PP - ELEC FLUID ACID BASE (112) Flashcards
solvents
liquids that hold a substance in solution (H20)
solutes
substances dissolved in a solution (electrolytes / non electrolytes)
osmosis
water passed from an area of lesser solute concentration to greater concentration until equilibrium is established
diffusion
tendency of solutes to move freely throughout a slovent (downhill??)
active transport
required energy (ATP - adenosine triphosphate) for movement of substances through the cell membrane from lesser solute concentration to higher solute concentration (salmon swimming upstream)
filtration
passage of fluid through a permeable membrane from the area of higher pressure to lower pressure ( like a mister or a balloon in the wind)
colloid osmotic pressure
the osmotic pressure exerted by large molecules, serves to hold water within the vascular space. It is normally created by plasma proteins, namely albumin, that do not diffuse readily across the capillary membrane LOOK UP ON NURSING>COM OR OSMOSIS
hydrostatic pressure
Hydrostatic pressure is the pressure that is exerted by a fluid at equilibrium at a given point within the fluid, due to the force of gravity LOOK UP ON NURSING>COM OR OSMOSIS
The average person’s weight is * one-half to two-thirds water.
60/40/20 rule
When a person is unable to drink enough fluids to compensate for excess water loss,
dehydration can occur
Thirst results from
nerve centers in the brain being stimulated when the body needs water. Osmoreceptors
In order to conserve water, the pituitary gland secretes
vasopressin (the antidiuretic hormone).
The vasopressin stimulates the kidneys to
excrete less urine which helps to conserve water.
Atrial natriuretic factor secreted by herat atria in resonse to atrial stretch
suppresses renin production, which limits aldosterone production -/kidneys will then excrete more sodium.
(Aldosterone stimulates
reabsorption of sodium excretion of potassium by the kidneys.
if aldosterone was released, it would promotes
retention of sodium and
An elevated secretion of aldosterone - lead to
sodium retention and, as a result, promote fluid retention. Ie increase BP
Atrial natriuretic factor (ANF) hormone secreted mainly by the heart atria in response to
atrial stretch. ANF acts on the kidney to increase sodium excretion and GFR, to antagonize renal vasoconstriction, and to inhibit renin secretion.
When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the
kidney and blood vessels, and promotes salt excretion, lowers blood volume and relaxes the vessel.
Is ANP released when blood pressure is high or low?
When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the kidney and blood vessels, and promotes salt excretion which leads to , lowers blood volume and relaxes the vessel.
can all lead to an electrolyte imbalance.
Dehydration; overhydration; certain medications; history of heart, kidney, or liver disorders; and incorrect intravenous fluids or feedings
ØHypovolemia occurs whe
n there is a decrease in blood volume within the body due to loss of body fluids or blood.
can lead to hypovolemia.
ØExcessive sweating, large burns, diuretics, inadequate fluid intake, and increased urination
third spacing
Third-spacing occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space—the nonfunctional area between cells. This can cause potentially serious problems such as edema, reduced cardiac output, and hypotension.
ØExcessive sweating, large burns, diuretics, inadequate fluid intake, and increased urination can lead to
can leadto hypovolemia
ØAt first, hypovolemia causes the
nose, mouth, and other mucous membranes to dry out; the skin to lose elasticity; and urine output to decrease.
ØThe body then tries to compensate for volume loss by
increasing the heart rate and strength of contractions.
ØBlood vessels are constricted
in the extremities to preserve blood flow for the heart, brain, and kidneys.
Dehydration symptoms
thirst / dry mouth / less frequent urination / headache / rapid heartbeat / dry skin
If hypovolemia goes untreated, serious symptoms may develop including:
Blue discoloration of lips and nail beds
Change in alertness or level of consciousness
Chest pain, tightness, or pressure
Palpitations
No urine production
Tachycardia – increased heart rate
Tachypnea – rapid breathing
Decreased blood pressure
Weak pulse
A client may have no signs of
hypovolemia or Hypovolemic shock
hypovolemic shock
which is when the body has lost 20 percent or one-fifth of its blood or fluid supply.
