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NU 340 > Ch. 14 > Flashcards

Ch. 14 Flashcards

1
Q

acid-base imbalances

A
  • metabolic acidosis
  • respiratory acidosis
  • combined metabolic and respiratory acidosis
  • metabolic alkalosis
  • respiratory alkalosis
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2
Q

metabolic acidosis

A
  • Overproduction of hydrogen ions
  • Under-elimination of hydrogen ions
  • Underproduction of bicarbonate ions
  • Over-elimination of bicarbonate ions

*too much H+, not enough HCO3

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3
Q

causes of metabolic acidosis

A
  • DKA
  • Shock
  • Severe Diarrhea
  • Impaired kidney function
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4
Q

clinical manifestations of metabolic acidosis

A
  • neuro
  • respiratory
  • GI (vomiting, diarrhea)
  • cardiac (EKG changes)
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5
Q

respiratory acidosis results from

A

retention of CO
*too much CO2

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6
Q

causes of respiratory acidosis

A

respiratory disorder
- resp. depression
- inadequate chest expansion
- airway obstruction (COPD)
- reduced alveolar-capillary diffusion
CNS depression
- sedation
- head injury

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7
Q

acidosis: patient-centered collaborative care

A
  • history
  • CNS changes
  • neuromuscular changes
  • cardiovascular changes
  • respiratory changes
  • skin changes
  • psychosocial assessment
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8
Q

neuromuscular changes with acidosis

A
  • decreased muscle tone
  • decreased DTR
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9
Q

cardiovascular changes with acidosis

A

early:
- increased heart rate
- cardiac output changes
worsening:
- hyperkalemia
- decreased heart rate
- T wave peaked
- QRS widened
- weak peripheral pulses
- hypotension

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10
Q

respiratory changes with acidosis

A

Kussmaul respiration (deep and rapid breathing)

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11
Q

skin changes with acidosis

A

(respiratory or metabolic acidosis)
- warm
- dry
- pink (vasodilation)

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12
Q

interventions for respiratory acidosis

A
  • focus on improving ventilation and O2, maintaining patent airway
  • drug therapy
  • O2 therapy
  • pulmonary hygiene
  • ventilation support
  • prevention of complications
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13
Q

drug therapy for respiratory acidosis

A
  • bronchodilators
  • anti-inflammatories
  • mucolytics
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14
Q

interventions for metabolic acidosis

A
  • hydration
  • drugs
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15
Q

drug therapy for metabolic acidosis

A
  • insulin to treat DKA
  • antidiarrheal drugs
  • bicarbonate only if serum bicarbonate levels are low
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16
Q

combined metabolic and respiratory acidosis is ___ than either form alone

A
  • more severe than either form alone
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17
Q

uncorrected respiratory acidosis leads to

A

poor oxygenation and lactic acidosis

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18
Q

example of a problem leading to combined metabolic and respiratory acidosis

A

cardiac arrest

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19
Q

metabolic alkalosis

A

excessive base, and acid deficit

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20
Q

causes of excessive base

A
  • excessive intake antacids (sodium bicarbonate or calcium bicarbonate)
  • citrates (blood transfusions)
  • IV sodium bicarbonate
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21
Q

causes of acid deficit

A
  • prolonged vomiting
  • excess cortisol
  • hyperaldosteronism
  • thiazide diuretics
  • prolonged NG suction
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22
Q

hallmark of base excess alkalosis

A

ABG result with increased pH and increased bicarbonate level with normal O2 and CO2 levels

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23
Q

respiratory alkalosis is usually caused by

A

excessive loss of CO2 via hyperventilation

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24
Q

causes of hyperventilation

A
  • anxiety (anxiety attack- hyperventilating)
  • fear
  • improper vent settings
  • stimulation of central respiratory center due to fever
  • salicylates
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25
Q

alkalosis: patient-centered collaborative care

A
  • assessment (same for metabolic and respiratory alkalosis)
  • hypocalcemia
  • hypokalemia
  • CNS changes
  • neuromuscular changes
  • cardiovascular changes (elevated)
  • respiratory changes (elevated)
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26
Q

CNS changes with alkalosis

A
  • positive Chvostek’s and Trousseau’s signs
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27
Q

neuromuscular changes with alkalosis

A
  • tetany
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28
Q

interventions for alkalosis

A
  • prevent further losses of hydrogen, potassium, calcium, and chloride ions
  • restore fluid balance
  • monitor changes
  • modify or stop gastric suctioning, IV solutions with base, drugs that promote hydrogen ion excretion
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29
Q

the lungs have one chemical:

A

CO2

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30
Q

what organ is sick during respiratory acidosis/alkalosis

A

the lungs

31
Q

sick lungs =

A

respiratory acidosis or alkalosis
- problem due to CO2

32
Q

what are the compensating organs in respiratory acidosis/alkalosis?

