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Funds Exam5 (from ppts) > Acid-Base Balance > Flashcards

Acid-Base Balance Flashcards

1
Q

Regulators of Acid-Base Balance
-Buffers

A
  • Primary regulators
  • Act immediately (within 1 second of abnormal pH)
  • Combine w/ acids or base to prevent pH changes (Examples include: Carbonic acid-sodium-bicarbonate, protein & phosphate buffering systems)
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2
Q

Regulators of Acid-Base Balance
-Resp system

A
  • Responds within minutes to hours to changes in acid/base to eliminate or retain CO2.
  • Respiratory center in medulla controls breathing
  • Increased respirations leads to increased CO2 eliminated from body + decreased CO2 in blood
  • Decreased respirations leads to decreased CO2 elimination from body + increased CO2 in blood
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3
Q

Regulators of Acid-Base Balance
-Renal system

A
  • Responds within hours to days (last line of defense; may take hours or days to restore normal hydrogen ion concentration)
  • Secretes hydrogen (H+) ions + reabsorbs bicarbonate (HCO3) ions
  • Reabsorption + secretion of electrolytes (e.g., Na, Cl)
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4
Q

Acid-Base Balance
-pH

A
  • Measures hydrogen ion concentration in body fluids
  • Body maintains a slightly alkaline pH of 7.35-7.45
  • Metabolic and respiratory processes work together to keep H+ levels within a normal range
  • Increase in H+ makes solution more acidic
  • Decrease in H+ makes solution more alkaline
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5
Q

Acid-Base Balance
-PaCO2

A
  • Partial pressure of CO2 in arterial blood
  • Reflection of depth of pulmonary ventilation
  • Normal range is 35-45 mmHg
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6
Q

Acid-Base Balance
-PaO2

A
  • Partial pressure of O2 in arterial blood
  • No primary role in acid-base balance regulation if within normal limits
  • Normal range is 80-100 mmHg
  • Hypoxemia may cause
    -anaerobic metabolism
    -hyperventilation
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7
Q

Acid-Base Balance
-Oxygen saturation

A
  • Percentage of Hgb saturated by oxygen
  • Normal value is 95-100%
  • If PaO2 drops below 60 mmHg, then will see a large drop in saturation
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8
Q

Acid-Base Balance
-Base excess

A
  • Amount of blood buffer that exists
  • Normal value is +/- 2
    -Base Excess
    -Base Deficit
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9
Q

Acid-Base Balance
-Bicarbonate

A
  • Major renal component of acid-base balance
  • Excreted + reproduced by the kidneys to maintain normal acid-base
  • Principle buffer of extracellular fluids in the body
  • Normal range is 22-26 mEq/L
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10
Q

Acid-Base Balance
-Anion gap

A
  • Reflection of anions, not routinely measured
  • Normal range is 12 mEq/L (+/-2)
  • Increase: Seen with lactic acidosis or ketoacidosis
  • Normal: Usually caused by loss of bicarb (i.e. diarrhea, diuretics)

Summary (via professor google)
* AG = (Na+ + K+) - (HCO3 + Cl-)
-w/ potassium given
w/o potassium given, eliminate K+
* Unmeasured anions
* HCO3 decrease is acidosis, but sometimes Chloride increases to maintain anion gap

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11
Q

How to obtain Arterial Blood Gases

A
  • Heparinized syringe
  • Blood from an artery
  • Make sure at least 15-20 minutes have passed after procedures
  • Apply pressure for 5 minutes
  • On ice
  • Prompt delivery to lab
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12
Q

Acid-Base Balance
-ABG norm values

A
  • pH 7.35-7.45 (7.4)
  • PaCO2 35-45 mmHg (acid)
  • HCO3 22-26 mEq/L (base)
  • PaO2 80-100 mmHg (partial pressure of oxygen in arterial blood)
  • SaO2 96-100% (arterial saturation)
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13
Q

Interpretation of ABGs
-Dx in 6 steps

A

1-Analyze pH
2-Analyze PaCO2
3-Analyze HCO3
4-Determine if PaCO2 or HCO3 matches alteration
5-Compensation?
6-Analyze PaO2 and SaO2

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14
Q

ROME

A

Respiratory
Opposite
-Alkalosis ↑ pH ↓ PaCO2
-Acidosis ↓ pH ↑ PaCO2
Metabolic
Equal
-Acidosis ↓ pH↓ HCO3
-Alkalosis ↑ pH↑ HCO3

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15
Q

If both respiratory and metabolic components match the pH, maybe it is a _.

A

If both respiratory and metabolic components match the pH, maybe it is a mixed disorder.

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16
Q

Degree of compensation
-Absent

A
  • pH is not within normal range
  • The component that does not match the pH imbalance is still within its normal range
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17
Q

Degree of compensation
-Partial

A
  • pH is not within normal range
  • The component that does not match the pH disorder is above or below the normal range
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18
Q

Degree of compensation
-Complete

A
  • pH is within the normal range
  • Both components are either above or below normal range
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19
Q

Respiratory Acidosis

A
  • high PaCO2
  • d/t alveolar hypoventilation
20
Q

Respiratory Alkalosis

A
  • low PaCO2
  • d/t alveolar hyperventilation
21
Q

Metabolic Acidosis

A
  • low pH
  • low HCO3-
  • d/t gain of hydrogen or loss of bicarbonate
22
Q

Metabolic Alkalosis

A
  • high pH
  • high HCO3-
  • d/t gain of bicarbonate or loss of hydrogen
23
Q

IV Fluid Replacement
-Crystalloids

A

Solutions w/ small molecules that flow easily from the bloodstream into cells & tissues

-General term for iso-/hypo-/hyper-tonic solution

24
Q

Isotonic Solutions?