Treatment of hypovolemic shock is aimed at
controlling fluid or blood loss, replacing those components, and restoring overall circulation in the body.
Hypervolemia, AKA or, is a
fluid overload. condition where the body has too much water.
Hypervolemia is commonly caused by problems with
the kidneys as they are responsible for balancing the salt and fluid in the body.
The goal of treatment of Hypervolemia is to
rid the body of excess fluid.
Parameters of Assessment for excess fluid or hypovolemia? CONFIRM WHICH SHE MEANT
Patient history and physical assessment
Fluid intake and output
Daily weights
Laboratory studies
One potential cause of an internal potassium balance shift i
sinsulin deficiency.
acidosis is to much acid in blood which means what about pH and hydrogen ions
higher concentration of hydrogen ions and so a lower pH - to lower pH move ions out of blood and into cells
So in order to help compensate for an acidosis, hydrogen ions enter cells and potassium ions leave the cells and enter the blood,
which might help with the acidosis, but results inhyperkalemia.
Respiratory acidosis isa condition that occurs when the
Potassium levels are not affected because Co2 lungs cannot remove all of the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic.A
Fluid Volume Excess Lab Tests
Complete Blood Count
Hematocrit
Blood Osmolarity - < 280 mOsm/kg
Serum Electrolytes - decreased
BUN - decreased
Urine Specific Gravity - <1.010
indicators of Hypervolemia/ Fluid Vol. Excess - CONFIRM THIS FROM YOUR READING
Blood Osmolarity - < 280 mOsm/kg
Serum Electrolytes - decreased
BUN - decreased
Urine Specific Gravity - <1.010 learn why urine specific gravity is effected and what normal level is
to replace fluids lost in hypovolemia
Intravenous Rehydration - Small particles that can easily pass from the bloodstream into cells and tissues
crystalloid solutions.
ØSmall particles that can easily pass from the bloodstream into cells and tissues are known as
ØEach crystalloid solution is categorized by its
tonicity
tonicity,
or ability to make water move in or out of cells via osmosis.
ØHypotonic solutions move water (cells swell)
from extracellular space into cells.
ØHypertonic solutions cause water to (cells shrivel - raisin up)
leave the cells.
isotonic solutions.
ØThere is no movement between extracellular and intracellular fluids in (water + inside and outside cell)
ØPacked red blood cells (RBCs), AKA
also known as erythrocytes, can be used to restore blood levels without substantially increasing the client’s overall blood volume.
ØWhole blood contains
white cells, red cells, and platelets suspended in blood plasma.
common uses for whole blood
Trauma and surgery causing a significant blood loss are common uses for whole blood.
ØThe liquid portion of blood is known as
plasma which is
plasma
where the platelets and red and white blood cells are suspended as they travel throughout the body.
ØPlatelets, or thrombocytes, sPlatelets are commonly used during organ transplants, cancer treatments, and surgery.
top or prevent bleeding.
Blood Transfusions
packed RBC’s / whole blood / plasma / platelets or thromboctes
ØIntake
simply refers to the amount taken in by a client.
ØOutput is the
amount produced by the body of a client.
ØI & O Should be recorded at least
every 8 hours or per a facility’s protocol.
ØIntake includes
anything the client puts in their mouth, takes in intravenously, or any feeding tubes.
ØOutput includes
urine, bowel movements, and vomiting. Wound drainage, etc
Mrs. White is a 78-year-old woman admitted to the hospital with a diagnosis of severe dehydration. The nurse assigned to Mrs. White is asked to collect data related to fluid status. The nurse expects Mrs. White’s blood pressure to be low because of fluid loss. The nurse also finds Mrs. White’s skin turgor to be poor, and the nurse notes that the urine output is scant and dark amber. The nurse asks Mrs. White is she knows what day it is, because severe dehydration may cause confusion. In addition, the nurse initiates taking daily weights because this the most accurate way to monitor fluid balance.
Mrs. White is a 78-year-old woman admitted to the hospital with a diagnosis of severe dehydration. The nurse assigned to Mrs. White is asked to collect data related to fluid status. The nurse notes Mrs. White’s blood pressure is low. The nurse also finds Mrs. White’s skin turgor to be poor, and the nurse notes that the urine output is scant and dark amber. The nurse asks Mrs. White is she knows what day it is, because severe dehydration may cause confusion. In addition, the nurse initiates taking daily weights because this the most accurate way to monitor fluid balance.