A

the kidneys
- secrete bicarbonate and excrete hydrogen, bring pH back to normal

33
Q

kidneys are _____ in compensating for respiratory acidosis/alkalosis

A

slow but effective

34
Q

what organ is sick during metabolic acidosis/alkalosis?

A

the kidneys
- cannot maintain pH

35
Q

what are the problem chemicals with metabolic acidosis/alkalosis?

A
  • bicarbonate
  • hydrogen
36
Q

what are the compensating organs with metabolic acidosis/alkalosis?

A

the lungs
- blow off or retain CO2 quickly to correct metabolic acidosis or alkalosis

37
Q

with metabolic acidosis/alkalosis, what chemical do the lungs work with to compensate?

A
  • CO2
  • the acid
38
Q

arterial blood gas (ABG) normal values: pH

A

7.35-7.45

39
Q

arterial blood gas (ABG) normal values: PCO2

A

35-45 mmHg

40
Q

arterial blood gas (ABG) normal values: HCO3

A

23-30 mEq/L

41
Q

arterial blood gas (ABG) normal values: PaO2

A

80-100 mmHg

42
Q

laboratory assessment values: metabolic acidosis

A

pH: <7.35
bicarbonate: < 23 mEq/L
PaO2: normal
PaCO2: normal or slightly decreased
serum potassium: high

43
Q

laboratory assessment values: respiratory acidosis

A

pH: <7.35
PaO2: low
PaCO2: high
serum bicarbonate: variable
serum potassium: elevated if acidosis is acute

44
Q

laboratory assessment values: metabolic alkalosis

A

pH: >7.45
bicaronate: >30 mEq/L
PaO2: normal
PaCO2: normal or slightly increased (compensation)
serum potassium: may be low

45
Q

laboratory assessment values: respiratory alkalosis

A

pH: >7.45
PaO2: normal
PaCO2: low
serum bicarbonate: normal
serum potassium: may be low

46
Q

analysis of ABG

A
  • look at pH draw arrow if it is high or low
  • look at PCO2 (respiratory) draw arrow low or high
  • look at HCO3 (metabolic) draw arrow low or high
47
Q

low ABG =

A

acidosis

48
Q

high ABG =

A

alkalosis

49
Q

(ABG analysis) if PCO2 arrows are in opposite direction =

A

respiratory acidosis or alkalosis

50
Q

(ABG analysis) if pH arrow and HCO3 arrow are in the same direction =

A

metabolic acidosis or alkalosis

51
Q

(ABG analysis) compensation is present if the arrows ____

A

if arrows of PCO2 and HCO3 are opposite

52
Q

(ABG analysis) partial compensation is present if the arrows ____

A

if arrows of PCO2 and HCO3 are in the same direction

53
Q

decreased pH =

A
  • acidodic
  • increased hydrogen ions
54
Q

increased pH =

A
  • alkalotic
  • decreased hydrogen ions
55
Q

normal blood pH

A

7.35-7.45

56
Q

acids

A

release hydrogen ions when dissolved in water or bodily fluids

57
Q

bases

A

bind with hydrogen ions in solutions and lower the amount of free hydrogen ions in solution

58
Q

buffers

A

can react either as acid or base

59
Q

bicarbonate (HCO3-) ions are a relationship between

A

CO2 and hydrogen ions

60
Q

acid base balance compensation: 3 ways

A
  1. buffers (bicarb, phosphate, protein, ammonium)
  2. respiratory system (adjusts CO2)
  3. renal system (controls bicarb)
61
Q

which compensation method is the quickest response?

A

respiratory system

62
Q

which compensation method is the longest response?

A

renal system (kidneys)
- takes 24-48 hours to respond

63
Q

1st line of defense against changes in free hydrogen ion levels (pH)

A

buffers

64
Q

common buffers

A
  • bicarbonate (main buffer of ECF)
  • phosphate
  • blood proteins (albumin, globulins)
65
Q

main buffer of ECF

A

bicarbonate

66
Q

second line of defense against pH changes

A

respiratory system
- hypoventilation
- hyperventilation

67
Q

physiologic conditions that lead the body’s response to hypoventilation

A
  • decreased rate and depth of respiration (hypoventilation)
  • inhibition of central chemoreceptors
  • decreased PaCO2
  • decreased H+
68
Q

physiologic conditions that lead the body’s response to hyperventilation

A
  • increased PaCO2
  • increased H+
  • stimulation of central chemoreceptors
  • increased rate and depth of respiration (hyperventilation)
69
Q

third line of defense against pH changes

A

renal system (kidneys)

70
Q

strongest for regulating acid-base balance

A

the renal system (kidneys)

71
Q

kidneys respond to pH changes by

A

movement of bicarbonate

72
Q

compensation is when

A

body attempts to correct blood pH changes

73
Q

fatal pH values

A

< 6.9 or > 7.8

74
Q

homeostasis of acid-base regularity depends on

A
  • hydrogen ion production being consistent and not excessive
  • CO2 loss from the body through breathing, keeping pace with all forms of hydrogen ion production

NU 340 (26 decks)

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