Acid/Base Flashcards by Rafael Gutierrez

Nonvolatile Acids (4)

Lactic acid: cellular death - anaerobic activity
Hydrochloric acid: stomach
Phosphoric acid: phospho-lipid
Sulfuric acid: sulfuric breakdown

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Volatile Acid (1)

Carbonic acid

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Buffers are substances that prevent what?

How?

Prevent major changes in pH

By releasing H+ ions

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Which system gets rid of “waste” quicker?

Slower?

Respiratory (Minutes to hours)

Renal (Hours to days)

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Pro and con of buffers?

React quickly

But have limited capacity to maintain pH

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Main buffer is?

Bicarbonate-carbonic buffer

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Other types of buffers?

Phosphate buffer system
Protein buffers
Hemoglobin

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pH normal level

7.35 - 7.45

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Serum bicarbonate normal level

24-28

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HCO3 : H2CO3 ratio

20:1

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How does respiratory maintain balance?

Increase respiratory drive to eliminate C02 when body senses acute increase in CO2

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How does renal maintain balance?

Regulating HCO3 levels

Responsible for eliminating most metabolic acids

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First line of defense?
Within what time period?
Action?

Buffers
Seconds
Remove or release H+

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Second line of defense?
Within what time period?
Action?

Lungs
Seconds to minutes
Elimination or retention of CO2 (Hyper/hypo ventilation)

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Third line of defense?
Within what time period?
Action?

Kidneys
Hours to days
Retention of HCO3, Reduction of fixed acids and elimination of H+

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Acidemia is?

pH is less than 7.35

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Acidosis is?

Increase in H+ (acid) or loss of base

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Alkalemia pH is?

pH greater than 7.45

Alkalosis is (H+ and base)?

decrease in H+ (acid) or increase in base

Respiratory acidosis: Lab findings

pH, PaCO2, HCO3, Electrolytes

pH less than 7.35 (DOWN) with PaCO2 greater than 45 mm Hg (UP)
HCO3: less than 22 (DOWN)
Elevated K+ : exchange of intracellular K+ for H+

Causes of acute respiratory acidosis

Ventilation failure 
Chest trauma 
Aspiration 
Pneumonia 
Sedative/narcotics
Airway obstruction 
Drug overdose

Causes of chronic respiratory acidosis

Asthma
Cystic fibrosis
Multiple sclerosis
COPD

Metabolic Acidosis: Lab Findings

pH, HCO3, CO2, Electrolytes, EKG

pH less than 7.35 (DOWN)
HCO3 less than 22 mEq/L (DOWN)
CO2 less than 38 (DOWN)
Elevated K+ : exchange of intracellular K+ for H+
Dysrhythmias

Metabolic Acidosis: Causes

Loss of HCO3 from diarrhea, draining fistulas, and TPN
Increase in Cl-
Ketoacidosis: diabetes, alcoholism, and starvation
Respiratory or kidney failure
Ingestion of toxins or drugs
Lactic acidosis

Respiratory Acidosis: Manifestions

Cerebral vasodilation: HA, blurred vision, irritability, AMS Warm, flushed Tachycardia

Chronic Respiratory Acidosis: Manifestions

``` Dull HA Impaired memory Personality change Weakness Sleep disturbance, daytime sleepiness ```

Respiratory Acidosis: Interventions

Multidisciplinary Emergency COPD: Limit O2 administered

Metabolic Acidosis: Manifestations

CNS: Headache, confusion, and drowsiness Increased respiratory rate and depth (compensation) N/V Decreased BP Decreased cardiac output and bradycardia (when pH 7.0)

Metabolic Acidosis: Interventions

Collaborative - Treat underlying cause: diabetes, diarrhea - Administer HCO3 - Treat electrolyte abnormality (K+) Independent - Safety precautions if confused - Monitor S/S of worsening (changes in resp, cardiac, CNS) - Monitor lab results (ABG, Electrolytes)

Respiratory Alkalosis: Lab Findings | ABG, Electrolytes, EKG

pH greater than 7.45 (UP) PaCO2 less than 35 (DOWN) Elevated K+ Dysrhythmias

Respiratory Alkalosis: Causes

``` Hyperventilation Altitude Anxiety Stimulation of hypoxemia: resp disorders CNS lesions Fever (increase of metabolic needs) Hypoxia Salicylate overdose ```

Respiratory Alkalosis: Manifestations

``` CNS: headache, confusion, and drowsiness Increased respiratory rate and depth N/V Decreased BP Decreased cardiac output Bradycardia Neuromuscular excitability ```

Respiratory Alkalosis: Interventions

``` Collaborative - Treat underlying cause Independent - Relaxation - Treat underlying cause ```

Metabolic Alkalosis: Lab Findings | ABG, Electrolytes

pH greater than 7.45 (UP) HCO3 greater than 28 (UP) Decreased K+ Decreased Cl-

Metabolic Alkalosis: Causes

``` Excessive H+ loss through vomiting or gastric suctioning Excessive use of K+ wasting diuretics Excessive adrenal corticoid hormones: - Cushings - Hyperaldosternism - Excessive HCO3 intake ```

Metabolic Alkalosis: Manifestations

``` Confusion, AMS Hyperreflexia Tetany Dysrhythmias Hypotension Seizure Respiratory failure ```

Metabolic Alkalosis: Interventions

Collaborative - Administer O2, K+, Cl- - Treat underlying problem Independent - Monitor I&Os, VS, LOC, Resp. - Electrolytes

Nursing Assessment for Alkalosis/Acidosis

Health history of imbalances Baseline vitals: ABG, serum electrolytes, serum CO2 and HCO3 levels, gluclose Assess S/S

Where can ABG labs be drawn from? | Performed by?

Artery (radial or femoral) | Respiratory therapist or by RN through arterial line

Whats the Allen test?

Pressure is applied over the ulnar and the radial arteries so as to occlude both of them

Compensation: Compensated

pH is NORMAL | PaCO2 and HCO3 ABNORMAL

Compensation: Partially Compensated

pH is ABNORMAL | Both PaCO2 and HCO3 ABNORMAL

Compensation: Uncompensated

pH is ABNORMAL | Either PaCO2 and HCO3 ABNORMAL