SI Acid/Base_Exam 4 Flashcards
____________ Imbalances
_______________
< 1.5 mEq/L
- Increased neuromuscular excitability
- Positive Chvostek’s (face twitches when masseter tapped) and Trousseau’s (hand tightens when blood pressure cuff kept above systolic pressure for long period of time)
- Insomnia
- Nystagmus
_______________
> 2.5 mEq/L
- Decreased neuromuscular excitability
- Flushing
- Diaphoresis - sweating
- Hypotension - low blood
- Bradycardia - low heart rate
Magnesium Imbalances
Hypomagnesemia (< 1.5 mEq/L)
Hypermagnesemia (> 2.5 mEq/L)
_________ imbalances
Neuronal Excitation/Bones
\_\_\_\_\_\_\_\_\_\_\_\_ < 8.5mg/dL 1. Increased neuromuscular excitability 2. Positive Chvostek’s (face twitches when masseter tapped) and Trousseau’s (hand tightens when blood pressure cuff kept above systolic pressure for long period of time) 3. Muscle cramps 4. Seizures
\_\_\_\_\_\_\_\_\_\_\_\_ > 10.5 mg/dL 1. Decreased neuromuscular excitability 2. Constipation 3. Muscle weakness 4. Diminished reflexes 5. ↓ LOC
Calcium Imbalances
Hypocalcemia
Hypercalcemia
Normal PaCO2 is 35 – 45 mmHg
Normal HCO3 is 22 – 26 mEq/L
Normal pH is 7.35 – 7.45
Study
• Occurs when PaCO2 is greater than 45 mmHg and pH is decreased
• Causes
o Alveolar hypoventilation
excess of CO2 in the blood (hypercapnia), which means excess carbonic acid
May be caused by depression of the respiratory center and disorders of the lung (pneumonia, PE)
• Signs/Symptoms
o Compensation by the kidneys: increased elimination of H+ ions
o Headache, blurred vision, breathlessness, restlessness, disorientation, muscle twitching, respiratory rate is rapid at first and gradually becomes depressed as the respiratory center adapts to increasing CO2
• Treatment – restoration of adequate alveolar ventilation removed excess CO2
Respiratory Acidosis
• Occurs when PaCO2 is less than 35 mmHg and pH is increased
• Causes
o Alveolar hyperventilation (deep, rapid respirations)
decreased CO2 (hypocapnia), which means decreased carbonic acid
May be triggered by hypoxemia, hypermetabolic states, salicylate intoxication, hysteria, cirrhosis, and gram negative sepsis
• Signs/Symptoms
o Compensation by kidneys: decrease H+ excretion and bicarbonate reabsorption
o Dizziness, confusion, tingling of extremities, convulsions, coma
• Treatment – treat the cause particularly hypoxemia
Respiratory Alkalosis
• Causes
o Diabetic ketoacidosis (occurs with type 1 diabetes when person has too little insulin)
o Renal failure
o Alcohol
o Aspirin overdose
o Prolonged diarrhea (losing bicarbonate)
• Signs/Symptoms
o Headache and lethargy
o Compensatory Kussmaul respirations
Metabolic Acidosis
• Causes:
o Hyperaldosteronim (decrease potassium)
o Diuretics (the ones that are not potassium sparing – aka loop diuretics)
o Antacids (increases the bicarbonate level)
o Vomiting
- S/S – weakness, tetany, muscle cramps, hyperactive reflexes, atrial tachycardia
- Treatment – treat the condition
Metabolic Alkalosis
Less concentrated to Higher concentrated
Osmosis
Water flows where _______ goes
sodium
_______ – equal concentration of solution
• D5W > when absorbed turns into a hypotonic
• Patients are given isotonic to ^ extracellular fluid:
- Blood Loss
- Dehydration
- Surgery
Isotonic
_______ – low concentration of solution
- Fluid moves intracellularly = cell swelling
- Cell swelling causes lyses = Rupture
- You can become hypovolemic
TX:
DKA
Hyperglycemia – hydrates the cells
Hyperosmolar
DON’T give _______ to a patient with ICP, burn patients, or trauma patients because they are hypervolemic.
