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Nursing 201 > ACID-BASE BALANCE > Flashcards

ACID-BASE BALANCE Flashcards

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1
Q

ACID BASE BALANCE

A

Process of regulating the pH, bicarbonate, and partial pressure of carbon dioxide of body fluids

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2
Q

ACID PRODUCTION

A

Generation of acid through cellular metabolism

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3
Q

ACID BUFFERING

A

Process to control changes in pH by neutralizing acid with buffers

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4
Q

ACID EXCRETION

A

Removal of acid from the body by the renal system(slowly) and by breathing quicker, faster, deeper

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5
Q

OPTIMAL LAB VALUES

A

pH- 7.35-7.45
CO2- 35-45
HCO3- 21-26

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6
Q

ACID BASE CONTROL ACTIONS : RESPIRATORY

A

Hyperventilation
Hypoventilation
Lungs compensate for acid-base imbalances of metabolic origin

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7
Q

ACID BASE CONTROL-KIDNEYS

A 
3rd line of defense against pH changes
Stronger regulating
Takes longer than lungs
Movement of bicarbonate
Kidneys compensate when respiratory system is overwhelmed or unhealthy
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8
Q

COMPENSATION

A

Body’s attempt to correct pH
PH <6.9 or >7.8 is usually fatal
Respiratory system is more sensitive can begin compensating in seconds to minutes
Kidneys are more powerful fully triggered in several hours to days

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9
Q

BICARBONATE

A

Weak base
Major buffer of ECF (extracellular fluid)
Intestinal absorption into ECF, kidney absorption and breakdown of carbonic acid
* level is usually 20 times greater than carbonic acid

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10
Q

OPTIMAL ACID BASE BALANCE

A

Acid excretion keeps pace with acid production
Buffers are not overwhelmed
PH is maintained 7.35-7.45

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11
Q

RESPIRATORY ACIDOSIS

A

Chronic COPD (bronchitis)
End stage type A COPD (emphysema)
Not getting rid of CO2
DECREASED PAO2 WITH RISING PACO3

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12
Q

SIGNS AND SYMPTOMS OF RESPIRATORY ACIDOSIS

A 
Bluish tint
Patient cant catch breath
Vasodilation hypotension
Headache
Short of breath
K+ may rise
Drowsy
Difficulty getting air in and out
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13
Q

COPD

A 
Air gets obstructed from getting all air out. Lung capacity expands to accommodate extra air.
Emphysema( enlarged air spaces, barrel chest)
Chronic bronchitis ( excessive mucous production, productive cough every winter)
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14
Q

NURSING RESPONSES TO IMPROVE OXYGENATION

A

Positioning
Pursed lip breathing
Relaxation techniques
Diaphragmatic breathing (belly breathing)]

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15
Q

NURSING RESPONSE FOR AIRWAY CLEARANCE

A 
Stop smoking cessation 
Increase fluid intake
Teach correct techniques for deep breathing and cough
Physiotherapy and postural drainage
Balance activity with rest
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16
Q

ACTIVITY TOLERANCE FOR COPD

A

Continue breathing exercises
Pace activities and monitor tolerance
Avoid temperature extreme temp changes
Pulmonary rehab classes

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17
Q

IMPROVE NUTRITIONAL INTAKE

A 
High protein
High calories
Vitamin and nutritional supplements
Rest before meals
Small frequent meals
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18
Q

METABOLIC ACIDOSIS

A

Too much H+ (hydrogen)

Too little HCO3 (bicarbonate)

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19
Q

SIGNS AND SYMPTOMS METABOLIC ACIDOSIS

A 
Hot and dry
HYPERKALEMIA ( K+ leaves the cell, H+ goes in)
Diabetic ketoacidosis renal failure
Kaussmaul breathing
Hyperventilation
Dehydrated
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20
Q

CAUSES OF METABOLIC ACIDOSIS

A

1) overproduction of hydrogen ions
2) under elimination of hydrogen ions (kidney failure)
3) underproduction of bicarbonate
4) overelimination of bicarbonate ions (diarrhea)