Risk Factors for fluid loss
Pathophysiology underlying acute and chronic illnesses
Abnormal losses of body fluids
Burns
Trauma
Surgery
Therapies that disrupt fluid and electrolyte balance
Data Analysis Related to Imbalances
Excess fluid volume
Deficient fluid volume
Risk for imbalanced fluid volume
Electrolytes Are Responsible for:
Balancing the amount of water in the body.
Balancing the body’s pH (acid/base) level.
Moving waste out of body cells.
Moving nutrients into body cells.
Allowing the body’s muscles, heart, nerves, and brain to function properly.
Electrolytes - Minerals in the body that can
conduct electricity.
where are electrolytes found
Found in urine, blood, tissues, as well as other body fluids.
electrolytes include
Include potassium, sodium, calcium, and magnesium (chloride, phosphorus).
while naturally occuring in the body, electrolytes can also be found in
ound in food, drinks, and supplements.
Normal Electrolyte Values
Potassium (K+)
3.5 – 5.0 mEq/L
Sodium (Na+)
136-145 mEq/L
Calcium (Ca2+)
9.0-10.5 mg/dL
Magnesium (Mg2+)
1.3-2.1 mg/dL
Chloride (Cl-)
98 – 106 mEq/L
Phosphorus (P-)
3 – 4.5 mg/dL
ØThe electrolyte sodium supports the
sodium function of nerves and muscles, helps maintain a normal blood pressure, and regulates the body’s fluid balance, and acid-base balance.
ØLow sodium levels are called
hyponatremia.
ØHigh sodium levels are called
hypernatremia.
ØThe electrolyte potassium helps w/
potassium nerve and muscle cell function while playing an important role in the muscle cells in the heart. support transmission electrical impulses body’s nerves / muscles.
K+ * Major role conduction nerve cells w/in heart.
ØLow potassium levels are called
hypokalemia.
ØHigh potassium levels are known as
hyperkalemia.
ØCalcium helps the body maintain
strong bones and is mostly stored in teeth and bones to support their hardness. Also helps muscles move, nerves to carry messages between the brain and body, and blood vessels to move blood throughout the body. / blood clotting
Low calcium levels are called
hypocalcemia.
High calcium levels are called
hypercalcemia.
ØHypoparathyroidism,
low parathyroid hormone levels,
ØHypoparathyroidism,aka low pth
can lead to hypocalcemia / . When PTH secretion is insufficient, hypocalcemia develops.
ØHypercalcemia is most commonly caused by
overactive parathyroid glands, or hyperparathyroidism. Hyperparathyroidism is a condition in which one or more of your parathyroid glands become overactive and release (secrete) too much parathyroid hormone (PTH). This causes the levels of calcium in your blood to rise, a condition known as hypercalcemia.
ØMagnesium’s role in the body is to
assist in the regulation of nerve and muscle function, blood pressure and blood sugar levels; as well as making bone, protein, and DNA.
ØLow magnesium levels are known as
hypomagnesemia.
High levels are called
hypermagnesemia.
what is intended function of potassium
helps with nerve and muscle cell function while playing an important role in the muscle cells in the heart. / potassium nerve and muscle cell function while playing an important role in the muscle cells in the heart. support transmission electrical impulses body’s nerves / muscles.
K+ * Major role conduction nerve cells w/in heart.
hypokalemia level
Anything lower than 3 mEq/L (3 mmol/L) may be considered severe hypokalemia
hyperkalemia level
Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L.
normal range for potassium
Potassium (K+)
3.5 – 5.0 mEq/L
what are the risk factors for hypokalemia
FLUID SHIFT FROM ECF TO ICF / ALKALOSIS / WATER INTOXICATION / CARDIAC DYSRYTHMIASDiarrhea.
Vomiting.
Excess sweating.