Hypotonic
_______ – excessive concentration of solution
• Fluid wants to move extracellularly = shrink cell
If given IV can cause a fluid overload – pulmonary edma
TX
Cerebral Edema
Hyponatremia = Reduces swelling
Hypertonic
Potassium
Body it trying to DITCH K+
Diarrhea I nadequate intake – anorexia/lacking diet T oo much water intake C H igh fluid loss – vomiting
CM: Bilateral Ascending flaccid muscle weakness Cardiac Dysrhythmias – U waves Constipation Polyuria
At Risk:
Patients with n/v, diarrhea
Patients with excessive sweating
Hypokalemia
Potassium
Body CARED too much for K+
C ellular movement – massive transfusion A R enal failure – Oliguria E xcessive K+ intake – IV infusion D rugs - Use of K+ sparing diuretics
CM: Bilateral Ascending flaccid muscle weakness Cardiac Dysrhythmias – cardiac arrest N/V Oliguria
At Risk:
Patients with Chronic Kidney Disease
Patients with Chronic Diarrhea
Hyperkalemia
Sodium LOVES EXTRAcellular
Causes: Loss of Na+ Dilution of Na+ by water excess Vomiting Suctioning
CM: S eizures A pprehension L ethargy T otal Confusion
At Risk
Acute nausea and vomiting
Acute fluid loss
Hyponatremia
Sodium
Causes: Retention or infusion of Na+ Decreased Intake Increased loss of water Associated with fever, respiratory tract infections
CM:
Weight gain
* Bounding pulse
Hyperreflexia
At Risk
Infants with severe diarrhea
* Patients with diabetes
Hypernatremia
Chloride follows her salty sister sodium and is regulated by sodium
!Acid/Base!
Causes:
* Vomiting – no more acid
Gastric suction
* Hyponatremia
CM:
Tetany
Spasticity
sweating
At Risk:
* Metabolic Alkalosis
Hypochloremia
Causes:
* Prolonged diarrhea – no more base
Loss of pancreatic secretion
* Hypernatremia
CM: Often asymptomatic Intense thirst Tachypnea Pitting edema
At Risk:
* Dehydration = Metabolic Acidosis
Hyperchloremia
Burns
Superficial - epidermis only
Very Painful
Sunburn
1st Degree
Burns
Superficial partial thickness
and deep partial thickness - some dermis
Painful
3-4 weeks to heal for partial
30-month to heal for deep partial
touching a hot pan - blister forms within minutes
2nd Degree
Burns
Full thickness - hypodermis
Dry, leathery, white
NO pain
Does not completely heal
3rd Degree
Burns
Full thickness + deeper - to the bone
Eschar - blackened dead tissue
Need skin graft - will not heal
4th degree
The process of regulations the pH, bicarbonate concentration and partial pressure of carbon dioxide
Acid-Base Balance
__ – represents the acidity or alkalinity of a solution
____ – substance that releases H+ ions
____ – substance that takes up H+ ions
Most important base is HCO3
pH
Acid
Base
The lungs, kidneys and bone are major organs involved in __________ the acid-base balance
regulating
Excess CO2 in the blood drives the equilibrium toward making _________ _____
Carbonic Acid H2CO3
Excess CO2 in the blood drives the equilibrium toward making _________ _____
Carbonic Acid H2CO3
_________ _____ moved from the cells hat produce it into the body fluids where it is buffered before it reaches the kidneys and is excreted
Metabolic Acid
____ Buffering process by which body fluids resist large changes in pH when acids or bases are added or removed
Acid Buffering
_____________
Chemical buffers, renal or respiratory function return pH within normal range
Underlying disease process still present
__________
Condition responsible for imbalance is controlled or no longer present
pH is within normal range
Compensation
Correction
__________ Buffering – intracellular and extracellular proteins have negative charges and can serve as buffers for H+
__________ is an excellent intracellular blood buffer because it can bind with H+ and CO2
Hemoglobin bound to H+ becomes a weak acid
Protein
Hemoglobin
_____ Buffering – the distal tubule of the kidney regulates acid-base by secreting H+ into the urine and reabsorbing bicarbonate
Renal
Alterations in Acidosis and Alkalosis
________
Decrease Muscles & Cardiac Contractility
Vasodilation of blood vessels =
Increased blood flow & ICP
________
Increased Neuromuscular and Cardiac contractility
Vasoconstriction of blood vessels = Decreased blood and O2 delivery to brain
Acidosis
Alkalosis
