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ACID BASE BALANCE Flashcards

1
Q

Body can handle alkalosis or acidosis better?

A

Alkalosis

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2
Q

Respiratory acid component?

A

CO2

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3
Q

Metabolic alkaline component?

A

HCO3

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4
Q

Normal acid-base balance

A

metabolic process continuously produce acids, which are waste

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5
Q

Nonvolatile acids

A

-lactic acid (cell death)
-Hydrochloric acid (digestion)
-Phosphoric acid (phospholipids and proteins)
-sulfuric acid
excreted by urine

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6
Q

Volatile acids

A
  • carbonic acid

- excreted by lungs

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7
Q

Buffers are..

A

substances that prevent major changes in pH by releasing H+ ions
-react quickly but have limited capacity maintain pH
main buffer: Bicarbonate-carbonic buffer (respiratory)
other buffers include: phosphate buffer system, protein buffers, hemoglobin

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8
Q

normal serum bicarbonate (HCO3)

A

24-28 mEq/L

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9
Q

serum carbonic acid (H2CO3)

A

1.2 mEq/L

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10
Q

bicarbonate: carbonic acid ratio

A

2:1

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11
Q

how does respiratory system maintain balance?

A
  • eliminates carbon dioxide
  • acute increase of CO2 stimulate respiratory drive
  • these processes happen very quickly (min-hrs)
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12
Q

how does renal system maintain balance?

A
  • regulate bicarbonate levels
  • responsible for eliminating most metabolic acids
  • takes longer
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13
Q

in acidosis, how does the renal system regulate bicarbonate levels?

A
  • retain bicarb ions

- excrete H+ ions

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14
Q

in alkaosis, how does the renal system regulate bicarbonate levels?

A
  • excrete bicarb ions

- retain H+ ions

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15
Q

List in order the defense mechanisms for maintaining balance and their actions

A

1st line of defense: buffers; work in seconds; Action: remove or release H+

  • 2nd line of defense: lungs; mins-hrs; Action: elimination or retention of CO2
  • 3rd line of defense: kidneys; delayed action, hrs-days; Action: retention of HCO3, reduction of fixed acids, and elimination of H+
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16
Q

acidosis causes potassium to

A

increase

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17
Q

alterations to acid base balance

A

concentrations of acid or base in the blood which leads to acid-base imbalance

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18
Q

increased H+, and decreased Bicarb lead to

A

Acidemia: pH is less than 7.35
AND/OR
Acidosis: increase in H+ (acid) or loss of base

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19
Q

not enough acid is…

A

Alkalemia: pH greater than 7.45
AND/OR
Alkalosis: decrease in H+ (Acid) or increase of base

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20
Q

Respiratory acidosis

A

pH less than 7.35

PaCO2 greater than 45 mm Hg

21
Q

Metabolic acidosis

A

pH less than 7.35

bicarb less than 22 mEq/

22
Q

causes of respiratory acidosis include

A

ACUTE: -ventilation failure, -chest trauma, -aspiration, -pneumonia, -sedative/narcotics, -airway obstruction
CHRONIC: -asthma, cystic fibrosis, -multiple sclerosis, -COPD
-cause CO2 to accumulate in the body

23
Q

Clinical manifestations and lab findings of respiratory acidosis

A

ACUTE: cerebral vasodilation; warm, flushed; tachycardia
CHRONIC: Dull HA, impaired memory, personality change, weakness, sleep disturbance, daytime sleepiness
ABG- pH less than 7.35, CO2 greater than 45
HCO3 less than 22
serum electrolytes- K+ elevated

24
Q

what causes metabolic acidosis?

A
  • loss of HCO3 from diarrhea, draining fistulas, and TPN.
  • increase in Cl-
  • ketoacidosis- diabetic, alcoholism, starvation
  • respiratory or kidney failure, ingestion of toxins or drugs
  • lactic acidosis
25
clinical manifestations and lab findings of metabolic acidosis
``` headache, confusion, drowsiness -increased respiratory rate and depth -N/V, decreased BP -decreased cardiac output and bradycardia ABG-pH less than 7.35, HCO3 less than 22 CO2 less than 38 Elevated K+ Dysrhthmias due to hyperkalemia ```
26
Interventions
- treat underlying cause (diabetes, diarrhea,lactic acidosis; etc) - administer bicarbonate - treat electrolyte abnormality- esp K+ - provide safety precautions - monitor for signs of worsening (changes in resp, cardiac, CNS) - monitor labs: esp K+, ABG
27
alkalosis
too much base or the loss of too much acid
28
Respiratory alkalosis labs
- pH greater than 7.45 | - PaCO2 less than 35
29
Metabolic akalosis labs
- pH greater than 7.45 | - bicarb greater than 26
30
causes of respiratory alkalosis
``` hyperventilation (self or ventilator) anxiety stimulation of hypoxemia- resp disorders CNS lesions fever hypoxia salicylate OD ```
31
Clinical manifestations and lab values related to respiratory alkalosis
- headache, confusion, drowsiness - increases respiratory rate and depth - N/V, decreased BP - decreased cardiac output and bradycardia - neuromuscular excitability - ABG pH greater than 7.45, CO2 less than 35 - elevated K+ - dysrhthmias
32
interventions for Resp. alkalosis
- treat underlying cause | - relaxation technique
33
metabolic alkalosis causes
- excessive H+ loss- vomiting or gastric suctioning - excessive use of K+ wasting diuretics - excessive adrenal corticoid hormones: Cushing's, hyperaldosteronism,excessive HCO3 intake
34
clinical manifestations and lab values related to metabolic alkalosis
-confusion, AMS -hyperreflexia -tetany -dysrhythmias -hypotension -seizure -resp. failure ABG pH> 7.45, HCO3>28 hypokalemia; hypochloremia
35
Interventions for metabolic alkalosis
collab: -administer O2, K+,C-; treat underlying problem indep: -monitor I&Os, VS, RR, LOC, electrolytes
36
normal range of pH
7.35-7.45
37
normal range of PaCO2/PCO2
35-45 mmHG | -partial pressure of arterial carbon dioxide
38
normal range of PaO2/PO2
80-100 mmHg | partial pressure of arterial oxygen
39
normal range of SaO2/SO2
95-100% | percent of O2 bound to hemoglobin
40
normal range of HCO3
serum bicarbonate | 22-28 mEq/L
41
Arterial blood gas
blood test used to determine most accurate acid-base info - must be drawn from artery (radial, femoral) - usually done by RT or drawn by RN through arterial line - special heparinized syringe
42
What does an allen test assess?
Radial artery
43
which 3 lab values should you monitor most closely when interpreting an ABG?
ph- is it acidic? basic? normal? PaCO2- is it high? low? normal? HCO3- High? Low? normal? which system is comensating
44
2 main systems used to maintain homeostasis?
Renal and Respiratory
45
compensation
- process of returning to a normal state (pH 7.35-7.45) | - can be determined through ABG interpretation process
46
fully compensated...
pH is in normal range and both PaCO2 and HCO3 are abnormal
47
partially compensated...
pH is abnormal and both the PaCO2 and HCO3 are abnormal | pH hasnt quite made it to full compensation
48
uncompensated
pH is abnormal and either the PaCO2 or HCO3 is abnormal

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