Acid Based Balance, Electrolytes Flashcards
acid base balance
refers to the mechanisms the body uses to keep its fluids close to neutral pH so the body can function normally
- regulation of HYDROGEN ions
cations
Positively charged electrolytes
- in bodys fluid supply: sodium, potassium, magnesium
anions
negatively charged electrolytes
- in bodys fluid supply: chloride, phosphate, sulfate, bicarbonate
electrolytes
chemical substances that separate into electrically charged particles called ions when dissolved in fluids
- the ions are capable of conducting electric currents vital for the function of nerves & muscles
What is the major electrolyte in extracellular fluid?
Sodium
is the major electrolyte in extracellular fluid, with potassium being present at much lower concentrations.
What is the major electrolyte in intracellular fluid?
Potassium
is the major electrolyte in intracellular fluid, with sodium found in lesser concentrations.
HYPONATREMIA & causes + diseases
- Low serum Sodium
- Usually caused by excessive sweating, diarrhea, vomiting, NG suction
- CHF, Renal disease, liver disease/cirrohsis
s/s of hyponatremia
- dizziness
- confusion
- weakness
- low blood pressure
- shock.
HYPERNATREMIA & causes + diseases
- Happens when sodium blood levels become too high:
because of excessive water loss (through GI system, lungs or skin), fluid restriction, or sodium ingestion - cushings syndrome, diabetes insipidus
s/s of hypernatremia
- extreme thirst
- dry swollen tongue
- restlessness
- agitation
POTASSIUM
- Creates much of the osmotic pressure in intracellular fluid and is the most abundant cation in it.
- essential for neuron and muscle cells
- an imbalance can cause hypokalemia or hyperkalemia
HYPOKALEMIA & cause
- Results when blood levels of potassium become too low
- is usually a consequence of vomiting, diarrhea or kidney disease.
s/s of HYPOKALEMIA
- fatigue
- confusion
- possible cardiac arrest.
HYPERKALEMIA & cause
- comes as a result of blood levels of potassium becoming too high
- cause: usually a consequence of Addison’s disease
s/s of HYPERKALEMIA
- weakness
- abnormal sensations
- cardiac arrhythmias
- possible cardiac arrest
- hypotension
CALCIUM
- Found most abundantly (98%) in bones and teeth with the remaining in tissues and fluids.
- It maintains normal excitability of neurons & muscle cells & is essential for blood clotting.
- An imbalance causes hypocalcemia or hypercalcemia.
HYPOCALCEMIA + causes
- Occurs when the blood levels of calcium become too low usually because of a decreased function of the parathyroid gland or a decreased calcium intake
S/S of HYPOCALCEMIA
muscle spasms leading to tetany (a continuous spasm)
HYPERCALCEMIA cause
Occurs when the parathyroid over functions.
S/S of hypercalcemia
- muscle weakness
- bone fragility
- possible kidney stones
PHOSPHATE
- most abundant (85%) in bones and teeth.
- functions primarily as an intracellular anion and is part of the nucleic acids-DNA, RNA, and ATP
- as well as phospholipids and the phosphate buffer system
BICARBONATE
- part of the buffer system
- helps regulate pH
what is used to measure pH (capacity of hydrogen)
arterial blood
- Carbon dioxide and bicarbonate blood levels
The normal range of arterial blood pH is
7.35 - 7.45
3 regulatory systems that helps the body maintain the acid-base balance
- chemical buffers: neutralize the offending acid or base imbalance
- respiratory system: regulates the retention or exhalation of acids
- kidneys: excrete or retain acids as needed
Hypermagnesemia causes
- excessive use of magnesium-containing antacids and laxatives
- untreated diabetic ketoacidosis
- excessive magnesium infusions
Hypomagnesemia causes
- malabsorption related to GI disease
- excessive loss of GI fluids
- acute alcoholism/cirrhosis
- diuretic therapy
- hyper-or-hypothyroidism
- pancreatitis
- preeclampsia
- NG suctioning
- fistula drainage
Fluid and electrolyte loss
vomit, sweat, dilated gut, diarrhoea, urine
Fluid and electrolyte replacement
mouth, IV drip, intreperitoneal drip
Role of lungs in acid-base balance
- release CO2 from lungs
- CO2 is a waste product of metabolism of O2
- CO2 gets excreted into blood, & the blood carries it to the lungs
- as CO2 accumulates in blood, pH decreases (acidity increases)
role of the kidneys in acid-base balance
- excrete excess acids or bases
- kidneys have some ability to alter the amount of acid or base that is excreted (slower than lungs), takes several days
hypovolemia & causes
- a decreased volume of circulating blood in the body
- caused by:
Loss of blood (external or internal bleeding)
Loss of plasma (severe burns and lesions discharging fluid)
Loss of body sodium and consequent intravascular water; e.g. diarrhea or vomiting
true or false: Excessive sweating is a cause of hypovolemia
false.
because the body eliminates significantly more water than sodium
Signs and Symptoms of Hypovolemia
- sweating, moist skin
- anxiety or agitation
- cool, clammy skin
- confusion
- decreased or no urine output
- general weakness
- pale skin colour (pallor)
- rapid breathing
Nursing interventions for Hypovolemia
- measure daily weights
- assess LOC
- measure intake and output
Signs & symptoms of hypervolemia?
