Acid-Base Balance

Question 1

What does pH tell you about the blood?

Answer 1

• If the blood is acidic, alkaline, or neutral.

Question 2

Major chemicals you have to remember

Answer 2

1.)C02

2.)HCO3

3.)Hydrogen

Question 2

What chemical is produced by the lungs ?

What chemicals are produce by the kidneys ?

What do this chemicals do ?

What does HCO3=

Answer 2

1.). Lung chemicals → CO (acid)

2..). Kidney chemicals → bicarb and hydrogen

These chemicals can either make you sick or compensate. It depends on which
imbalance you have.

Bicarb (base )=HCO3) , Hydrogen( acid ), CO2(acid)-it mixes with water in the body and becomes carbonic acid

Question 3

Normal pH range _________-_______

every solution has a pH
Water=
A coke =

Answer 3

7.35-7.45

every solution has a pH
Water=7
A coke =3

Question 4

What does pH below 7.35 means the PH is ?

So a pt can go into ?

Answer 4

Acidosis

Very serious problems
A person can going to coma and die

Question 5

What does pH above 7.45 means the PH is ?

So a pt can go into ?

Answer 5

Alkalosis

makes the nervous system becomes very excited which can lead to convulsions and die

Question 6

5. The _________ does not like it when the pH is messed up.

Answer 6

The brain

Question 7

How’s does The kidneys removed hydrogen ?

How’s does The kidneys removed the bicarb ?

How long does the kidney take to work ?

Answer 7

Urine = excrete exess hydrogen ion Through the urine and retain those ions if the body needs more acids

The kidneys either hold on to bicarb and return it back to the blood or they excreted thru the urine

Kidneys takes hours to days to do
their job-they are slow but efficient

Question 8

How does the lungs retain CO2 ?

How does the lungs get rid CO2 ?

How long does it take to work ?

Answer 8

Exhale so increasing or decreasing the respiratory rate will alter the amount of CO2 in the body

Hypoventilation retain CO2
__________ Hyperventilation eliminate CO2

The lungs response is fast-they take seconds to minutes but they are not as efficient is the kidneys

Question 9

What are the 6 causes of respiratory acidosis

Men never see pink purple Canarys

Answer 9

Causes:

• Retain CO2

Mid abdominal incision,

narcotics,

sleeping pills,

pneumothorax,

pneumonia

collapsed lung,

Question 10

Respiratory Acidosis:

1. Pathophysiology:

Answer 10

Is this a lung problem or a kidney problem? Lungs

b. What chemical is causing the problem? CO2-this is the only chemical

c. Do we have too much or too little of this chemical in the body? Too much CO2

d. Hypoventilating or hyperventilating? Hypoventilating AND BREATHING way too slow causing them to retain CO2

e. Who’s going to compensate? Kidney

f. How, with what chemicals? Bicarb and hydrogen

g. The body must excrete the acid. –other words get rid of the hydrogen

h. The body will retain bicarb. –so the body Secrete bicarb into the blood because A base in a Acid solution that solution is going to become less acid. The whole purpose of compensation is to return to balance state

i. Is the pH high or low? Low

Question 11

11S/S respiratory acidosis

Hypoxic
• Give them ___________________
• Early sign and symptoms of hypoxia? _______________ & ______________

Answer 11

S/S:

a. Headache, confuse, sleepy

1•Bradycardia
2• Bradypnea
3•hypo-reflexia,
4• Hypotension
5;•anorexia
6• ↓ lucidity
7• lethargy
8• coma
9• cardia arrest
10• suppressed, decreased, falling
11•paralytic ileus (decreased
bowel sounds)

b. If not corrected, could lead to a coma
c. Hypoxic because one CO2 is a high oxygen is low making it harder to breathe

• Give them oxygen

• Early sign and symptoms of hypoxia? Restlessness and tachycardia

Question 12

TESTING STRATEGY
Restlessness think what 1st?

Answer 12

Hypoxia

Question 13

Treatment for respiratory acidosis

Answer 13

Tx:

a. Fix the breathing problem. Because the client would not improve into the breathing problem is fixed

b. 7 Treat pneumonia, get rid of secretions by postural drainage, percussion (vibration
therapy), deep breathing exercises, suctioning, fluids, elevate HOB, and incentive
spirometry.

c. Pneumothorax client will have chest tubes

d. Encourage post-op to turn, cough and deep breath

If you help prevent pneumonia you help prevent respiratory acidosis as well

Question 14

Respiratory alkalosis pathophysiology

Answer 14

Who’s sick? Lungs Who’s going to compensate? Kidneys
b. Kidneys excrete bicarb Retain hydrogen
c. Problem chemical? CO2
d. Gaining or losing CO2
?
Losing

e. Hypoventilating or hyperventilating? Hyperventilate
f. pH? High

Question 15

TESTING STRATEGY
↑CO2
TESTING STRATEGY
↑CO2= ↓LOC
↑CO2= ↓O2
CO2and O2have an inverse
relationship.

= ↓LOC
↑CO2

= ↓O2

CO2

and O2

have an inverse
relationship.

Answer 15

TESTING STRATEGY
↑CO2= ↓LOC
↑CO2= ↓O2
CO2and O2have an inverse
relationship.

Question 16

Normal lab values for PH are?

