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NUR 230 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

what is the definition of acid-base balance?

A

the process of regulating the pH, bicarbonate concentration, and partial pressure of carbon dioxide of body fluids

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2
Q

What are the acid-base balancing processes?

A
  • acid production (consistent)
  • acid buffering (maintains ratio between bicarb and carbonic acid)
  • acid excretion (through lungs and through kidneys)
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3
Q

acid-base imbalance characteristics

A
  • develops as a complication of another underlying condition
  • never considered “normal” but may be “expected” if a chronic condition is present
  • ex respiratory acidosis d/t COPD
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4
Q

how does the body maintain optimal acid-base balance?

A
  • acid excretion keeps up with production
  • if too much acid is produced the buffers can become overwhelmed
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5
Q

what is acidosis caused by?

A

too much acid or loss of too much base

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6
Q

characteristics of respiratory acidosis

A
  • too much carbonic acid
  • buffers cannot maintain balance
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7
Q

what causes respiratory acidosis?

A
  • COPD
  • asthma
  • pneumonia
  • pulmonary edema
  • narcotic overdose
  • Guillan Barre
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8
Q

What is metabolic acidosis?

A
  • metabolic acid (H+) retention/ingestion or bicarb loss
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9
Q

What can cause metabolic acidosis?

A
  • DKA
  • diarrhea (bicarb loss through intestinal tract)
  • renal disease
  • thyroid storm
  • starvation ketoacidosis
  • build up of lactic acid
  • acid ingestion, aspirin overdose
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10
Q

what is alkalosis caused by?

A

too much base or loss of too much acid

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11
Q

what is respiratory alkalosis?

A

carbonic acid loss

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12
Q

what causes respiratory alkalosis

A

hyperventilation (pain, anxiety, hypoxia, head injury)

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13
Q

what is metabolic alkalosis

A
  • excess of bicarb or metabolic acid loss
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14
Q

what causes metabolic alkalosis

A
  • emesis
  • continuous NG tube suction
  • tums (excess antacids)
  • IV sodium bicarb
  • diuretics (decreases fluid volume which can increase bicarb excretion)
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15
Q

what does the body do to prevent these acid base imbalances?

A

can attempt to correct it with compensation

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16
Q

How long does it take for the lungs to compensate

A

happens very quickly, breathing is adjusted

17
Q

how long does it take for the kidneys to compensate?

A
  • happens in 2-3 days to make a clinically significant difference
18
Q

expected ABG values for metabolic alkalosis and compensation

A

HIGH pH and HIGH HCO3
compensation- low RR

19
Q

expected ABG values for metabolic acidosis and compensation

A

LOW pH and LOW HCO3
compensation- high RR

20
Q

expected ABG values for respiratory acidosis

A

LOW pH and HIGH CO2

21
Q

expected ABG values for respiratory alkalosis

A

HIGH pH and LOW CO2

22
Q

how do you know if compensation is partial or full?

A

if the pH is normal it is full compensation, if the pH is still abnormal it is partial compensation

23
Q

what are some teaching points to prevent acid base imbalance

A
  • Diet: safe weight loss, safe food handling to avoid food poisoning
  • smoking cessation/prevention
  • preventing overdose of meds at home (antacids, aspirin)
24
Q

What clients are at risk for DKA?

A
  • type 1 diabetics due to their complete lack of insulin
  • pts who are noncompliant with their insulin
  • undiagnosed diabetics (young children)
25
Q

what are the assessment findings for a client with DKA

A
  • decrease in LOC
  • polyuria
  • polydipsia
  • fatigue
  • nausea
  • anorexia
  • abdominal pain
  • dehydration
  • orthostatic hypotension
  • tachycardia
  • Kussmaul’s breathing
  • acetone breath
26
Q

what are the treatments/management priorities for DKA

A
  • IV fluids: infuse fast to improve dehydration (1 L/hour)
  • IV regular insulin drip: infuse slow to reverse acidosis and prevent hypoglycemia
  • avoid activities that increase intracranial pressure
27
Q

what are the expected lab values/diagnostics for a pt with DKA?

A
  • BG 250-800
  • ketones and glucose in urine
  • positive ketones in blood
  • metabolic acidosis on an ABG (pH low, HCO3 low, CO2 low)
28
Q

what would indicate decline in client status in a client with DKA

A
  • decreased LOC
  • low BP
  • tachycardia
  • decreased urine output
29
Q

should 0.9% normal saline be the IV fluid infused for the entire time the client is on an insulin drip?

A

no, when blood glucose is 250-300 we switch to a dextrose drip to avoid hypoglycemia

30
Q

what are complications associated with the treatments of DKA?

A
  • cerebral edema
  • hypoglycemia
  • hypokalemia
  • fluid overload
31
Q

What are the sick day rules?

A
  • take insulin agents as usual
  • test blood glucose and urine ketones every 3-4 hours
  • report elevated glucose levels or urine ketones to primary provider
  • take supplemental doses of doses of regular insulin every 3-4 hours if needed
  • substitute soft foods six to eight times a day if you cannot follow your usual meal plan
  • take liquids every 1/2 to 1 hour to prevent dehydration and to provide calories, if vomiting, diarrhea, or fever persists
    report nausea, vomiting, and diarrhea to your primary provider because extreme fluid loss may be dangerous
  • be aware that if you are unable to retain oral fluids you may require hospitalization to avoid DKA and possibly coma
32
Q

why is an insulin drip started for a client in DKA?

A

to reverse the acidosis

33
Q

what are expected patient outcomes for DKA

A
  • achieves fluid and electrolyte balance
  • demonstrates knowledge about DKA
  • decreased anxiety
  • absence of compliance
34
Q

when should potassium replacement start for DKA?

A
  • once potassium levels are NORMAL
  • hold replacement if hyperkalemia or no urination

NUR 230 (1 decks)

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