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Fundamentals in Nursing - Lecture > Acid-Base Balance > Flashcards

Acid-Base Balance Flashcards

1
Q

substance that releases hydrogen ions (H+)

A

Acid

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2
Q

have a low hydrogen ion concentration and can accept hydrogen ions in solution.

A

Bases (Alkalis)

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3
Q

the relative acidity or alkalinity of a solution

A

pH

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4
Q

reflects the hydrogen ion concentration of the solution (inversely proportional)

A

pH

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5
Q

normal pH

A

7.35-7.45

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6
Q

prevent excessive changes in pH by removing or releasing hydrogen ions

A

buffers

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7
Q

Major buffer systems in the ECF:

A
  • Bicarbonate (HCO3-)
  • Carbonic acid (H2CO3)
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8
Q

acid buffer; opponent of acids

A

Bicarbonate (HCO3-)

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9
Q

weak acid

A

Carbonic acid (H2CO3)

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10
Q

TO ACHIEVE NORMAL pH

A

1 part Carbonic Acid (1.2 mEq/L) : 20 parts bicarbonate (24
mEq/L)

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11
Q

adding a strong acid in the ECF, depleting the bicarbonate and lowering the pH levels

A

ACIDOSIS

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12
Q

adding a strong base to the ECF, depleting carbonic acid as it combines with the base, increasing the pH levels.

A

ALKALOSIS

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13
Q

The lungs help regulate acid-base balance by eliminating or retaining Carbon Dioxide (CO2), a potential acid

A

RESPIRATORY REGULATION

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14
Q

Carbon Dioxide (CO2) + Water (H2O) =

A

Carbonic acid (H2CO3)

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15
Q

The lungs help regulate acid-base balance by ________________________________, a potential acid.

A

eliminating or retaining Carbon Dioxide (CO2)

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16
Q

respiration rate and depth increases, exhaling CO2 and decreasing carbonic acid levels

A

High Carbonic acid (H2CO3) and CO2 levels

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17
Q

the respiration rate and dept are reduced, retaining CO2 and increasing carbonic acid levels

A

High Bicarbonate (HCO3-) levels

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18
Q

are the ultimate long-term regulator of acidbase balance, although slower to respond to changes

A

Kidneys

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19
Q

regulate pH by reabsorbing and regenerating bicarbonate and hydrogen ions

A

Kidneys

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20
Q

Hydrogen ion (H+) + Bicarbonate (HCO3-) =

A

Carbonic acid (H2CO3)

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21
Q

kidneys reabsorb and regenerate bicarbonate and excrete hydrogen ions ○ H2CO3&raquo_space; H+ (excreted) and HCO3- (retained)

A

High H+ ions (acidic)

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22
Q

excess bicarbonate is excreted and H+ ion is retained ○ H2CO3&raquo_space; H+ (retained) and HCO3- (excreted)

A

Low H+ ions (alkalosis)

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23
Q

FACTORS AFFECTING BODY FLUID, ELECTROLYTES, AND ACID-BASE BALANCE:

A

◎ Age
◎ Gender and Body Size
◎ Environmental Temperature
◎ Lifestyle

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24
Q

Two basic types of Fluid Imbalances

A

Isotonic and Osmolar

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25
Q

water and electrolytes are lost or gained in equal proportions

A

Isotonic

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26
Q

loss or gain of only water, so that the osmolality of the serum is altered (electrolytes are concentrated)

A

Osmolar

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27
Q

Four Categories of Fluid Imbalances

A

◎ Fluid Volume Deficit
◎ Fluid Volume Excess
◎ Dehydration (hyperosmolar imbalance)
◎ Overhydration (hypo-osmolar imbalance)

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28
Q

The body loses both water and electrolytes from the ECF (intravascular compartment) in similar proportions

A

Fluid Volume Deficit (FVD)

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29
Q

The body loses both water and electrolytes from the ECF (intravascular compartment) in similar proportions, so it often is called ______________________

A

hypovolemia

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30
Q

Causes of Fluid Volume Deficit (FV):

A

○ Abnormal losses through the skin, GI tract, kidney
○ Movement of fluid in a third space (area that deems the fluid unavailable for us)

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31
Q

The body retains both water and sodium in similar proportions to normal ECF

A

Fluid Volume Excess (FVE)

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32
Q

The body retains both water and sodium in similar proportions to normal ECF, often called ___________________________

A

hypervolemia

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33
Q

Causes of Fluid Volume Excess (FVE):

A

○ Increased intake of NaCl (sodium level is still normal, since both water and sodium are equally retained)
○ Infusion of sodium-containing fluids rapidly
○ Disease processes (heart failure, kidney failure, liver cirrhosis)

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34
Q

excess interstitial fluid

A

Edema

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35
Q

leaves a small depression or pit after finger pressure is applied

A

Pitting Edema

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36
Q

Water is lost from the body, leaving the client with excess sodium

A

Dehydration (Hyperosmolar imbalance)

