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S4 2539 > M1 Acid Base > Flashcards

M1 Acid Base Flashcards

1
Q

Three mechanisms of regulating acid base balance

A

Buffering system
Respiratory compensation
Metabolic/renal compensation

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2
Q

Resp reguation of acid base 101

A

Lungs regulate CO2 that combines with H2O which forms H2CO3 - carbonic acid

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3
Q

H2 CO3

A

Carbonic acid

regulated by resp A/B system

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4
Q

What part of brain regulates Resp A/B balance

A

Medulla chemo receptors

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5
Q

Breathing faster/deeper - hyperventilation =

Breathing slower/shallower - hypoventilation =

A

CO2 elimination, increases pH

CO2 accumulation, decrease pH

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6
Q

Renal regulation of A/B balance

A

KIDNEYS key player

reabsorb or excrete acids or bases

can produce HCO3 bicarbonate

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7
Q

Carbonic acid

Bicarbonate

A

H2CO3 - acidic

HCO3 - basic

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8
Q

1 part carbonic acid =

A

20 parts bicarbonate

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9
Q

Kidney pH adjustments take ___ …

A

TIME

days to weeks

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10
Q

Normal Acid Base values
pH
PaCO2
HCO3
Pao2
Sao2

A

pH 7.35-7.45
PaCO2 45-35
HCO3 22-28

Pao2 80-100
Sao2 greater than %95

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11
Q

SpO2 -

Sao2 -

Pao2 -

A

SpO2 = oxygen saturation as measured by pulse oximeter

Sao2 = oxygen saturation as measured by blood analysis (e.g. a blood gas)

Pao2 = partial pressure of oxygen in the blood

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12
Q

ABG interpretation steps

A

classify pH
assess PaCO2
assess HCO3

determine compensation
total, partial, uncompensated

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13
Q

Respiratory acidosis

A

Decrease in rate of alveolar ventilation

pH less than 7.35
PaCO2 greater than 45mmHg

compensation = increase in HCO3

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14
Q

Respiratory acidosis causes

A

respiratory center depression
drug sedation/anesthesia
resp arrest
impaired ventilation/airway obstruction

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15
Q

Acidosis S/S CNS

A

Decrease in excitability
Drowsiness
Disorientation
Coma

restlessness
headache

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16
Q

Acidosis S/S cardiovascuar

A

Dysrhythmia
Decreased contractility
Hypotension

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17
Q

Resp alkalosis causes

A

Hypoxemia
Anemia
Fever
Dyspnea
Anger

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18
Q

S/S of alkalosis CNS/lytes/cardio

A

Increased excitability

numbness
tingling
confusion
blurred vision

Hypokalemia
Hypocalcemia

hypertension

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19
Q

Respiratory alkalosis renal compensation

A

HCO3 reabsorption drops

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20
Q

Metabolic acidosis 101

lab values

A

primary decrease in plasma bicarbonate

pH less than 7.35

HCO3 less than 22

Compensation = decrease in PaCO2

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21
Q

Metabolic acidosis causes

A

Loss of HCO3 - diarrhea

Decreased acid elimination - renal failure

Excess acid production -
Starvation
Diabetic/alcoholic ketoacidosis
Cardiac arrest
Sepsis
Shock

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22
Q

Metabolic alkalosis 101

lab values

A

Increase in bicarbonate in ECF (extracellular fluid)

pH greater than 7.45

HCO3 greater than 28

Compensatory increase in PaCO2

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23
Q

Metabolic alkalosis causes

A

Excess of base/loss of acid
Vomiting
GI suction

Alkali intake increase
med or diet

Furosemide diuretic

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24
Q

Methazolamide/acetazolamide and A/B balance

A

Carbonic anhydrase inhibitor

causes increase in metabolic acidity

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25
Q

Calcium carbonate antacids and A/B balance

A

Used to treat GERD

will lower pH

may result in metabolic alkalosis

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26
Q

Myasthenia gravis (MG)

A

Chronic autoimmune disorder
Antibodies destroy communication between nerves and muscle

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27
Q

Potassium and Acid Base Balance

A

Acidosis causes decreased K(+) secretion and increased reabsorption. SO, MORE K+
Alkalosis has the opposite effects, often leading to hypokalemia. SO, LESS K+

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28
Q

Increased anion gap indicates

Decreased anion gap indicates

A

Metabolic acidosis

Metabolic alkalosis

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29
Q

Normal anion gap range

A

8-12

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30
Q

Only thing the lungs control

A

CO2

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31
Q

Simple nursing intervention for hyperventilation

A

paperbag

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32
Q

CO2 is high

CO2 is low

A

Breathing slow and low, retaining

Breathing fast, blowing off

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33
Q

What is the anion gap

What does it represent

Values

A

Difference between all positively charged and negatively charged electrolytes

represents unmeasured phosphate sulfate and proteins that act as Acid Base buffers