Poor diet.
both severe hypokalemia and severe hyperkalemia can lead to paralysis, cardiac arrhythmias, and cardiac arrest. Hyperkalemia, generally carries a higher risk of morbidity and mortality if left untreated. Severe hypokalemia may also cause respiratory failure, constipation and ileus.
Taking certain medicines, such as diuretics or beta-2-adrenergenic agonists.
Poorly-controlled diabetes.
Alcohol use disorder or withdrawal.
Eating disorders.
what are the risk factors for hyperkalemia
o Potassium level above ERR 3.5 to 5 mEq/L.
.ACE INHIBITOS / NSAIDS / POTASSIUM SPARING DIURECTICS / RAPID INFUSION OF POTASSIUM CONTAIN IV SOLUTIONS / KIDNEY DISEASE / ADDISONS DISEAS (ADRENAL INSUFFICIENCY)/ ACIDOSIS / HYPERICEMIA / HYPERCSTSBOLISMAlcohol use (excessive)
Chronic kidney disease.
Diabetic ketoacidosis.
Diarrhea.
Diuretics (water retention relievers)
Excessive laxative use.
Excessive sweating.
Folic acid deficiency.
what are the expected findings of hypokalemia
Severe muscle weakness or rhabdomyolysis. Cardiac arrhythmias and ECG abnormalities. Kidney abnormalities. Glucose intolerance /ORTHOSTATIC HYPOTENSION (fall risk) PARESTHESIA / SHALLOW RESPIRATIONS / THREADY / WEAK / IREGGULAR PULSE / HYPOREFLEXIA / HYPOACTIVE BOWEL SOUNDS
rhabdomyolysis
Rhabdomyolysis (often called rhabdo) is a serious medical condition that can be fatal or result in permanent disability. Rhabdo occurs when damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death
what are the expected findings of hyperkalemia
muscle weakness, URINE ABNORMALITIES / RESPIRATORY DISTRESS / DECREASED CARDIAC CONTRACTILITY (LOW hr / lOW bp) fatigue, and depression. O respiratory muscle weakness
Hyperkalemia symptoms include:
Abdominal (belly) pain and diarrhea.
Chest pain.
Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat).
Muscle weakness or numbness in limbs.
Nausea and vomiting.
priority nursing focue hypokalemia
Because hypokalemia affects the transmission of cardiac impulses, the client is at risk for developing cardiac arrhythmias. Cardiac monitoring has the highest priority . Hypokalemia can lead to clinically significant life-threatening arrhythmia. TPOTASSIUM ‘ SODIUM OPPOSITE EFFECTS Place the patient on a high-potassium diet. If increasing dietary potassium is insufficient to treat moderate hypokalemia, provide oral potassium supplements. A patient who has severe hypokalemia or who can’t take oral supplements may need I.V. potassium replacement therapy.
priority nursing focue hyperkalemia
Nursing Interventions for Hyperkalemia · Monitor cardiac, respiratory, neuromuscular, renal, and GI status · Stop IV potassium if running and hold any PO … Calcium therapy will stabilize the cardiac response to hyperkalemia and should be initiated first in the setting of cardiac toxicity. Calcium does not alter the serum concentration of potassium but is a first-line therapy in hyperkalemia-related arrhythmias and ECG changes.
what is intended function of sodium
supports the function of nerves and muscles, helps maintain a normal blood pressure, and regulates the body’s fluid balance, and acid-base balance.
hyponatremia level
Hyponatremia occurs when the sodium in your blood falls below 135 mEq/L.
hypernatremia level
Doctors diagnose hypernatremia when the concentration of sodium in blood serum is higher than 145 milliequivalents per liter (mEq/l)
normal range for sodium
Sodium (Na+)
136-145 mEq/L
what are the risk factors for hyponatremia
Certain medications. …
Heart, kidney and liver problems. …
Syndrome of inappropriate anti-diuretic hormone (SIADH). …
Chronic, severe vomiting or diarrhea and other causes of dehydration. …
Drinking too much water. …
Hormonal changes.
what are the risk factors for hypernatremia
Advanced age.
Mental or physical impairment.
Uncontrolled diabetes (solute diuresis)
Underlying polyuria disorders.
Diuretic therapy.
Residency in nursing home, inadequate nursing care.