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21
Q

TREATMENT OF METABOLIC ACIDOSIS

A

Rehydrate
Give insulin
Anti emetics
Anti diarrheal

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22
Q

ALKALOSIS

A

Loss of too much acid or retention of too much base

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23
Q

RESPIRATORY ALKALOSIS

A

Hyperventilation ( anxiety, fear, PE, mechanical respirations)
Dizzy, pale, confused
PH above 7.45
PCO2 under 35

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24
Q

METABOLIC ACIDOSIS

A

Increase of base or decrease of acids
Excessive intake of bicarbonate, carbonates, acetates, and citrates, use of too many antacids

Medical treatments such as massive blood transfusions and IV sodium bicarbonate given to correct acidosis

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25
Q

ALKALOSIS ASSESSMENT

A

Low calcium and low potassium levels
Dizziness, agitation, confusion, and hyper reflexes, may progress to seizures
Tingling and numbness may occur around the mouth and the toes (respiratory alkalosis)
Positive chvostek’s and trousseau’s signs

26
Q

CONSEQUENCES OF ALKALOSIS

A

Impaired cellular and organ function

Altered cell function especially in the brain
Progressive CNS changes
Change in intracellular enzyme activity resulting in cell dysfunction

Decreases level of consciousness, may cause dysrhythmias

27
Q

CONSEQUENCES OF ACIDOSIS

A

COPD can become somnolent and less and less responsiveness

28
Q

ARTERIAL BLOOD GASES NORMAL VALUES

A

PH 7.35-7.45
PaCO2 35-45 mm Hg
HCO3 21-26 mEq/L (bicarbonate)

29
Q

ROME

A

R espiratory
O pposite
High pH low PCO2 = alkalosis
Low pH high PCO2 = acidosis

M etabolic
E qual
High pH high PCO2 = alkalosis
Low pH low PCO2 = acidosis

30
Q

TIC TAC TOE METHOD

A

ACID / NORMAL/ BASE
/ /
/ /

31
Q

FULL COMPENSATION

A

Occurs when pH is normal

32
Q

PRIMARY PREVENTION FOR ACID BASE BALANCE

A 
Healthy eating habits
Safe weight loss
Smoking prevention/cessation
Poison control measures
Safe food handling
33
Q

A PATIENT IS BROUGHT TO ED WITH RESPIRATORY DEPRESSION. THE PATIENT HAS HISTORY OF COPD. WHAT ACID BASE IMBALANCE IS MOST LIKELY?

A

Respiratory acidosis

34
Q

THGE REANAL SYSTEM IMPROVES pH BALANCE BY REGULATING?

A

Extracellular fluid electrolytes

35
Q

CATECHOLAMINE

A

Destroys neurotransmitters

36
Q

GAS EXCHANGE

A

Process by which oxygen is is transported to cells and carbon dioxide is transported from cells

37
Q

HYPOXIA

A

Not having enough O2

38
Q

ANOXIA

A

No oxygenation

39
Q

RESPIRATORY SYSTEM

A

Upper and lower airways
Lungs
Alveoli
Capillaries

40
Q

IMPAIRED GAS EXCHANGE

A

Ineffective ventilation
Reduced capacity for gas transportation
Inadequate perfusion

41
Q

INDIVIDUAL RISK FACTORS

A 
Age
Smoking
Chronic medical conditions
Immunosuppressive
Reduced state of cognition
Brain injury
Prolonged immobility
42
Q

COPD

A

Emphysema
Chronic bronchitis

Bronchospasm and dyspnea
Tissue damage is not reversible, increases in severity, leads to respiratory failure

43
Q

ELEMENTS OF RESPIRATORY ASSESSMENT

A

History
Family history. Vital signs
Current meds. Inspection
Lifestyle behaviors. Auscultation of lung sounds
Occupation
Social environment
Problem based history

44
Q

COMMON DIAGNOSTIC TESTS FOR COPD

A

Arterial blood gases, CBC, sputum, biopsy

Chest x-ray, CT, MRI, PET scan

Pulmonary function studies
Endoscopy

45
Q

COMPLICATIONS OF COPD

A

Hypoxemia/ tissue anoxia
Acidosis
Respiratory infections
Cardiac failure ( cor pulmonale, causes right side of heart to fail. Long term high blood pressure in the arteries of the lung and right ventricle of the heart)

