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Nursing 202 - Midterm > Acid/Base Imbalances > Flashcards

Acid/Base Imbalances Flashcards

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1
Q

Where is an ABG typically obtained from?

A

Radial, femoral, or brachial artery

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2
Q

What is the normal range of pH?

A

7.35-7.45

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3
Q

What is the pH range compatible with life?

A

6.8-7.8

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4
Q

What are the major regulators of acid-base balance?

A
  • Major ECF buffer system: bicarbonate-carbonic acid buffer system
  • Lungs, under control of medulla, regulate CO2 —> carbonic acid in ECF
  • Kidneys regulate bicarbonate in ECF
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5
Q

How fast does each regulatory mechanism respond to changes in acid-base imbalances?

A
  • Buffers = immediately
  • Lungs = minutes-hrs
  • Kidneys = 2-3 days, but the kidneys can manage balance indefinitely in chronic imbalances
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6
Q

Why can acidosis cause hyperkalemia?

A

When ECF H+ are increased, H+ enters the cells in exchange for K+

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7
Q

Why can alkalosis cause hypokalemia?

A

With decreased H+ levels, H+ enters plasma in exchange for K+

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8
Q

How does respiratory system respond to increased H+?

A

Increase in RR & depth —> increased CO2 elimination & decreased CO2 in blood

Hyperventilation = acidosis

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9
Q

How does respiratory system respond to decreased H+?

A

Decrease in RR —> CO2 retention

Hypoventilation = alkalosis

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10
Q

What is the normal range of urine pH?

A

Avg = 6, can increase or decrease b/t 4-8

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11
Q

What is the base:acid content ratio?

A

20:1

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12
Q

Normal ABG values

A 
PH 7.35-7.45 
PaCO2 35-45 
HCO3 22-26
PaO2 80-100
Oxygen sat >94% 
Base excess/deficit +/- 2 mEq/L
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13
Q

Metabolic acidosis

S/S

A

HA, confusion, drowsiness, increased RR/depth, decreased BP, decreased CO, dysrhythmias, shock

If decrease is slow pt may be asymptomatic until bicarbonate is <15

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14
Q

Metabolic acidosis

Causes

A

DKA
Lactic acid accumulation (shock)
Severe diarrhea
Kidney disease

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15
Q

Metabolic acidosis

Compensation

A

Lungs increase CO2 excretion w/Kussmaul’s respiration (deep & rapid)

Kidneys attempt to excrete additional acid

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16
Q

Metabolic acidosis

Nursing interventions

A
  • Monitor K level (can cause hyperkalemia)
  • Serum calcium levels may be low w/chronic metabolic acidosis —> must be corrected prior to TX, can result in tetany from increase in pH & decrease in ionized calcium
17
Q

Anion gap

A

Measurement of the difference b/t negatively and positively charged electrolytes

Used to help identify the cause of metabolic acidosis

18
Q

What is normal anion gap?

A

8-12

19
Q

How is anion gap affected from metabolic acidosis?

A

Increased w/acid gain (lactic acid, DKA)

Remains WNL when acidosis caused by bicarbonate loss (diarrhea, diuretics)

20
Q

How to calc anion gap

A

Anion gap = Na - (Cl + HCO3)

21
Q

Metabolic alkalosis

S/S

A

R/T decreased Ca - respiratory depression, tachycardia

R/T hypokalemia

22
Q

Metabolic alkalosis

Causes

A

Prolonged vomiting, NG suction

Gain of HCO3 (ingestion of baking soda)

23
Q

Metabolic alkalosis

Compensation

A
  • Renal excretion of HCO3

- Decreased RR to increase plasma CO2

24
Q

Metabolic alkalosis

Management

A
  • Correct underlying problem
  • Supply Cl to allow excretion of bicarb
  • Restore fluid vol w/NS solutions
25
Q

Respiratory acidosis

Causes

A

Always due to respiratory problem w/inadequate excretion of CO2 (hypoventilation, respiratory failure)

26
Q

Respiratory acidosis

S/S

A

Suddenly increased pulse, RR, BP
Mental changes
Feeling of fullness in head

In chronic, may be asymptomatic because of compensation

27
Q

Respiratory acidosis

Compensation

A

Kidneys conserve HCO3 & secrete H+ in urine

28
Q

Respiratory acidosis

Complication

A

Increased ICP - if PaCO2 increases rapidly, cerebral vasodilation will increase ICP —> cyanosis, tachypnea

29
Q

Respiratory alkalosis

Cause

A

Always due to hyperventilation

30
Q

Respiratory alkalosis

S/S

A

Lightheaded, inability to concentrate, numbness/tingling, sometimes loss of consciousness

31
Q

Causes of hyperventilation

A

Extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-neg bacteremia, inappropriate ventilator settings

32
Q

Respiratory alkalosis

Compensation

A

Rarely occurs when acute
Can buffer w/bicarbonate shift
Renal compensation if chronic

Nursing 202 - Midterm (12 decks)

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