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NURS 304 > Acid-Base Balance > Flashcards

Acid-Base Balance Flashcards

1
Q

Acid Base Imbalances are named according to…

A
  1. Body system that is the primary cause of the disorder
  2. the resultant pH

*these are not diseases, they are conditions caused by a disorder of pathological processes

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2
Q

Lungs or CO2 problem?

A

Respiratory acidosis: elevation of PCO2 = ventilation depression

Respiratory alkalosis: depression of PCO2 = hyperventilation

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3
Q

Any other organ or HCO3- problem

A

Metabolic acidosis: depression of HCO3- or elevation of any noncarbonic acid

Metabolic alkalosis: elevation of HCO3- (usually caused by excessive lost of metabolic acids)

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4
Q

Normal Range of pH

A

7.35-7.45
Below 7.4 = acidosis
Above 7.4 = alkalosis

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5
Q

PaCO2

A

35-45
alkalemic –> acidic

the lower the CO2, the less acidic the blood will be

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6
Q

HCO3

A

22-26

acidic –> alkalemic

the lower the HCO3-, the more acidic blood will be

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7
Q

PaO2

A

80-100

usually not a concern unless it goes under 60, or COPD patients, or pt at high elevation

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8
Q

Metabolic Acidosis

Description and Cause

A

increased concentrations of noncarbonic acids OR loss of bicarb from ECF OR bicarb cannot be regenerated from kidney

may develop quickly: lactic acidosis from decreased perfusion
slowly: kidney failure, diabetic ketoacidosis, starvation

-diarrhea: GI HCO3- loss, loss of pancreatic juices

renal HCO3- loss: kidney failure

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9
Q

S/S of Metabolic Acidosis

A

if slow onset –> headache, lethargy, confusion, coma

deep and rapid breathing (Kussmaul respirations/hyperventilation)

Anorexia, nausea, vomiting, diarrhea, abdominal discomfort, cardiac dysrhythmias, decreased BP, death

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10
Q

Hyperkalemia and acidosis

A

High H+ concentration in blood –> H+ diffuses into ISF –> H+ enters cells and displaces K+ –> K+ diffuses into blood

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11
Q

Metabolic Acidosis

The compensation

A

Respiratory: reduce PaCO2 by breathing quickly and deeply

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12
Q

Metabolic Acidosis

Clinical Management

A

Address underlying disorder: improve perfusion, reverse hyperglycemia

Support compensation: observe for signs of fatigue, intubation may be necessary

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13
Q

Metabolic Alkalosis

Description and Potential Etiologies

A

excessive loss of metabolic acids OR increase in bicarb ion

Causes:
Loss of H+ (vomiting, suction, renal loss)
Gain of HCO3-
Some diuretics
Hyperaldosteronism
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14
Q

Metabolic Alkalosis

S/S?

A

varies w/ cause and severity

Leads to low ionized calcium levels –> excitable cells become HYPOpolarized –> easier generation of action potentials
-weakness, muscle cramps, hyperactive reflexes
-atrial tachycardia
irritablility, confusion, convulsions
-paresthesia

Respirations: may be shallow to RETAIN CO2

-HYPOkalemia

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15
Q

Metabolic Alkalosis

The compensation

A

Slowed ventilation = CO2 retained = increased PaCO2

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16
Q

Respiratory Acidosis

Description and Cause

A

alveolar hypoventilation = CO2 retention = PaCO2 increases

  • suppression of medullary respiratory centers by drugs
  • trauma (CVA)
  • problems with breathing muscles
  • thoracic deformaties
  • lung problems
17
Q

Respiratory Acidosis

S/S

A

slow, shallow, absent breathing

18
Q

Respiratory Acidosis

The Compensation

A

increased H+ renal excretion

Increased generation of new HCO3-

19
Q

Respiratory Acidosis

Clinical Management

A

increase ventilation

support compensation

do not try to remedy a high HCO3- level (if there is one)

20
Q

Respiratory Alkalosis

Description and Cause

A

alveolar hyperventilation (deep, rapid breathing) = excess CO2 elimination = PaCO2 falls

Hypoxemia
Hypermetabolic states 
latrogenic (over ventilation w/ chemical ventilator)
Hypoxemia 
Trauma to medullary respiratory centers
Anxiety, pain, hysteria
21
Q

Respiratory Alkalosis

S/S

A

Dizziness,confusion, tingling of extremities

hyperventilating?

irritable?
cramps, tetany, Chovstek and trosseau sign

22
Q

Respiratory Alkalosis

The compensation

A

increase H+ retention

(takes several days)

if chronic problem –> renal compensation lowers HCO3- to partially correct pH

23
Q

Respiratory Alkalosis

Clinical Management

A

Address underlying disorder

reduce rate and or volume of ventilation, relieve anxiety, relieve pain

breathe in paper bag if anxiety attack

24
Q

Concentration of H+ ions in blood

A

less than 0.0001 mEq/L

25
Q

Changes of normal pH interferes with

A

changes shape and reduces function of hormones and enzymes

changes distribution of other electrolytes (causing fluid and electrolyte imbalances)

changes excitable membranes (making heart, nerves, GI tract and muscles more active than normal

decreases effectiveness of many drugs

changes in pH has PROFOUND effects on side chains of amino acids = all proteins are sensitive to pH

26
Q

chemical buffer systems

A

Bicarbonate buffer system: most important system of ECF

Protein buffer system (ECF and ICF)

  • hemoglobin
  • amino acid buffers
  • plasma protein buffers

Phosphate buffer system: ICF; buffers pH of ICF AND urine

27
Q

physiological buffer systems

A

lungs, kidneys, bones

28
Q

chemoreceptors of medulla oblongata

A

“central” chemoreceptors

monitor changes in pH (reflective of CO2 levels in blood)

29
Q

chemoreceptors of carotid bodies

A

“peripheral” chemoreceptors

monitor pH, pCO2, and PO2

30
Q

chemoreceptors of aortic arch

A

“peripheral” chemoreceptors

monitor pCO2 and PO2

31
Q

The Carbonic Acid-Bicarbonate Buffer System and CO2 transport

A

70% of CO2 is transported as HCO3- in blood

  • H+ stays inside RBC –> binds to hemoglobin (Hb)
  • HCO3- diffuses in plasma to be used as a buffer

23% of CO2 stays in RBC and binds to Hb

7% of CO2 dissolves in plasma

32
Q

When RBC’s reach alveoli

A

HCO3- returns to RBC –> reacts with H+ to form H2CO3 –> dissociates into Water and CO2 –> CO2 is exhaled

33
Q

Renal Response to Acidosis w/ Ammonia

A

NH3 (ammonia) is formed in proximal convoluted tubule and secreted into tubular fluid

NH3 can serve as a buffer distally

H+ and secreted and bound to NH3 to be excreted in urine

34
Q

Renal Response to Acidosis w/ Phosphate

A

H+ is secreted from Type A inctercallated cell of collecting duct

Secreted H+ combines with phosphate ion to be excreted in urine

35
Q

Acid Elimination

A

respiratory elimination of CO2 (ventilation)

Urine

Gastric Suction/Emesis

36
Q

Base elimination

A

Loss of intestinal/colonic fluid

Urine

NURS 304 (4 decks)

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