- Edema
- headache
- stomach bloating
- high blood pressure caused by excess fluid in the bloodstream
- shortness of breath caused by extra fluid entering the lungs and reduce ability to breathe normally
- heart problems, because excess fluid can speed up or slow your heart rate
Hypervolemia causes
caused by:
excessive water intake
excessive intake of sodium from foods
IV solutions and blood transfusions
medications
Nursing interventions for hypervolemia
- diuretics
- limit intake of water, fluids
- limit intake of sodium and salt
Acidosis
blood has too much acid (or too little base) resulting in a decrease in blood pH
Alkalosis
blood has too much base (or too little acid) resulting in an increase in blood pH
metabolic acidosis
when there is an accumulation of H+ (acids) or a loss of bicarbonate (base) in extracellular fluid- blood
causes of metabolic acidosis
- overproduction of ketones in body
- can occur with diabetes, cardiac failure, starvation, severe infection with fever
- can also occur from a decreased ability of the kidneys to excrete acids (impaired kidney function)
- abnormal loss of alkali (diarrhea)
- K+ sparing diuretic
S/S of metabolic acidosis
- resp: hyperventilation (compensate for excess acid)
- CNS: drowsiness, disorientation, coma and death
- cardiac: tachycardia, arrhythmias, decreased output and decreased BP, warm flushed skin
- gastro: nausea, vomiting, diarrhea
treatment of metabolic acidosis
- if severe: sodium bicarbonate IV to neutralize acidity
- maintain IV
- dialysis
- ventilation
- assess LOC
- if from diabetes=insulin
- remove toxin from body
Metabolic alkalosis
loss of acid and a gain of bicarbonate or both
Causes of metabolic alkalosis
- loss of acid from vomiting or drainage of the stomach (NG suctioning)
- overactive adrenal gland (cushings syndrome)
- use of diuretics
- kidney disease
diagnosis of metabolic acidosis
measurement of blood pH in sample of arterial blood (radial artery)
S/S of metabolic alkalosis
- neuro: dizziness, irritability, confusion
- cardio: tachycardia, dysrhythmias (hypokalemia from compensation)
- neuromuscular: tremor, muscle cramps, tingling in figners & toes, muscle cramps
- gastro: anorexia, nausea, vomiting
treatment of metabolic alkalosis
- monitor vitals
- O2 if hypoxic
- assess LOC
- watch for muscle weakness/tetany/decreased activity
respiratory acidosis
- when the body is unable to rid itself of enough CO2 to maintain a healthy pH balance (excess CO2)
- occurs when you hypoventilate (unable to blow off CO2)
- in acute: pH decreases (kidneys try to compensate by retaining bicarbonate or making, but not fast enough)
Causes of respiratory acidosis
- hypoventilation: depression of resp centre (drug overdose, brain injury)
- problems with neuromuscular functioning, lung disease or airway obstruction
- mechanical hypoventilation
S/S of Respiratory Acidosis
- neuro: headache, disorientation, confusion, coma, death
- cardiac: tachycardia, decreased BP, warm flushed skin
seizures
treatment of respiratory acidosis
- focus on improving ventilation
- monitor vitals (tachy)
- monitor neuro status
- maintain patent airway
- O2 therapy
- adequate humidification to moisten secretions
- chest auscultation
- deep breathing
- careful with sedatives
respiratory alkalosis
develops when rapid, deep breathing (HYPERVENTILATION) causes too much CO2 to be expelled from bloodstream
causes of resp alkalosis
- anxiety is #1
- aspirin overdose (early stages)
- fever
- low O2 in blood
- pain
S/S of respiratory alkalosis
- neuro: lethargy, light-headed, confusion
- cardio: tachy, dysrhythmias
- gastro: nausea, vomiting, epigastric pain
- neuro-muscular: numbness, tingling of extremities, seizures
treatment of resp alkalosis
- O2 if hypoxic
- anti-anxiety meds
- controlled breathing exercises
- hyperventilation can be treated by breathing into a paper bag which forces patient to rebreathe exhaled CO2
