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Nursing 104 (Applied Science For Nursing) > Acid Base Imbalance > Flashcards

Acid Base Imbalance Flashcards

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1
Q

Do acids donate or accept hydrogen ions when dissolved in water?

A

Donate

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2
Q

Do alkalis donate or accept hydrogen ions when dissolved in water?

A

Accept

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3
Q

What can buffers do in relation to hydrogen ions?

A

They can bind or release hydrogen ions in solution

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4
Q

What is the main extracellular buffering system?

A

The bicarbonate buffer system

H2O + CO2 ⇌ H2CO3 ⇌ H+ + HCO3-

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5
Q

Which enzyme facilitates the conversion of H2O and CO2 into H2CO3 and back again within the bicarbonate buffer system?

A

Carbonic Anhydrase

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6
Q

What is the main intracellular buffering system?

A

The ammonia/phosphate buffer system
HPO4- + H+ ⇌ H2PO4
NH3 + H+ ⇌ NH4+

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7
Q

How can proteins act as buffers?

A

Some amino acids contain Carboxyl and Amino groups that can act as weak acids and bases
Haemoglobin can buffer extra H+ ions

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8
Q

What is the normal blood pH range?

A

7.35-7.45

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9
Q

What is a blood pH lower than 7.35 known as?

A

Alkalosis

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10
Q

What is a blood pH higher than 7.45 known as?

A

Acidosis

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11
Q

When taking into account compensation, what is the exact normal value for blood pH?

A

7.4

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12
Q

What is the normal range of partial pressure for CO2 in arterial blood?

A

4.6-6.0kPa

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13
Q

If blood partial pressure of CO2 increases, what happens to blood pH?

A

It decreases, becoming more acidic

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14
Q

If blood partial pressure of CO2 decreases, what happens to blood pH?

A

It increases, becoming more basic

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15
Q

Will hyperventilation cause the partial pressure of CO2 in blood to increase or decrease?

A

Decrease, as CO2 is being expelled from the body faster due to the faster breathing rate

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16
Q

Will hypoventilation cause the partial pressure of CO2 in blood to increase or decrease?

A

Increase, as CO2 is being expelled from the body slower due to the slower breathing rate

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17
Q

What is the normal range of partial pressure for O2 in arterial blood?

A

10-14kPa

18
Q

What is a blood O2 partial pressure below 10kPa called?

A

Hypoxemia

19
Q

What is the normal range of HCO3- concentration in arterial blood?

A

22-26 mEq/L

20
Q

If blood concentration of HCO3- increases, what happens to blood pH?

A

It increases, becoming more basic

21
Q

If blood concentration of HCO3- decreases, what happens to blood pH?

A

It decreases, becoming more acidic

22
Q

What is a healthy oxygen saturation level?

A

Greater than 95%

23
Q

What does an oxygen saturation level below 93% indicate?

A

Hypoxemia, low blood O2 partial pressure

24
Q

What is the difference between Hypoxia and Hypoxemia?

A

Hypoxia refers to the reduced oxygenation of tissues, whereas hypoxemia refers to a low blood partial pressure of oxygen

25
Q

How is the respiratory system involved in acid base balance?

A

H2O + CO2 ⇌ H2CO3 ⇌ H+ + HCO3-

It works via the CO2

26
Q

How is the renal system involved in acid base balance?

A

H2O + CO2 ⇌ H2CO3 ⇌ H+ + HCO3-

It works via the HCO3-

27
Q

Is the renal system slower or faster than the respiratory system when it comes to compensating?

A

Slower

28
Q

How does the renal system respond to blood pH changes?

A

It alters the rate of H+ and HCO3- secretion and absorption depending on pH

29
Q

What are the steps to acid/base balance interpretation?

A
  1. Is pH normal?
  2. Is PaCO2 normal?
  3. Is HCO3- normal?
  4. Does PaCO2 or HCO3- match pH?
  5. Does the PaCO2 or the HCO3- go the opposite direction of the pH?
  6. Is the PaO2 and the Oxygen saturation normal?
30
Q

What are some causes of metabolic acidosis?