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37
Q

Sodium levels are increased

A

Dehydration (Hyperosmolar imbalance)

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38
Q

Cells are dehydrated/shrunk

A

Dehydration (Hyperosmolar imbalance)

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39
Q

Causes of Dehydration (Hyperosmolar imbalance)

A

○ Diabetic Ketoacidosis (DKA)
○ Osmotic diuresis
○ Administration of hypertonic solutions

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40
Q

Water is gained in excess of electrolytes, resulting in low serum osmolality and low serum Na+ levels

A

Overhydration (hypo-osmolar imbalance)

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41
Q

Cells are swollen

A

Overhydration (hypo-osmolar imbalance)

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42
Q

Can lead to cerebral edema and impaired neurologic function

A

Overhydration (hypo-osmolar imbalance)

43
Q

Causes of Overhydration (hypo-osmolar imbalance)

A

○ Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
○ Head Injury

44
Q

ELECTROLYTE IMBALANCES: SODIUM

A

Hyponatremia
Hypernatremia

45
Q
  • Less than 135 mEq/L
  • Severe cases: <110 mEq/L
  • Can lead to neurological damage (cerebral edema) due to low serum osmolality
  • Causes: burns, GI losses, diuretics, head injury
A

Hyponatremia

46
Q
  • Higher than 145 mEq/L
  • Cells are dehydrated
  • Primary manifestations are neurological in nature
  • Causes: water deprivation, diabetes insipidus, excessive use of NaCl
A

Hypernatremia

47
Q

ELECTROLYTE IMBALANCES: POTASSIUM

A

Hypokalemia and Hyperkalemia

48
Q
  • Less than 3.5 mEq/L
  • Causes:
    GI losses (vomiting, diarrhea)
    Potassium-wasting diuretics
    Poor intake of Potassium
  • S/Sx: muscle weakness, lethargy, cardiac dysrhythmias
A

Hypokalemia

49
Q
  • More than 4.5 mEq/L
  • More dangerous than hypokalemia – can lead to cardiac arrest
  • Causes:
    1. Renal Failure
    2. High Potassium Intake
    3. Burns
  • S/Sx: confusion, muscle weakness, bradycardia, irregular pulse, numbness in extremities
A

Hyperkalemia

50
Q

ELECTROLYTE IMBALANCES: CALCIUM

A

Hypocalcemia and Hypercalcemia

51
Q
  • Total calcium: >10.5 mg/dL
  • Ionized calcium: >5 mg/dL
    Calcium is mobilized from the skeleton due to malignancy or prolonged immobilization
    S/Sx: depressed DTR, cardiac dysrhythmias, hypercalciuria, flank pain secondary to urinary calculi
A

Hypercalcemia

51
Q
  • Total calcium: <8.5 mg/dL
  • Ionized calcium: <4 mg/dL
  • SEVERE HYPOCALCEMIA CAN CAUSE TETANY WITH MUSCLE SPASMS AND PARESTHESIAS AND CAN LEAD TO CONVULSIONS. Other manifestations include: decreased cardiac output, hyperactive DTR
  • Two signs:
  • Chvostek’s sign
  • Trousseau’s sign
    Causes: total thyroidectomy, hypomagnesemia, chronic alcoholism
A

Hypocalcemia

52
Q

ELECTROLYTE IMBALANCES: MAGNESIUM

A

Hypomagnesemia and Hypermagnesemia

53
Q
  • More than 2.5 mEq/L
  • Often iatrogenic (result of overzealous magnesium therapy)
  • S/Sx: depressed DTR, bradycardia, lethargy, respiratory depression, cardiac arrest
A

Hypermagnesemia

54
Q
  • Less than 1.5 mEq/L
  • Common cause: chronic alcoholism
  • Other causes: GI losses, burns, pancreatitis
  • S/Sx: Chvostek’s and Trousseau, increased reflexes,
    respiratory difficulties, cardiac dysrhythmias
A

Hypomagnesemia

55
Q

ELECTROLYTE IMBALANCES: CHLORIDE

A

Hypochloremia and Hyperchloremia

56
Q
  • Below 95 mEq/L
  • Causes: GI/kidney losses, sweating
  • S/Sx: muscle twitching, tremors, tetany
A

Hypochloremia

57
Q
  • Above 108 mEq/L
  • Causes: excess replacement of NaCl or KCl
  • S/Sx: acidosis, weakness, lethargy, dysrhythmias, coma
A

Hyperchloremia

58
Q

ELECTROLYTE IMBALANCES: PHOSPHATE

A

Hypophosphatemia and Hyperphosphatemia

59
Q
  • Below 2.5 mg/dL
  • Causes: GI losses, use of phosphate-binding antacids, alcohol withdrawal
  • S/Sx: paresthesias, muscle weakness and pain, metal
    changes, and possible seizures
A

Hypophosphatemia

60
Q
  • Above 4.5 mg/dL
  • Causes: tissue trauma, chemotherapy, renal failure, increased ingestion/administration of phosphate
    • S/Sx: numbness, tingling around the mouth and
      fingertips, muscle spasms, tetany
A