A
  • Osmolality 275-290 mOsm/L
  • Same concentration of osmotically active particles in ECF
  • Osmotic pressure is the same inside & outside
  • Fluid does not shift b/w extracellular & intracellular areas
  • Therefore good choice for ECF dehydration. Used most commonly.
25
Isotonic Solutions -Examples
* Dextrose 5% in water (remember dangers associated with D5W!!) -provides carbohydrates./causes hyponatremia d/t **diluting in fluid** -**tx**=hypernatremia/provide free water to kidneys * 0.9% Sodium Chloride (Normal Saline), actually 154 mEq Na+ -**tx**=hemorrhage/vomiting/diarrhea/drainage from GI suction/metabolic acidosis/shock * Lactated Ringers -**tx**=burn/trauma pts d/t similar to blood plasma concentration./acute blood loss/hypovolemia from third-space shifts/electrolyte imbalance/metabolic acidosis * Plasmalyte
26
Hypotonic Solutions?
* Osmolality less than 275 mOsm/L * Less concentrated than extracellular fluid * Fluid will move from blood stream into cell * Used to dilute ECF + rehydrate cells * Used for **hypertonic imbalances**
27
Hypotonic Solutions -Examples
0.45% Sodium Chloride (1/2 Normal Saline) **tx**=hypernatremia/diabetic ketoacidosis **disolving too quickly can cause hemolysis in RBCs**
28
Hypertonic Solutions?
* Solutions w/ osmolality greater than 295 mOsm/L * Draws fluid from intracellular space, causing cells to shrink + extracellular space to expand
29
Hypertonic Solutions -Examples
* Dextrose 5% in half normal saline solution * Dextrose 5% in normal saline solution * Dextrose 10% in water * 3% Saline
30
Colloids?
* Plasma expanders used if blood volume does not improve w/ crystalloids * Pulls fluid into bloodstream * Needs close monitoring d/t risk of volume overload=**not used as first-line tx**
31
Colloids -Examples
Solutions w/ * Albumin * Dextran
32
Needle Gauges
* Higher the gauge, smaller diameter of angiocath * Increased fluids over short amt of time * Routine IV fluid administration
33
IV -Regulation & maintenance
* Assessment * Infiltration * Phlebitis * Review complications * Dressing * Changes/tubing changes * Site Changes
34
Transfusions?
* Restores blood volume or corrects deficiencies in blood’s oxygen carrying capacity or coagulation components * Requires consent * Review in Taylor & Hinkle: -Administration -Assessment -Symptoms of transfusion reaction -Interventions for reaction
35
Respiratory Acidosis -Causes
* Acute resp dz * pulmonary edema * aspiration of foreign body * actelactasis * overdose of secative or anesthetic * cardiac arrest * chronic resp dz * emphysema * bronchial asthma * cystic fibrosis * inadeq mechanical ventilation * CNS depression * neuromuscular dz
36
Respiratory Acidosis -S/s
* Acute respiratory acidosis * mental cloudiness * dizziness * muscular twitching * unconsciousness * chronic respiratory acidosis * weakness * dull headache
37
Respiratory Acidosis -Tx(s)
* directed at **improving ventilation** * pharmacologic measures * pulmonary hygiene measures * adequate hydration * supplemental O2 * Mechanical ventilation to correct disorder but must be used cautiously to decrease PaCO2 slowly
38
Respiratory Alkalosis -Causes
* hyperventilation * extreme anxiety **MOST COMMON CAUSE** * hypoxemia * high fever * early sepsis * excessive ventilation by mechanical ventilator * CNS lesion involving resp center
39
Respiratory Alkalosis -S/s
* lightheadedness * inability to concentrate * hyperventilation syndrome * tinnitus=ringing in ears * palpitations * sweating * dry mouth * tremulousness * convulsions & LOC
40
Respiratory Alkalosis -Tx(s)
* if anxiety, encourage pt to breathe more slowly or breath in closed system=paper bag, to accumulate CO2./sedative may be neccessary in extreme anxiety * if other causes, correct underlying problem
41
Metabolic Acidosis -causes
* diarrhea * intestinal fistulas * parenteral nutrition * excessive intake of acids (such as Salicylates) * diabetic ketoacidosis * renal failure * starvational ketoacidosis
42
Metabolic Acidosis -S/s
* headache * confusion * drowsiness * increased resp rate & depth * Nausea & vomiting * peripheral vasodilation * hyperkalemia, freq present
43
Metabolic Acidosis -Tx(s)
* aimed at **correcting metabolic deficit** * if excessive intake of chloride, focus on eliminating source. admin bicarb, when neccessary
44
Metabolic Alkalosis -causes
* vomiting or gastric suction * hypokalemia * potassium-wasting diuretic * alkali ingestion (bicarb-containing antacids) * renal loss of H+ (ex: from steroid or diuretic use)
45
Metabolic Alkalosis -S/s
* dizziness * tingling of fingers & toes * hypertonic muscles * depressed respirations (compensatory) * hypokalemia may be present
46
Metabolic Alkalosis -Tx(s)
* aimed at **reversal of underlying disorder**. -sufficient chloride must be supplied for kidney to absorb sodium w/ chloride (allows excretion of excess bicarb) -tx also incl admin of NaCl to restore normal fluid volume

Funds Exam5 (from ppts) (11 decks)

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