8 to 12mEq/L

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34
Q

Reverse metabolic acidosis by giving

A

Sodium bicarbonate

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35
Q

When giving sodium bicarb to correct metabolic acidosis pt will become at risk of

why

A

cardiac arrest

potassium will shift back into cells resulting in hypokalemia

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36
Q

Diuretics like thiazide and furosemide can cause

This is due to

A

Metabolic alkalosis

Urination of lytes (potassium) and acids

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37
Q

Hypocalcemia symptoms

A

tingling in fingers/toes
dizziness
tetany

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38
Q

Why does metabolic alkalosis cause hypocalcemia

A

loss of H+ creates excess (-) ions, Ca++ binds to those and gets used up, creating hypocalcemia

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39
Q

Hypokalemia symptoms

A

heart palpitations
muscle weakness

prominent U waves

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40
Q

Why does metabolic alkalosis cause hypokalemia

A

Body holds on to H+ to correct issue.
Excess H+ replaces K+ and K+ gets excreted

This results in hypokalemia

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41
Q

Best way to narrow down cause of metabolic alkalosis

A

Urine chloride level

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42
Q

Carbonic anhydrase inhibitor med

MOA

A

Acetazolamide

enhance bicarbonate exertion

used for metabolic alkalosis

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43
Q

atelectasis

A

lung collapse

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44
Q

COPD causes

A

resp acidosis

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45
Q

When CO2 combines with water it becomes

A

Acidic

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46
Q

Acidic pt behavior =

alkalotic pt behavior =

A

lethargic

excitable

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47
Q

PT with Pulmonary embolism will first have resp alkalosis then acidosis why

A

first they hyperventilate due to panic, then the clot blocks off CO2 exchange sites

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48
Q

Only way to rid of CO2

A

exhalation

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49
Q

Can lungs fix them selves

A

NO, need kidneys to adjust

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50
Q

Kidneys control both

A

Hydrogen and bicarb

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51
Q

High anion gap =

A

accumulation of fixed acid

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52
Q

basic cause for metabolic acidosis

A

kidney failure

53
Q

Atropine?

A

?

54
Q

Do you even leave an unstable client?

A

NO, call rapid response.

55
Q

do you ever push or mix potassium

A

NO

56
Q

Common causes of metabolic acidosis

A

DKA
Renal Failure
Diarrhea

57
Q

Resp acidosis S/S

A

confusion, disorientation, drop in LOC

58
Q

Potassium and Resp Acidosis

A

Increase in K+

59
Q

Treatment for resp acidosis

A

Oxygen vent or supplemental

bronchodilators, nebulizers

hydration

60
Q

Respiratory acidosis and headaches

resp alkalosis and loc

A

Increase in CO2 dilates brain blood vessels

in resp alkalosis CO2 will drop which is why pt passes out

61
Q

Resp alkalosis S/S

A

numbness
tingling
tinnitis
due to low calcium

loss of consciousness

62
Q

Salicylate intoxication

causes which AB problem

A

Aspirin poisoning

Resp alkalosis

63
Q

PaO2

normal range

A

Partial pressure or oxygen in arterial blood
How much PRESSURE oxygen exerts in blood

80-100mmHg

64
Q

SaO2

A

Arterial oxygen SATURATION measured by pulse oximetry
95-100%

65
Q

Allen test

A

Do PRIOR or taking blood gas

check radial and ulnar arterial flow before draw

66
Q

In partial compensation, both CO2 and HCO3 levels are

A

Abnormal

67
Q

In full compensation pH is

A

Normal

68
Q

Biggest characteristics of ARDS

A

Ventilation problems
Refractory Hypoxemia

69
Q

Surfactant

A

Liquid produced by alveoli to maintain function

No surfactant, no function

70
Q

Most worrisome alarm on a ventilator

A

Low pressure

Drop in oxygenation

71
Q

Basic assessment for ventilation

A

Auscultate all lobes for noise

72
Q

If you cant fix the vent

A

Face mask pt and provide O2
Call for help

73
Q

ARDS CXR will appear

A

White

74
Q

ARDS ABGs will show a decrease in

A

O2 sat

75
Q

Initial ABGs for ARDS will reveal resp
then

A

Alkalosis
Acidosis

76
Q

FiO2

A

Fraction of inspired O2
Concentration of oxygen in gas mixture

room air is 21%

77
Q

Best position for ARDS

A

Prone or up right

78
Q

PEEP = _ = _

A

Vent = DECREASE IN CARDIAC OUTPUT

79
Q

Due to ventilation and peep
Cardiac output will drop

this results in

A

Drop in BP
Drop in perfusion
Drop in urine output
Drop in LOC

80
Q

Normal Cardiac output in L

A

4-6L/m

81
Q

95% of all PE come from

A

Deep veins of legs

82
Q

Different types of Thrombus

A

Blood clot
Lipid
Tumor
Amniotic sac (from baby)