Hospitalization. [22, 32]
what are the expected findings of hyponatremia
Nausea and vomiting. ORTHOSTATIC HYPOTENSION / SEZURES / STOMACH CRAMPING / TAACHYCARIDA
Headache.
Confusion.
Loss of energy, drowsiness and fatigue.
Restlessness and irritability.
Muscle weakness, spasms or cramps.
Seizures.
Coma.
what are the expected findings of hypernatremia
Muscle weakness. INCREASED BP / INCREASED FLUID RETENTION / EDEMA AGITATION / THIRST / DECREASED URINE OUTPUT
Restlessness.
Extreme thirst.
Confusion.
Lethargy.
Irritability.
Seizures.
Unconsciousness.
priority nursing focue hyponatremia
In a patient who is hypovolemic and hyponatremic, the priority is to restore adequate circulating volume. In particular, restoring adequate circulating volume takes priority over any concerns that the hyponatremia might be corrected too rapidly and lead to osmotic demyelination syndrome.
priority nursing focue hypernatremia
Hypernatremia is treated by replacing fluids. In all but the mildest cases, dilute fluids (containing water and a small amount of sodium in carefully adjusted concentrations) are given intravenously. The sodium level in blood is reduced slowly because reducing the level too rapidly can cause permanent brain damage
slowly lower sodium levels
what is intended function of calcium
helps the body maintain strong bones and is mostly stored in teeth and bones to support their hardness. Calcium also helps muscles move, nerves to carry messages between the brain and body, and blood vessels to move blood throughout the body.
hypocalcemia level
total serum (blood) calcium concentration is less than 8.8 mg/dL.
hypercalcemia level
hypercalcemia is defined as a serum calcium level greater than 10.5 mg/dL (>2.5 mmol/L)
normal range calcium
Calcium (Ca2+)
9.0-10.5 mg/dL
what are the risk factors for hypocalcemia
Low levels of calcium cause the muscles to contract more easily, leading to increased deep tendon reflexes. Vitamin D deficiency.
A parathyroid disorder or parathyroid gland surgery.
Thyroid removal surgery (thyroidectomy).
A family history of genetic conditions such as certain genetic mutations, genetic vitamin D disorder or DiGeorge syndrome.
what are the risk factors for hypercalcemia
Parathyroid problems.
Certain cancers.
Too much calcium in the diet.
Excess vitamin D and/or vitamin A.
Certain medicines—such as lithium, diuretics, and antacids with calcium.
Certain inherited conditions.
Kidney disease or failure.
what are the expected findings of hypocalcemia
neuromuscular irritability. Patients often complain of numbness and tingling in their fingertips, toes, and the perioral region. Paresthesias of the extremities may occur, along with fatigue and anxiety. Muscle cramps can be very painful and progress to carpal spasm or tetany
tetany
a condition marked by intermittent muscular spasms, caused by malfunction of the parathyroid glands and a consequent deficiency of calcium
what are the expected findings of hypercalcemia
Hypercalcemia can cause stomach upset, nausea, vomiting and constipation. Bones and muscles. In most cases, the excess calcium in your blood was leached from your bones, which weakens them. This can cause bone pain and muscle weakness
priority nursing focue hyponcalcemia
dminister IV calcium as ordered (ex: 10% calcium gluconate)…. give slowly as ordered (be on cardiac monitor and watch for cardiac dysrhythmias). Assess for infiltration or phlebitis because it can cause tissue sloughing (best to give via a central line)
priority nursing focus hypercalcemia
Initial therapy of severe hypercalcemia includes the simultaneous administration of intravenous (IV) isotonic saline, subcutaneous calcitonin, and a bisphosphonate (typically, IV zoledronic acid [ZA]) (table 1). Isotonic saline – Most patients with severe hypercalcemia have marked intravascular volume depletion
what is intended function of magnesium
role in the body is to assist in the regulation of nerve and muscle function, blood pressure and blood sugar levels; as well as making bone, protein, and DNA.
hypomagnesemia. level
(less than 1.46 mg/dL) in the blood.