A 
Diabetic ketoacidosis
Diarrhoea
Renal failure
Shock induced hypoxemia
Aspirin overdose
Sepsis
Starvation
Exercise without sufficient caloric intake (lactic acidosis)
31
Q

What are some symptoms of metabolic acidosis?

A

Anorexia, Nausea and Vomiting
General malaise (feeling “ugh”), fatigue
Weakness, reduced deep tendon reflexes (knee reflex hammer test)
Warm, flushed skin and mucous membranes
Tachycardia –> increased cardiac output (could lead to tired myocardium, bradycardia and decreased cardiac output and bp, also dysrhythmia)
Kussmaul’s respirations (deep and rapid breaths)
Decreased levels of consciousness (confusion, stupor and coma)
Possibly increased potassium and decreased magnesium

32
Q

What are some treatments for metabolic acidosis?

A

Hydration (especially if diarrhoea and vomiting)
Correct the issue (e.g. insulin, antidiarrheal medications, dialysis)
Sodium bicarbonate (not routinely given anymore)

33
Q

What are some causes of metabolic alkalosis?

A 
Excess base production
Loss of gastric secretions (e.g. vomiting)
Overuse of antacids
Potassium wasting diuretics
Blood transfusions (sometimes)
Thiazide diuretics
34
Q

What are some symptoms of metabolic alkalosis?

A

Confusion and reduced levels of consciousness
Blood pressure drop, seizures
Tingling and numbness around mouth, fingers and toes
Shallow Bradypnea

35
Q

What are some treatments for metabolic alkalosis?

A

Treat underlying cause
Antiemetic medications (anti vomiting and nausea)
Monitor electrolytes and replace as indicated
Seizure precautions

36
Q

What are some causes of respiratory acidosis?

A 
Failure of lungs to eliminate CO2
Hypoventilation
Chronic Obstructive Pulmonary Disease (COPD)
Airway obstruction
Drug overdose
Chest or head trauma
Pulmonary oedema
Neuromuscular disease
Respiratory depression (induced hypoventilation by narcotics and analgesics e.g. morphine)
Alveolar disorders
37
Q

What are some symptoms of respiratory acidosis?

A

Headache, confusion, irritability and decreased level of consciousness
Weakness, decrease in deep tendon reflexes (knee reflex hammer test)
Tachycardia –> increased cardiac output (could lead to tired myocardium, bradycardia and decreased cardiac output and bp, also dysrhythmia)
Ineffective respiratory efforts

38
Q

What are some treatments for respiratory acidosis?

A

Maintain patient airway and enhance ventilation
- Oxygen
- Pulmonary toilet (get gunk out of lungs)
- Ventilatory support (Endotracheal tube)
- Frequent blood monitoring
- Medication
Assess level of consciousness frequently
Low carb, high fat diet

39
Q

What are some causes of respiratory alkalosis?

A 
Lungs eliminate too much CO2
Hyperventilation
Hypoxemia (leads to hyperventilation, blowing out CO2)
Panic, anxiety
Neurogenic disorders
Asthma (hyperventilation)
Salicylate toxicity
40
Q

What are some symptoms of respiratory alkalosis?

A

Rapid, deep respiration
Anxiety, irritability, lightheadedness
Tetany/carpopedal spasm (claw hands), seizures
Pins and needles (Paresthesia)
Decreased calcium –> Ckvostek sign (twitching of facial muscles in response to tapping over area of facial nerves)
Muscle cramping, weakness
Tachycardia, may be hypotensive, palpitations
Skin and mucous membranes are pale to cyanotic (blue/grey skin)

41
Q

What are some treatments for respiratory alkalosis?

A

Monitor due to possibility of respiratory failure
Decrease respiratory rate
- Focused breathing
- Decreased breaths per minute on ventilator
- Oxygen therapy
Anti anxiety medications (paper bags included)

Nursing 104 (Applied Science For Nursing) (19 decks)

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