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MS1 > ACID BASE BALANCE > Flashcards

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
Q

clinical manifestations and lab findings of metabolic acidosis

A 
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
Q

Interventions

A
  • 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
Q

alkalosis

A

too much base or the loss of too much acid

28
Q

Respiratory alkalosis labs

A
  • pH greater than 7.45

- PaCO2 less than 35

29
Q

Metabolic akalosis labs

A
  • pH greater than 7.45

- bicarb greater than 26

30
Q

causes of respiratory alkalosis

A 
hyperventilation (self or ventilator) 
anxiety
stimulation of hypoxemia- resp disorders
CNS lesions
fever
hypoxia
salicylate OD
31
Q

Clinical manifestations and lab values related to respiratory alkalosis

A
  • 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
Q

interventions for Resp. alkalosis

A
  • treat underlying cause

- relaxation technique

33
Q

metabolic alkalosis causes

A
  • excessive H+ loss- vomiting or gastric suctioning
  • excessive use of K+ wasting diuretics
  • excessive adrenal corticoid hormones: Cushing’s, hyperaldosteronism,excessive HCO3 intake
34
Q

clinical manifestations and lab values related to metabolic alkalosis

A

-confusion, AMS
-hyperreflexia
-tetany
-dysrhythmias
-hypotension
-seizure
-resp. failure
ABG pH> 7.45, HCO3>28
hypokalemia; hypochloremia

35
Q

Interventions for metabolic alkalosis

A

collab: -administer O2, K+,C-; treat underlying problem
indep: -monitor I&Os, VS, RR, LOC, electrolytes

36
Q

normal range of pH

A

7.35-7.45

37
Q

normal range of PaCO2/PCO2

A

35-45 mmHG

-partial pressure of arterial carbon dioxide

38
Q

normal range of PaO2/PO2

A

80-100 mmHg

partial pressure of arterial oxygen

39
Q

normal range of SaO2/SO2

A

95-100%

percent of O2 bound to hemoglobin

40
Q

normal range of HCO3

A

serum bicarbonate

22-28 mEq/L

41
Q

Arterial blood gas

A

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
Q

What does an allen test assess?

A

Radial artery

43
Q

which 3 lab values should you monitor most closely when interpreting an ABG?

A

ph- is it acidic? basic? normal?
PaCO2- is it high? low? normal?
HCO3- High? Low? normal?
which system is comensating

44
Q

2 main systems used to maintain homeostasis?

A

Renal and Respiratory

45
Q

compensation

A
  • process of returning to a normal state (pH 7.35-7.45)

- can be determined through ABG interpretation process

46
Q

fully compensated…

A

pH is in normal range and both PaCO2 and HCO3 are abnormal

47
Q

partially compensated…

A

pH is abnormal and both the PaCO2 and HCO3 are abnormal

pH hasnt quite made it to full compensation

48
Q

uncompensated

A

pH is abnormal and either the PaCO2 or HCO3 is abnormal

MS1 (4 decks)

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