hypermagnesemia level
(<3 mEq/L, 3.6 mg/dL, or 1.5 mmol/L)
normal range magnesium
Magnesium (Mg2+)
1.3-2.1 mg/dL
what are the risk factors for hypomagnesemia.
alcoholism, congestive heart failure, diabetes, chronic diarrhea, hypokalemia, hypocalcemia, and malnutrition (strength of recommendation: C, based on expert opinion, physiology, and case series).
what are the risk factors for hypermagnesemia.
acute or chronic kidney disease. In these individuals, some conditions, including proton pump inhibitors, malnourishment, and alcoholism, can increase the risk of hypermagnesemia. Hypothyroidism and especially cortico-adrenal insufficiency, are other recognized causes.DIABETIC KETOACIDOSIS
what are the expected findings of hypomagnesemia.
Clinical manifestations include anorexia, nausea, vomiting, lethargy, weakness, personality change, tetany (eg, positive Trousseau or Chvostek sign or spontaneous carpopedal spasm, hyperreflexia), and tremor and muscle fasciculations.
what are the expected findings of hypercalcemia
stomach upset, nausea, vomiting and constipation. Bones and muscles. In most cases, the excess calcium in your blood was leached from your bones, which weakens them. This can cause bone pain and muscle weakness.
priority nursing focus hypomagnesemia.
Monitor cardiac, GI, respiratory, neuro status. …SEIZURE PRECAUTIONS
May administer potassium supplements due to hypokalemia (hard to get magnesium level up if potassium level is down)
Administering calcium supplements (oral calcium supplements w/ Vitamin-D or 10% Calcium Gluconate)
priority nursing focue hypermagnesemia.
DIURETICS / AVOID LAXATIVES / ANTACIDS / HEMODYIALYSISNursing interventions for patients with hypermagnesemia or at risk for this imbalance include the following: Teach patients to avoid magnesium-rich foods, especially green, leafy vegetables; whole grains; and nuts. Monitor serum magnesium, potassium, calcium, and phosphate levels
neutral pH is what? a figure expressing the acidity or alkalinity of a solution
7 (pure water)
Acid is
1 (gastric acid) -6 (milk)
Base is what
8 (egg) -14 (concentrated solutions of alkalis (ex bleach / ammonia are bases)
Buffers for pH Regulation
The blood
The lungs
The kidneys
Acid-Base Balance
ØIs the correct balance of acidic and basic (alkaline) compounds in the blood.
ØAcidosis occurs
when the levels of acid in the blood are too high.
ØAlkalosis occurs
when the blood becomes too alkaline.
Normal Arterial Blood Gas Values (test to measure for acid base components and pressure of gasses in blood
pH: 7.35-7.45
PaCO²: 35-45 mm Hg
HCO³-: 21-28 mEq/L
•pH: ( figure expressing the acidity or alkalinity of a solution)
7.35-7.45
7.45 =
Alkalosis
7.35 =
Acidosis
•PaCO²: (PARTIAL PRESSURE CARBON DIOXIDE)
35-45 mm Hg
45 mm Hg =
Acidosis
35 mm Hg =
Alkalosis
•HCO³-: BICARBONATE
21-28 mEq/L
28 mEq/L =
Alkalosis
21 mEq/L =
Acidosis
Alkalosis
isexcessive blood alkalinity caused by an overabundance of bicarbonate in the blood or a loss of acid from the blood(metabolic alkalosis), or by a low level of carbon dioxide in the blood that results from rapid or deep breathing (respiratory alkalosis).
Acidosis
Acidosisoccurs when acid builds up or when bicarbonate (a base) is lost. Classified as either respiratory or metabolic acidosis.Respiratory acidosisdevelops when there is too much carbon dioxide (an acid) in the body.
four major ways excess acid can accumulate in the body
increased acid production,
decreased elimination of acids
elimination of acids
increased elimination of base,
metabolic acidosis.
The buildup of acid in the body due to kidney disease or kidney failureis called metabolic acidosis. When your body fluids contain too much acid, it means that your body is either not getting rid of enough acid, is making too much acid, or cannot balance the acid in your body.
