HC03 in the bloodstream
Ph alkalosis could be caused by what
excess HCO3 in the bloodstream
a deficit of H+ ions in the bloodstream
pH represents the______ ______ of the H+ concentration, that is a pH of 7.0 implies a concentration of 10-7
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
Protein are amphoteric - meaning
can function as acids (releasing H+ ions) or bases (bind H+ ions)
Rank in order the acid–base balance mechanisms from most rapidly acting to the slowest acting.
The three acid–base balance mechanisms are ranked as follows:
• Buffers act the most rapidly.
• Respiratory mechanisms are intermediate. • Renal mechanisms act the slowest.
Renal system buffer acts on bicarb HCO3 how?
reabsorbs or produces
Renal system buffer acts on H+ ions how?
conserves or excretes
Renal system buffer is
slow - can take hours to days
respiratory alkalosis cause
hyperventilation
Respiratory buffer mechanism is
fast - rapid changes in H+
Respiratory disorders involve an alteration in the ______, reflecting an increase or decrease in ______ ________
pCO2
alveolar ventilation
Respiratory mechanism control the body’s carbonic acid supply via
carbon dioxide retention or removal to maintain the 20:1 ratio of base to acid.
Retention of CO2 in lungs is what disorder
Respiratory Acidosis
S/S of hypervolemia
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
S/S of Metabolic Acidosis
Changes in LOC - confusion drowsiness headache decreased BP muscle twitching vasodilation - warm, flushed skin N/V/D
S/S of Metabolic Alkalosis
hypoventilation (compensatory - trying to hold on to CO2 restless then lethargy dysrhythmias (tachycardia) dizziness N/V/D Tingling of extremities ( fingers, toes)
S/S of progressing hypovolemia is
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
S/S of Respiratory Acidosis
hypoventilation - leading to hypoxia rapid shallow respirations dec BP d/t vasodilatation hyperkalemia dysrhythmias - d/t inc K+ drowsiness, dizzy, disoriented muscle weakness/hyperrelexia
s/s of Respiratory alkalosis
hyperventilating (deep rapid breathing) tachycardia numbers/tingling confusion light headedness
So pH, a measure of acidity and alkalinity, is a
characteristic of blood
The amount of acid or base present in a solution is measured as
pH
The body’s precise regulation of the H+ ions is necessary to maintain what
cell integrity
membrane excitability
the speed of enzymatic reactions
The body’s precise regulation of H+ ions is necessary to
maintain cell integrity, membrane excitability and the speed of enzymatic reactions
The Chvostek sign (/ˈkvɒstɪk/) is a clinical sign of _________. It is evidenced by the ____ ____ ______innervated by the facial nerve (CNVII).
hypocalcemia
twitching of muscles
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.
slower
excretion
The major, homeostatic control point for maintaining a stable pH balance is
renal excretion
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 __________
blood serum
inside
hypotension or hypovolemia.
the ratio of carbonic acid ions to bicarbonate ions is
1:20
the respiratory system compensates for _______ and metabolic (renal) compensates for ______
metabolic
respiratory
The usual ratio of NaHCO3 to H2CO3 is
20:1
Things that create acid in our body
breathing, digestion, sustained muscle moment
Three complex mechanisms maintain acid–base balance:
(1) buffers, (2) respiratory control of carbon dioxide, and (3) renal regulation of bicarbonate (HCO3–).
Three major chemical buffer systems in the body are the:
Carbonic acid-bicarbonate buffer system
Phosphate buffer system
Protein buffer system
to be fully compensated the Ph must be what
normal
under the elimination of H+ ions in metabolic acidosis causes what
kidney failure
What 2 electrolyte imbalances do you see with Metabolic Acidosis
hyperkalemia and hypercalcemia
What are the major concerns associated with sodium and potassium intake?
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)
What could cause Metabolic Acidois (keeping/making too much acid or getting rid of too much base?
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
What could cause Metabolic Alkalosis
severe vomiting (getting rid of acid)
excessive GI suctioning (getting rid of acid)
Potassium wasting diuretics (lassie, fuorisomide)
Excessive NaHCO3 (sodium bicarb - antacids)
what disorder causes too much loss of CO2
Metabolic Alkalosis
What electrolyte disorder is associated with Metabolic Alkalosis
hypokalcemia
what electrolytes would you see with respiratory alkalosis
hypocalcemia, hypokalemia
What is a cation
a positively charged particle
what is the balancing mechanism for acid-base imbalances
carbonic
What is the body trying to do with Kussmaul respirations
get rid of acid through the lungs
What kind of patients will you see with Metabolic alkalosis
excessive ventilation from mechanical vent hyperventilating from : fear anxiety fever sepsis
What kind of patients would you see with Respiratory Acidosis - who keeps/can’t get rid of CO2?
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
What patient do you associate Kussmaul reparations with
diabetic Ketoacidosis
What systems regulate acid-base balance
renal and pulmonary
where is bicarbonate produced?
kidneys and pancreas
who is at risk for acid/base imbalances
elderly
people on multiple meds
people with chronic health problems
people with mental status changes
Who is at risk for pH imbalances
elderly
poly pharmacy - lots of meds
chronic health problems
mental status changes - dehydration or fluid overload
