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Nursing G140 Exam #1 (MS) > Acid-base Imbalances > Flashcards

Acid-base Imbalances Flashcards

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1
Q

What is an acid?

A

A substance that releases H+

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2
Q

What is a base?

A

A substance takes up H+

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3
Q

What two types of acids are continuously being made and how are they excreted?

A
  • carbonic acid —> excreted through lungs

- metabolic acid —> excreted by the kidneys

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4
Q

What is buffering?

A

Process of body fluids resisting large changes in pH when acids or bases are added or removed

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5
Q

What are buffers?

A

Pairs of weak acids and its base

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6
Q

For the ECF, what is the most important buffering system?

A

Bicarbonate buffering system

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7
Q

What does the bicarbonate buffering system consist of and what is the ratio?

A

-20 bicarbonate: 1 carbonic acid

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8
Q

How quickly does the respiratory buffer work?

A

Minutes

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9
Q

What does free H+ form in the pulmonary capillaries? What does it turn into in the lungs? How is that blown off? What does this do to the blood pH?

A
  • it forms carbonic acid
  • it turns into H2O and CO2
  • it is blown off by breathing
  • blood becomes less acidic and increases pH
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10
Q

How quickly does the renal buffer system work?

A

24 hours initially then possible days for effective action

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11
Q

What do the kidney reabsorb/conserve in the renal buffer system? What do they eliminate? What does this do to blood pH?

A
  • they conserve bicarbonate
  • they eliminate H+ (excretion of acidic urine)
  • blood less acidic, increase pH
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12
Q

How does acidosis occur?

A
  • buffers overwhelmed and body fluids have too much acid

- acid excretion not able to keep up with acid production or intake

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13
Q

How does alkalosis occur?

A
  • too little acid, buffers unable to keep pH in normal range
  • occurs when there is too much bicarbonate added to the system and acid excretion > production
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14
Q

What are the general risk factors of acid-base imbalances?

A
  • excessive production or intake of metabolic acid
  • altered acid buffering due to a loss or gain of HCO3
  • altered acid excretion
  • abnormal shift of H+ into the cells
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15
Q

Examples of excessive production or intake of metabolic acid

A

DKA, poisoning

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16
Q

Examples of altered acid buffering due to a loss or gain of HCO3

A

Loss: Diarrhea
Gain: overuse of antacid or Na+ bicarbonate therapy

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17
Q

Examples of altered acid excretion

A
  • renal failure
  • ppl with respiratory issues (COPD, atelectasis, PNA)
  • elderly-kidneys do not work as well
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18
Q

What causes an abnormal shift of H+ into cells?

A

Hypokalemia- K+ ions leave cells and H+ enters cell to maintain electrochemical charge

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19
Q

Normal ABG levels

A 
-pH—> 7.35-7.45
PaCO2 —> 35-45
PaHCO3 —> 22-26
PaO2 —> 80-100
SaO2 —> 96-100%
20
Q

What is respiratory acidosis?

A

Too much CO2 being retained in the body

21
Q

What causes respiratory acidosis?

A

Hypoventilation

22
Q

What can cause hypoventilation?

A
  • CNS depressants (narcotics, a esthetics, barbiturates) —> decreased respiratory center-CO2 retained
  • Pulmonary conditions (COPD —> decrease in SA in alveoli for gas exchange—pulmonary edema, PNA —> inhibits effective gas exchange)
  • respiratory muscle weakness (chest injuries, polio, guillian barre syndrome) —> decreased respiration’s and CO2 is retained
23
Q

Respiratory Acidosis values and treatment

A
  • pH —> decreased
  • PaCO2 —> increased
  • compensation HCO3 —> increased

-treat cause of hypoventilation (give NARCAN, high Fowler’s,provide O2)

24
Q

S/S Respiratory acidosis (8)

A
  • rapid, shallow breaths
  • low BP
  • dyspnea
  • HA
  • hyperkalemia
  • dysrhythmias
  • drowsy, dizzy, disoriented
  • muscle weakness, hyper reflexive.
25
Q

What causes respiratory alkalosis?

A

Hyperventilation

26
Q

Respiratory alkalosis values and treatment

A
  • pH high
  • PaCO2 low
  • compensation occurs with low HCO3

-treat cause of hyperventilation

27
Q

S/S respiratory alkalosis (8)

A
  • seizures
  • deep,rapid breathing
  • hyperventilation
  • tachycardia
  • hypokalemia
  • paresthesias
  • lethargy/confusion
  • N/V
28
Q

Metabolic acidosis etiology (too much acid in the body (6) and bicarbonate deficit (1)

A
  • too much acid
  • starvation, severe malnutrition
  • renal failure
  • DKA
  • hyperthyroidism
  • trauma/shock
  • excess exercise, severe infection, fever

Bicarbonate deficit —> diarrhea

29
Q

Metabolic acidosis values

A
  • low pH
  • low HCO3
  • compensation LOW PaCO2
30
Q

Which respiration’s are known as a sign of metabolic acidosis?

A

Kussmaul respirations (fast and deep respiration’s)

31
Q

S/S metabolic acidosis (8)

A
  • HA
  • low BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin
  • N/V/D
  • changes in LOC
  • Kussmaul respiration’s
32
Q

What is the anion gap? What does is diagnose?

A
  • balance between cations and anions

- diagnoses metabolic acidosis

33
Q

What is the anion gap equation? What is the Normal range?

A

Na+K-Cl-HCO3

The normal range is 12 + - 4 mEq/L

34
Q

What does a normal anion gap mean?

A

Loss of bicarbonate (diarrhea, GI fistula, diuretics, early renal insufficiency, TPN w/o bicarbonate)

35
Q

What does a high anion gap mean?

A

Acid accumulation (ketoacidosis, lactic acidosis, ingestion of toxins)

36
Q

What does a low anion gap mean?

A

Hyponatremia

THIS IS EXTREMELY RARE

37
Q

How can metabolic alkalosis happen?

A

Acid deficit —vomiting, GI suction

Bicarbonate excess—peptic ulcers -> pt takes excessive amount of acid neutralizers

38
Q

Lab values for metabolic alkalosis

What patients to monitor

A
  • pH high
  • HCO3 high
  • compensation PaCO2 high

Clients on NG suction, severe vomiting, or on meds that decrease acid secretion (cimetidine, omeprazole)

39
Q

S/s Metabolic alkalosis

A
  • restless; followed by lethargy
  • dysrhythmias
  • hypoventilation
  • confusion
  • N/V/D
  • hypokalemia
  • muscle twitching, cramps
  • paresthesias
40
Q

What do ABGs determine? Which values do they look at?

A
  • which acid-base imbalance is happening

- looks at pH, PaCO2, HCO3

41
Q

What is base excess? What is the normal range?

A

Indicates how well buffers are managing acid

Normal range= -2 or +2 mmoL/L

42
Q

What does uncompensated mean?

A

PH and either PaCO2 or HCO3 are abnormal

43
Q

What does partially compensated mean?

A

All values are abnormal

44
Q

What does fully compensated mean?

A

PaCO2 and HCO3 are abnormal and pH is normal

45
Q

It is respiratory if pH and PaCO2 move in ____directions

A

Opposite

46
Q

It is metabolic if pH and HCO3 move in the ____ direction.

A

Same

Nursing G140 Exam #1 (MS) (5 decks)

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