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ABSN NUR 406 > NUR 406 ACID BASE BALANCE > Flashcards

NUR 406 ACID BASE BALANCE Flashcards

1
Q

What is pH?

A

the “potential” or “power” of Hydrogen

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2
Q

What does [H+] mean?

A

The hydrogen ion concentration

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3
Q

pH is the negative logarithm of?

A

Inverse ratio or proportion

When the [H+] goes up, the pH goes down
When the [H+] goes down, the pH goes up

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4
Q

Acids have more?

A

H+ ions

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5
Q

Bases have less?

A

H+ ions

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6
Q

What is the most acidic area in the body?

A

The stomach

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7
Q

What do strong acids do in solution?

A

Completely dissociate

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8
Q

What do weak acids do in solutions?

A

Partially dissociate

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9
Q

Why is hydrogen important in the body?

A

Helps maintain cell membranes
Helps with enzyme activity
Component of H20 and keeps the body hydrated
Helps in energy production

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10
Q

Hydrogen is a component of?

A

Sugars
Proteins
Starch
Fats

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11
Q

On an acid base scale, 7 is?

A

Neutral

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12
Q

What is anormal pH?

A

7.35 - 7.45

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13
Q

How do we measure the pH?

A

Serum blood

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14
Q

How is the stomach uniquely designed to handle HCl?

A

Duodenum has a defense mechanism to neutralize the acid.

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15
Q

What does the LES prevent?

A

Gastric acid from moving into the esophagus

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16
Q

Why are there many different pH ranges in the GI tract?

A

Aids in digestion

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17
Q

What is the pH of the skeletal muscle?

A

6.9-7.2

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18
Q

What is the pH level of bone?

A

7.4

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19
Q

What is the pH level of the liver

A

7.2

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20
Q

What is the pH level of pleural fluid

A

7.6

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21
Q

When do body systems function best?

A

pH range of 7.35-7.45

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22
Q

What does acid base balance affect?

A

Electrolytes = Na, K, Cl

hormones

oxygen transport and delivery - oxygemoglobin dissociation curve

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23
Q

What pH levels are incompatible with life?

A

<6.8 or >7.8

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24
Q

How many types of acids are in the body and what are their names?

A

2 - volatile and non-volatile

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25
Q

What is a volatile acid?

A

Can be converted to gas
Excreted/eliminated by the lungs

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26
Q

What is the name of one violatile acid in the body?

A

Carbonic acid

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27
Q

What is the equation for carbonic acid?

A

H2CO3 <—>H2O + CO2

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28
Q

What are non-volatile acids?

A

Lactic acid
Phosphoric acid
Sulfur acid
Acetoacetic acid
Beta-hydroxybutyric

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29
Q

How are non-volatile acids eliminated?

A

Excreted by the kidneys.
Exception - lactic acid which is metabolized by the body primarily the liver and kidney

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30
Q

How does the body produce more acid than bases?

A

Ingest in food/drink
Metabolism of lipids and proteins
Cellular metabolism waste product - CO2 a volatile acid

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31
Q

Which imbalance is harder to correct and why?

A

Alkalosis - The hemoglobin hold on to oxygen more

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32
Q

How do we maintain acid-base homeostasis?

A

Buffers
Respiratory system
Renal system

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33
Q

What are buffers?

A

Chemicals in the body that combine with acid or base to change the pH
Accepts or release a H+
Almost instantaneous
Short-lived

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34
Q

What are the 3 main buffer systems

A

Bicarbonate - carbonic acid buffer
Phosphate buffer
Protein buffers - hemoglobin

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35
Q

What is Bicarbonate - Carbonic acid ?

A

main ECF buffer

CO2 byproduct of cellular metabolism
Combines with H2O in serum to form carbonic acid

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36
Q

What is carbonic anhydrase?

A

Enzyme that breaks down carbonic acid
In many tissues of the body, including lungs and kidneys

In lungs: H2O + CO2
In kidneys: H+ + HCO3-

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37
Q

What is a phosphate buffer?