Common Causes of Metabolic Acidosis (HCO3-: <22 mEq/L)
Kidney disease
Lactic acidosis
Diabetic acidosis –
Severe dehydration
Severe diarrhea
why is sever diarrhea a Common Causes of Metabolic Acidosis (HCO3-: <22 mEq/L)
due to loss of too much sodium bicarbonate
compensation. Withmetabolic acidosis,(HCO3-: <22 mEq/L)
respiratory system is the main mode of compensation. The process begins when chemoreceptors in the brain sense a high concentration of hydrogen ions, which stimulates an increase in respirations, or hyperventilation, which increases the rate at which CO2 is eliminated from the body.
lactic acidosis,
increased acid production,
caused by decreasedtissue perfusionand resulting anaerobic metabolism
Common Causes of Metabolic Alkalosis(HCO3-: >26 mEq/L)
Loss of potassium or sodium from the body quickly
Ingestion of bicarbonate
Alcohol abuse
Loss of potassium or sodium from the body quickly - conditions can cause
*Diuretic overuse
*Excess vomiting
*Antacids
*Laxatives
Diabetic acidosis – AKA Diabetiketoacidosis (DKA)
ketones that are acidic build up when diabetes is uncontrolled
diabetic ketoacidosis,
increased acid production,
extreme hyperglycemia and an excessive breakdown offatty acidsin people withdiabetes. It can also be caused by increased ingestion of acids, like methanol,salicylates, or ethylene or propylene glycol.
kussmaul respirations
if underlying cause is diabetic ketoacidosis - rapid, deep respirations will be present. Compensation can’t completely correct the pH imbalance, and it won’t fix the underlying cause of it either
Common Cause of Respiratory Alkalosis (PaCO2: <35 mm Hg)
•Respiratory alkalosis occurs when the carbon dioxide levels in the body drop too low and may be a result of breathing too fast or too deep.
•Respiratory alkalosis occurs (PaCO2: <35 mm Hg)
when the carbon dioxide levels in the body drop too low and may be a result of breathing too fast or too deep.
respiratory alkalosis - common cause
Hyperventilation, or over breathingd ue to the action of deep or rapid breathing ridding the body of too much carbon dioxide.
Respiratory acidosis(PaCO2 > 45 mm Hg )
Respiratory acidosis isa condition that occurs when the lungs cannot remove all of the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic.
Respiratory Acidosis PaCO2: >45 mmHg - Common Causes of
Airway diseases such as COPD and asthma
Diseases that affect the chest and breathing ability such as scoliosis
Diseases of the lung tissues
Medicines that suppress breathing such as narcotics
Severe obesity
Obstructive sleep apnea
Anaerobic metabolism,
which can be defined asATP production without oxygen (or in the absence of oxygen),
renal failure
decreased elimination of acids
MUDPILES,
M stands for methanol; U for uremia, which happens in renal failure; D for diabetic ketoacidosis, P for propylene glycol; I for iron tablets and isoniazid, which can cause acidosis with an overdose; L for lactic acidosis; E for ethylene glycol; and finally, S for salicylates.
Hyperventilation, or over breathing,
is a common cause of respiratory alkalosis
Hyperventilation, or over breathing, a common cause of respiratory alkalosis
due to the action of deep or rapid breathing ridding the body of too much carbon dioxide.
respiratory acidosis occurs.
•When the lungs cannot remove enough carbon dioxide from the body,
DATA ANALYSIS RELATED TO ACID IMBALANCES
Excess fluid volume
Deficient fluid volume
Risk for imbalanced fluid volume
Plan (Objective/Goal): The Patient will…..
Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days).
Maintain urine specific gravity within normal range (1.010-1.030).
Practice self-care behaviors to promote balance.
WHAT DO THESE THINGS MEAN??
Implementation
Dietary modifications
Modifications of fluid intake
Medication administration
IV therapy
Blood and blood products replacement
TPN
Decrease patient anxiety as needed
Appropriate patient and family teaching
Administering Medications/Therapies
Mineral–electrolyte preparations
Diuretics
Intravenous therapy
Oxygen
Evaluation
Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days). Goal met
Maintain urine specific gravity within normal range (1.010-1.030). Goal met
Practice self-care behaviors to promote balance. Goal met