Hyperphosphatemia

61
Q

Acid-base imbalances
◎ Classified as:

A

respiratory or metabolic

62
Q

are normally regulated by the lungs through the retention/excretion of CO2 (respiratory acidosis or alkalosis)

A

Carbonic acid levels

63
Q

Carbonic acid levels are normally regulated by the ____________ through the retention/excretion of CO2 (respiratory acidosis or alkalosis)

A

lungs

64
Q

________________________________________ are regulated by
the kidneys (metabolic acidosis or alkalosis)

A

Bicarbonate and Hydrogen ion levels

65
Q

Bicarbonate and Hydrogen ion levels are regulated by
the _____________ (metabolic acidosis or alkalosis)

A

kidneys

66
Q

Hypoventilation and CO2 retention cause carbonic acid
to increase and the pH to fall below 7.35

A

RESPIRATORY ACIDOSIS

67
Q

This causes the kidneys to retain bicarbonate to restore the normal carbonic acid to bicarbonate ratio

A

RESPIRATORY ACIDOSIS

68
Q

When a person hyperventilates, exhaling more CO2 and decreasing carbonic acid levels = pH greater than 7.45

A

RESPIRATORY ALKALOSIS

69
Q

Kidneys will excrete bicarbonate

A

RESPIRATORY ALKALOSIS

70
Q

When bicarbonate levels are low in relation to the amount of carbonic acid = decreased pH

A

METABOLIC ACIDOSIS

71
Q

Stimulates the respiratory center = increase depth and rate of respirations; CO2 is eliminated and carbonic acid falls

A

METABOLIC ACIDOSIS

72
Q

The amount of bicarbonate in the body exceeds to the normal ratio

A

METABOLIC ALKALOSIS

73
Q

Depresses the respiratory rate (slow and shallow) = CO2 is
retained and carbonic levels increases

A

METABOLIC ALKALOSIS

74
Q

Types of Intravenous Fluids:

A

Hypertonic solution
Hypotonic solution
Isotonic solution

75
Q

concentrated with solute, expanding vascular volume

A

Hypertonic solution

76
Q

less solutes, for treatment of cellular dehydration

A

Hypotonic solution

77
Q

Enteral Fluid and Electrolyte Replacement

A
  1. Fluid intake modifications
  2. Dietary changes
  3. Oral electrolyte supplements
78
Q

Sodium Chloride

A

Normal Saline

79
Q

Ringer’s solution

A

Sodium, chloride, potassium, calcium

80
Q

Lactated Ringer’s solution

A

Sodium, chloride, potassium, calcium, and lactate

81
Q

metabolized in the liver to form bicarbonate

A

lactate

82
Q

– dextran, plasma, albumin
- used for severe blood/plasma loss

A

Volume expanders

83
Q

hourly rate of the fluid

A

Milliliters per hour (cc/hr)

84
Q

cc/hr =

A

total infusion volume/total infusion time

85
Q

Drops per minute

A

gtts/min

86
Q

gtts/min

A

total infusion volume x drop factor/total time of infusion in minutes

87
Q

number of drops delivered per mL of solution (gtts/mL)

A

Drop factor

88
Q

commonly used for intermittent or continuous infusions

A

Metacarpal, basilic and cephalic veins

89
Q

inserted in the subclavian or jugular vein, with the distal tip
resting in the SVC.

A

Central Venous Catheters

90
Q

complications of Central Venous Catheters:

A

hemothorax/pneumothorax, cardiac perforation, thrombosis, infection

91
Q

inserted in basilic or cephalic vein, for long -term intravenous access when the client will be maintaining IV
therapy at home

A

Peripherally Inserted Central Venous Catheter (PICC)

92
Q

Can be effective in restoring intravascular (blood) volume

A

BLOOD TRANSFUSIONS

93
Q

Four main groups/types of human blood:

A

A, AB, B, O

94
Q

Rhesus (Rh) Factor:

A

Rh+ or Rh-

95
Q

is the only IV solution that is compatible with blood products

A

0.9% NaCl (Plain NSS)

96
Q

not commonly used except for extreme cases of acute hemorrhage; RBCs, plasma, plasma proteins, fresh platelets, and other clotting factors

A

Whole Blood

97
Q

increase the oxygencarrying capacity of blood in anemia, surgery and blood disorders

A

Packed Red Blood Cells (RBCs)

98
Q

bleeding disorders or platelet deficiency

A

Platelets

99
Q

expands blood volume and provides clotting factors. No need to be typed and crossmatched

A

Fresh Frozen Plasma (FFP)

100
Q

blood volume expander

A

Albumin and Plasma Protein Fraction

101
Q

Blood Products

A

Whole Blood
Packed Red Blood Cells (RBCs)
Platelets
Fresh Frozen Plasma (FFP)
Albumin and Plasma Protein Fraction

102
Q
A

Fundamentals in Nursing - Lecture (10 decks)

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