A

Main intracellular buffer
H+ + HPO4 (-2) = H2PO4
Hydrogen + hydrogen phosphate = dihydrogen phosphate ion

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38
Q

What are protein buffers?

A

Nearly all proteins can function as buffer.

Carboxyl group (COOH) is a weak acid that gives up a H+
*Amino acid
*Acetic acid

Amino group (NH2-) accepts H+
*Amino acids have both a carboxyl group and an amino group
*Ammonia NH3

Hemoglobin is considered in this group
*Picks up CO2 at the cellular level

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39
Q

Increase in [H+] causes?

A

pH decrease - more acids
H+ move into the cell
More positvely charged ions in the cell
K+ moves out of the cell
Electrical neutrality is restored inside the cell

40
Q

What is a temporary correction of the pH?

A

Process will reverse as the pH returns to normal
If the kidneys are working, they will excrete the excess K+
Body can have a depletion of K+

41
Q

What is the respiratory mechanisms?

A

Body produces CO2
CO2 and H2O create carbonic acid
Exhalation excretes carbonic acid
It does not affect fixed acid (non-volatile acids) such as lactic acid
Body pH can be adjusted by changind the rate and depth of breathing

42
Q

What happens with kidney excretion

A

Can eliminate large amounts of acid except carbonic acid
Can also excrete base
Can conserve and produce bicarb ions
Most effective regulator of pH
If kidneys, fail, pH balance fails
Depends on normal functioning of renal system

43
Q

What are rates of correction?

A

Buffers function almost instantaneously

Respiratory mechanism takes several minutes to hours

Renal mechanisms take several hours to days

44
Q

What is considered acidosis?

A

<7.35

45
Q

What is considered alkalosis?

A

> 7.45

46
Q

The body’s response to acid-base imbalance is called?

A

Compensation

47
Q

May be _____ if brought back within normal limits

A

Complete

48
Q

_______ if range is still outside norms

A

Partial compensation

49
Q

If the underlying problem is _____, hyperventilation or hypoventilation can help __________

A

Metabolic, respiratory compensation

50
Q

If problem is ______, renal mechanisms can bring about ________

A

Respiratory, metabolic compensation

51
Q

Remember the _____ buffer system responds in seconds

A

blood

52
Q

Respiratory buffer responds in?

A

minutes to hours

53
Q

______ are the primary controller of H2CO3 supply

A

Lungs

54
Q

In the lungs, excess CO2 combines with H20 to form ______

A

Carbonic acid

55
Q

______ is carried in the blood to the lungs

A

CO2

56
Q

Carbonic acid triggers the lungs to do what?

A

increase or decrease the rate and depth of ventilation to adjust the pH

57
Q

_____ is when CO2 is blown off and pH increases

A

hyperventilation

58
Q

_____ is when CO2 is retained and pH decreases

A

Hypoventilation

59
Q

Renal buffer responds in ______

A

Hours to days

60
Q

Kidneys are the primary controller of _____ supply

A

HCO3

61
Q

Kidneys control pH by adjusting the amount of HCO3 that is?

A

Reabsorbed into the bloodstream
Excreted into the urine

62
Q

If blood is too acidic, kidneys will?

A

Reabsorb bicarb

63
Q

If blood is too alkaline, kidneys will?

A

excrete bicarb

64
Q

The ___, ____, and ____ all work together to maintain normal acid-base balance.

A

Blood, lungs, and kidneys

65
Q

What does an arterial blood gas consist of?

A

pH, PaCO2, HCO3

66
Q

What is PaCO2 and what is the normal level?

A

Respiratory parameter
35-45

67
Q

What is HCO3 and what is the normal level

A

Metabolic parameter. Calculated on the ABG.
On a chemistry panel, HCO3 is reported as CO2

22-26

68
Q

What does a venous blood gas consist of and what are the levels?

A

pH 7.31-7.41
PvCO2 41-51
HCO3

69
Q

On a BMP, how is the HCO3 level interpreted?

A

Serum CO2

70
Q

What is a primary event and what are examples?

A

The problem that initiates the acid-base imbalance.

Hypoventilation, hyperventilation, vomiting, diarrhea

71
Q

What is a primary disorder and what are examples?