83
Q

Lipid thrombus is concern for first _h after long bone break

A

36

84
Q

Other MAJOR site contributing to Thrombus development

A

Heart
A FIB specifically

85
Q

If DVT suspected never do _ test

A

Homans

86
Q

PLURAL FRICTION RUB =

A

Pulmonary Embolism

87
Q

Cholesterol meds kill what organ

A

Liver

88
Q

HIV tests

A

Elissa
Westernblot

89
Q

PE can lead to right side heart failure T/F

A

True

90
Q

D-dimers indicates only that

not

A

there is a clot

not a particular location

91
Q

Best treatment for Hypoglycemia

A

DEXTROCE 50%

92
Q

Anemia due to drop in kidney function

v in kidney function = _ = _

A

v in bone marrow = v in erythropoietin

93
Q

Erythropoietin

A

Glycoprotein hormone
Produced by peritubular cells of kidney
Stimulates RBC production

94
Q

v in RBC production can happen due to (GI)

A

Lack of iron
Lack of nutrition
Lack of erythropoietin

95
Q

Livers major functions
4 of em

A

Detoxify body
Clotting
Metabolizes drugs
Synthesizes albumin

96
Q

Aplastic anemia is also known as

A

Bone marrow aplasia

97
Q

Aplastic anemia 101

A

body stops producing enough blood cells due to BONE MARROW damage

98
Q

Aplastic anemia can happen due to

A

Birth defect

Poisoning - radiation, infection, medication

99
Q

Diagnosing Aplastic anemia

A

Bone marrow biopsy
CBC
WBC
HnH

100
Q

Treatment for aplastic anemia

A

Antithymocyte globulin ATG
Cyclosporins - immunosuppressant

101
Q

Hemolytic anemia 101

A

RBC deformity

102
Q

Intrinsic vs acquired hemolytic anemia

A

Something inside

Due to meds, treatment, developed condition

103
Q

GI organ most impacted by CF

A

Pancreas

will become blocked and literally digest self

104
Q

CF genome is autosomal

A

recessive

105
Q

For tissue repair you need _ and _

A

Protein and Vit C

106
Q

B1 =
B2 =

A

targets heart
targets lungs

1 heart 2 lungs

107
Q

AKI = v in GFR =

HF = fluid overload =

A

Hyperkalemia

Hypokalemia

108
Q

When not to give isotonic fluids
3 situations

A

HF
Renal failure
^BP

109
Q

GFR numbers

A

90-100 idea
hospital wants greater than 60

110
Q

Best Lab indicator of Renal Failure

A

Creatinine

111
Q

Treating prerenal failure

A

Increase volume
give meds

112
Q

Heart EF numbers

A

Want it to be greater than 50

less than 40 is HF

113
Q

Mycin

vancomycin tobramycin S/S or toxicity

A

Ototoxicity
Nephrotoxicity

114
Q

Peaks and trophs with mycin drugs

A

Check troph before giving
check peak 1h after

115
Q

rhabdomyolysis 101

S/S

A

Kidney toxicity related to myoglobulin release from muscle injury

Dark urine (tea colored)

116
Q

Glomerulonephritis big cause

moa

treat with

A

4 weeks after strep

PROTEINURIA

steroids

117
Q

can bun and creatinine drop

A

NO
only normal or elevated

118
Q

Big S/S of fat embolism

A

Petechia

119
Q

NY Heart function classification

A

1-4
ok - worst

120
Q

2-3lb increase in a week

A

HF

121
Q

HF prevention BIGGEST MONITORING intervention

A

MONITOR WEIGHT DAILY

122
Q

Right HF basic S/S

A

JVD
Liver pain
Clear breath sounds

123
Q

Beta blockers block what system

what chemicals

A

Sympathetic

Epi Norepi

124
Q

RAAS system most potent constrictor

converted at

A

ANGIOTENSIN II

Lungs

125
Q

Nitro Directions

A

q5m for 3 doses
CALL EMS

126
Q

B Blocker contraindications

A

COPD
Asthma
DIABETES - will mask symptoms

127
Q

PT arrives at hospital
first 4 interventions
AONM

A

Aspirin
O2
Nitro
Morphine

128
Q

Normal hematocrit

M
F

A

42-52
37-47

S4 2539 (11 decks)

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