Cardiac dysrhythmias

46
Q

INTERVENTIONS OF COPD

A 
Improve oxygenation and reduce CO2
Prevent weight loss
Minimize anxiety
Improve activity tolerance
Prevent respiratory infection
47
Q

LAB ASSESSMENTS FOR COPD

A 
ABG values
Sputum samples
CBC
Hemoglobin and hematocrit
Serum electrolytes
Serum AAT
Chest x-ray
Pulmonary function test
48
Q

CLINICAL MANAGEMENT FOR COPD

A 
Smoking cessation
Pharmacotherapy
Nutrition therapy
Positioning
Chest physiotherapy
Postural drainage
Oxygen therapy devices
Airway suctioning
Endotracheal tubes
Mechanical ventilation
Chest tube management
49
Q

BETA ADRENERGIC AGONISTS

A

Short acting- Long acting-
Albuterol. Arformoterol
Levalbuterol. Formoterol
Pirbuterol. Salmeterol (combined with steroid to make
Terbutaline. Advair)
Metaproterenol

50
Q

NONSELECTIVE ADRENERGICS

A

Stimulate alpha and both beta1 and beta 2 receptors (epinephrine)

51
Q

NONSELECTIVE BETAADRENERGICS

A

Stimulate both beta 1 and beta 2 receptors (metaproterenol)

52
Q

SELECTIVE BETA 2

A

Stimulates primarily beta 2 (albuterol)

53
Q

BETA-AGONISTS

A 
Dilation of airway
Used in treatment and prevention of acute attacks
Adverse effects include :
Insomnia
Restlessness
Anorexia
Hypoglycemia
Tremor
Cardiac stimulation
54
Q

ADVERSE EFFECTS OF ALBUTEROL

A

Hypotension or hypertension
Vascular headache
Tremor

If used to frequently it loses its beta2 specific actions at larger doses

55
Q

ANTICHOLINERGICS

A 
Ipratropium bromide (atrovent)
Tiotropium (spiriva)

Used to prevent bronco constriction, not used for ACUTE asthma or COPD.

Blocks acetylcholinewhich causes bronchial constriction

56
Q

ADVERSE EFFECTS OF ANTICHOLINERGICS

A 
Dry mouth
Nasal congestion
Heart palpitations
GI distress
Headache 
Cough
Anxiety
No known drug interactions
57
Q

XANTHINE DERIVITIVES

A

Plant alkaloids , caffeine, theobromine, and theophylline

Increased cAMP levels, smooth muscle relaxation, bronchodilator,and increased airflow

58
Q

NURSING IMPLICATIONS OF XANTHINE DERIVITIVES

A

Caution use in GI or PUD disorders and cardiac disease
Report tremors, nausea, vomiting, insomnia, and irritability
Be aware of drug interactions( oral contraceptives, antibiotics)
Cigarette smoking enhances XANTHINE metabolism
Interacting foods (charcoal broiled, high protein, low carb foods)
Keep in therapeutic range (less than 20)

59
Q

CORTICOSTEROIDS

A

Anti inflammatory
Used for CHRONIC asthma and COPD
Oral or inhaled forms
May take several weeks before full affects are seen

60
Q

INHALED CORTICOSTEROIDS

A

Beclomethasone diprpionate

Dexamethasone sodium phosphate

Fluticasone

USED FOR LONG TERM TREATMENT OF ASTHMA AND COPD

61
Q

NURSING IMPLICATIONS OF INHALED CORTICOSTEROIDS

A

Do not use in patients with psychosis, fungal infections, AIDS,TB
Teach patients to gargle and rinse mouth after use
If bronchodilator and steroid are ordered, make sure patient gets bronchodilator several minutes before inhaled steroid
Clean mouth piece after each use
Can cause glucose levels to rise

62
Q

EXPECTORANTS

A

Loosening and thinning of respiratory tract secretions

Results in thinner mucus that is easier to remove

Nursing 201 (8 decks)

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