A

What results from the primary event.

Respiratory acidosis, metabolic alkalosis

72
Q

If the lungs are the problem with imbalance, which organ will compensate?

A

Kidneys

73
Q

If the kidneys are the problem with imbalance, which organ will compensate?

A

the lungs

74
Q

What is the cause of metabolic imbalance?

A

HCO3 level changes secondary to metabolic alterations. The problem is metabolic in nature.

75
Q

What is the cause of respiratory imbalance?

A

H2CO3 level changes secondary to respiratory alterations. The problem is respiratory in nature.

76
Q

What is Metabolic acidosis?

A

Decreased HCO3, pCO2, pH

77
Q

What is respiratory alkalosis?

A

Decreased pCO2 and HCO3, Increased pH

78
Q

Respiratory acidosis?

A

Increased pCO2 and HCO3, decreased pH

79
Q

Metabolic alkalosis?

A

Increased HCO3 and pH, normal PaCO2

80
Q

What is metabolic alkalosis?

A

Too much bicarb or not enough carbonic acid

pH >7.48
PaCO2 35-45
HCO3 >26

81
Q

What are causes of Metabolic Alkalosis?

A

Taking excess baking soda, alka seltzer.
Too much base results in hypokalemia causing hydrogen to shift out of the intracellular space and potassium goes into the cell

Prolonged vomiting, NG tube, Diuretics

82
Q

Clinical manifestations of metabolic alkalosis?

A

CNS over excitability
Confusion
Tremors
Muscle cramps
Paresthesias
Coma
N/V/D
Resp depression

83
Q

What is respiratory alkalosis?

A

H2CO3 deficit in ECF

pH >7.45
PaCO2 <35
HCO3 22-26

84
Q

What causes respiratory alkalosis

A

Hyperventilation
Fever, sepsis
medications
acute anxiety
hypoxia
PE or lung disease
CNS lesions
Ventilator settings

85
Q

Clinication manifestations of respiratory alkalosis

A

CNS over excitability
tachypnea
lightheadedness
confusion
blurry vision
paresthesia
hyperactive reflexes
seizures
coma

86
Q

What is respiratory acidosis?

A

H2CO3 excess in ECF
pH <7.35
PaCO2 >45
HCO3 22-26

87
Q

What causes respiratory acidosis?

A

Hypoventilation

88
Q

HCO3 is within normal limits with ____ respiratory acidosis

A

acute - no time for kidneys to compensate

89
Q

Clinical signs and symptoms of respiratory acidosis

A

CNS DEPRESSION which causes HYPOVENTILATION

90
Q

Common causes of respiratory acidosis

A

Cardiopulmonary arrest
head injury
narcotic/sedatives
anesthesia
pulmonary disorders - acute asthma COPD exacerbation, PNE, resp failure
pain
abdominal distention
airway obstruction
chest wall deformities
neuromuscular problems

91
Q

What is metabolic acidosis

A

HCO3 deficit in ECF

pH <7.35
PaCO2 35-45
HCO3 <22

92
Q

If the lungs are compensating for metabolic acidosis, the CO2 will be

A

decreased

93
Q

Clinical S/S

A

Lethargy, drowsy
confusion
tremors, muscle cramps
Parasthesias
Hypotension
Hyperkalemia
Deep breathing - kussmaul DKA
Fruity odor breath

94
Q

Common causes of metabolic acidosis

A

Renal failure
fistulas
DM type 1
lactic acidosis
Prolonged diarrhea
Starvation
Medication overdose - aspirin
Shock and cardiac arrest

95
Q

Respiratory Acidosis/Alkalosis Compensation are

A

The results of the respiratory alterations and the KIDNEY compensates by either
*Conserving (reabsorbing) HCO3 ions - acidosis correction
*Excreting HCO3 - alkalosis correction

96
Q

Metabolic acidosis/alkalosis compensation are

A

The results of metabolic alterations and the LUNGS compensate by:
*Conserving CO2 ions - hypoventilation (alkalosis correction)
*excreting CO2 ions - hyperventilation (acidosis correction)

ABSN NUR 406 (2 decks)

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