Acid/Base Imbalances

Question 1

Acidic

Answer 1

<7

Question 2

Alkaline

Answer 2

> 7

Question 3

Normal Blood pH

Answer 3

7.35-7.45

Question 4

Homeostasis

Answer 4

state of equilibrium within the body: in regard to

• fluid balance
• electrolyte balance
• acid/base balance

Question 5

External respiration

Answer 5

what happens when you breathe oxygen into your lungs and breathe out CO2 and H2O (as vapour)

Question 6

Internal Respiration

Answer 6

what happens at the tissue level when the arterial capillary beds allow diffusion of O2 into the cell and the venule capillary beds release CO2 into the plasma for return back to the lungs

Question 7

Acid-base regulation (3)

Answer 7

• buffer system (reacts immediately)
• respiratory system - responds in minutes; maximum effectiveness reached within hours
• renal system - takes 2-3 days to reach maximum response can maintain balance for a long period of time

Question 8

Buffer System

- how do lungs and kidneys influence acid/base balance

Answer 8

• electrolyte exchange in the cells. K+ is exchanged with H+
• alkalosis leads to –> hypokalemia because there is not enough H+ in the blood so the cells will trade their H+ for potassium from the bloodstream leading to a hypokalemic state in the blood
• acidosis leads to –> hyperkalemia because there is too much H+ in the bloodstream so it will move into the cells and the potassium will move out putting the body in a hyperkalemic state
  (lungs - exhalation of CO2 decreases acidity)
  (kidneys - excretion and/or retention of acids and bicarbonate)

Question 9

Lungs

Answer 9

• rapid respirations (exhalation of CO2 -> decreased acidity)
• slow respirations (retention of CO2 -> increased acidity)

Question 10

Kidneys

Answer 10

• excretion of H+ and reabsorption of HCO3 -> decreased acidity
• electrolyte exchanges
• hypokalemia (alkalosis)
• hyperkalemia (acidosis)

Question 11

the lungs…

Answer 11

“blow off” CO2 to increase pH in response to metabolic acidosis
- kidneys excrete H+ and reabsorb HCO3 to increase pH in response to respiratory acidosis

Question 12

Kidney ->

Respiratory ->

Answer 12

metabolic

Respiratory component

Question 13

Respiratory acidosis: causes (12)

Answer 13

• anything that causes hypoventilation
• COPD
• Barbiturate or sedative overdose
• severe pneumonia
• atelectasis
• respiratory muscle weakness
• mechanical hypoventilation
• sleep apnea
• head trauma
• post op
• pneumonia
• asthma

Question 14

Respiratory Acidosis: Lab values

Answer 14

• increased PCO2 and decreased pH if uncompensated

Question 15

Resp acidosis: manifestations (4)

Answer 15

• drowsiness, dizziness, headache, disorientation, coma
• decreased BP, ventricular fib, warm flushed skin from peripheral vasodilation
• dyspnea, hypoventilation with hypoxia
• seizures

Question 16

Resp acidosis: interventions

Answer 16

treat underlying cause: give narcan, oxygen therapy (low flow), respiratory therapy (Bipap)

Question 17

Resp alk: causes

Answer 17

• anything causing hyperventilation
• 2nd degree to hypoxia, fear/anxiety, fever
• stimulated resp center - sepsis, brain injury, salicylate poisoning
• mechanical overventilation

Question 18

Resp alk: lab values

Answer 18

• decreased PCO2 and increased pH if uncompensated

Question 19

Resp alk: manifestations

Answer 19

• lethargy, light-headedness, confusion
• increased HR, dysrhythmias
• nausea, vomiting, epigastric pain
• tetany, numbness. tingling, hyperreflexia, seizures
• rapid, shallow breathing (kussmauls breathing)
• fast resps

Question 20

Resp alk: interventions (6)

Answer 20

treat underlying cause
rebreather mask
assist client to slow respirations
decreased anxiety
oxygen therapy if hypoxia is the underlying cause
monitor VS, ABGs and electrolyte imbalances

Question 21

Metabolic acidosis: causes

Answer 21

• accumulation of acid
• DKA
• septic shock (lactic acid accumulation)
• starvation
• loss of bicarbonate
• diarrhea
• renal failure

Question 22

Met acidosis: lab values

Answer 22

• decreased HCO3 and decrease in pH if uncompensated

- resp system is going to try and compensate to blow off the CO2 and increase the pH (Kussmauls breathing happens)

Question 23

Met: acidosis manifestations

Answer 23

• drowsiness, confusion, headache, coma
• Decreased BP, dysrhythmias, warm, flushed skin (vasodilation)
• nausea, vomiting, diarrhea, abdominal pain
• deep, rapid respirations (kussmauls resps)

Question 24

Interventions: met acidosis

Answer 24

• treat underlying cause
• respiratory support
• administer sodium bicarbonate to neutralize acid

Question 25

Metabolic alk: causes

Answer 25

• loss of acid - NG suctioning, prolonged vomiting
• loss of K+ to diuretic therapy
• gain of bicarbonate - ingestion of baking soda

Question 26

Met alk: lab values

Answer 26

• HCO3 increased and increased pH if uncompensated

Question 27

met alk: manifestations

Answer 27

• dizziness, irritability, nervousness, confusion
• tachycardia, dysrhythmias
• anorexia, nausea, vomiting
• tremors, hypertonic muscles, muscle cramps
• hypoventilation

Question 28

Met alk: interventions (4)

Answer 28

• treat underlying cause
• replace lost fluids and electrolytes
• support renal function (dialysis)
• administer acetazolamide - promotes loss of bicarb in urine (diuretic)

Question 29

Mixed

Answer 29

• two or more simple disorders present at the same time
• pH will depend on type, severity and acuity
• respiratory acidosis and metabolic alkalosis
• mixed acidosis
• mixed alkalosis

Question 30

Normal ABG values

Answer 30

pH: 7.35-7.45
PaCO2: 35-45 mmHg
PaO2: 80-100 mmHg
HCO3: 22-26 mEq/L

Question 31

vomiting and diarrhea

Answer 31

• vomiting will decrease acidity because of the stomach acid being lost
• stool contains bicarbonate so when you have diarrhea - you will become acidotic

Question 32

Fully Compensated

Answer 32

• pH returned to normal despite the presence of abnormalities in both resp and/or metabolic systems
• acidosis because it is more leading towards acidosis