Normal Lab Values
pH: ?
PaO2 : ?mmHg
PaCO2: ? mmHg
HCO3: Bicarbonate: ? mEq/L

Answer 16

Normal Lab Values
pH: 7.35-7.45
PaCO2: 35-45 mmHg
HCO3: Bicarbonate: 22-26 mEq/L
PaO2 :80-100 mmHg

Question 17

Causes respiratory alkalosis

Answer 17

Causes:

a. Problem? Hyperventilation

b. Hysterical
The client is breathing too fast and,
c. Acute aspirin overdose therefore, removing CO2

d. Situation: Hysterical client

Question 18

10 Signs and symptoms of respiratory alkalosis

Answer 18

S/S:

• Lightheaded, faint, peri-oral numbness, numbness and tingling in fingers and toes.

•Tachycardia
• Tachypnea
•Hyperreflexia
• Hypertensive
•tetany
•Tremors
• Seizure
• Agitated
•Borborygmi

Question 19

Treatment for respiratory alkalosis

Answer 19

Tx:

a. Do not wait for kidneys to kick in.

b. Breathe into a bag-forces clients to take back their CO2 c. Some people become so anxious they May have to be sedate to decrease respiratory rate.

d. Treat the cause -determine why the client is breathing fast

e. Monitor ABGs

Question 20

Metabolic acidosis pathophysiology

Answer 20

Pathophysiology:

a. Who’s sick? Kidneys
Who’s going to compensate? Lungs

b. With what chemical? CO2
c. Problem chemicals? Bicarb & hydrogen
This client is retaining hydrogen or (excreting )does not have enough bicarb.

d. pH? Low

e. Respiratory rate will increase to get rid of all that acid

Question 21

Causes of metabolic acidosis

Answer 21

Causes:

a. DKA

b. Starvation
Cells are starving for Glucose__, so the body will break down protein and fat produce ketones. ketones are acids. So the acids will go up in the blood
c. Renal failure when the kidneys are failing they are no longer effective in filtering out acid or retaining base

d. Severe diarrhea-The Lower Gi contains alot of bicarb which is a base. So if a client is having diarrhea they are losing base from their body. If exes base is loss then acid remains behind

Question 22

S/S of. Metabolic acidosis

when pH goes up; potassium goes down… when pH goes down; potassium goes up!

Answer 22

S/S:

a. Depend on the causes
b. Hyperkalemia
• Muscle twitching, muscle weakness, flaccid paralysis, arrhythmias
c. Increased respiratory rate

Question 23

Treatment for metabolic acidosis

Answer 23

Tx:

a. Treat the problem
b. Drug to help acidosis? IVP sodium bicarb! It will not fix the problem but it will buy you some time into they figure out what is causing the metabolic acidosis

Question 24

Metabolic alkalosis pathophysiology

Answer 24

Pathophysiology:

a. Who’s sick? Kindneys__
Who’s going to compensate? Lungs

b. With what chemical? _CO2
c. Problem chemicals? Bicarb &hydrogen

The client is in alkalosis, so they are retaining too much bicarb and excreting hydrogen.

e. pH? High

Question 25

Causes of Metabolic alkalosis

Answer 25

Causes:

a. Loss of upper GI contents (vomiting, G.I. secretions that are lost through a G.I. tube through suctioning
b. Too many antacids…. Too much base

c. Too much IV bicarb

Question 26

Signs and symptoms of metabolic alkalosis

Answer 26

S/S:

a. Depend on cause

b. Observe LOC

c. Serum K+ will go up in metabolic acidosis and go down in
metabolic alkalosis.

d. Monitor for muscle cramps and life-threatening arrhythmias

Question 27

Metabolic alkalosis treatment

Answer 27

Tx:
a. Fix the problem.

b. Replace potassium

Question 28

TESTING STRATEGY
Metabolic Acidosis = Hyperkalemia

Metabolic Alkalosis = Hypokalemia

Answer 28

TESTING STRATEGY
Metabolic Acidosis = Hyperkalemia

Metabolic Alkalosis = Hypokalemia

Question 29

Normal:
pH: acidosis ↓ 7.35 – 7.45 ↑ alkalosis

PCO2: base ↓ 35 – 45 ↑ acidic

HCO3: acidic ↓ 22 – 26 ↑ basic

Answer 29

Normal:
pH: acidosis ↓ 7.35 – 7.45 ↑ alkalosis
PCO2
:
basic ↓ 35 – 45 ↑ acidic
HCO3
:
acidic ↓ 22 – 26 ↑ basic

Question 30

R.O.M.E=

Answer 30

Respiratory opposites
Metabolic equals

Question 31

PH is up and pco2 is down =

Ph is down and pco2 is up =

PH is up and hco3 is up =

Ph is down and hco3 is down =

Answer 31

PH is up and pco2 is down =Respiratory alkalosis

Ph is down and pco2 is up =Respiratory acidosis

PH is up and hco3 is up = metabolic alkalosis

Ph is down and hco3 is down =Metabolic acidosis

Question 33

pH: _____ ↓ 7.35 – 7.45↑ ______
PCO2: _____ ↓ 35 – 45 ↑ _____
HCO3: ______ ↓ 22 - 26↑ _____

Answer 33

pH: acidosis ↓ 7.35 – 7.45↑ alkalosis PCO2: basic ↓ 35 – 45 ↑ acidic
HCO3: acidic ↓ 22 - 26↑ basic

Question 34

if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis…
why?

Answer 34

if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis…
why? losing acid = becomes basic..

Question 35

as the pH goes… so goes my patient!!
Except ______?

Answer 35

-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH goes down;
potassium goes up!

Question 36

Increase in Latic acid indicates?

Answer 36

Latic acid is build up when the body goes without oxygen indicating hypoxia has occurred