Unit 4 - Acid/Base Flashcards
acid _____ hydrogen ions in solution
release
Bases _____ hydrogen ions in solution
accept
_____ _____ determines acidity of body fluids
hydrogen ions (H+)
how do you measure hydrogen ions
pH
Describe pH as you increase H+
decrease pH = > acidic
Describe pH as you decrease H+
increase pH = > basic
normal ABG pH of body fluids
7.35-7.45
metabolic processes produce _____
acids
- volatile (carbonic acid)
- nonvolatile
3 systems that work together to maintain pH
- buffer systems
- respiratory system
- renal system
Buffers prevent major changes in _____
pH
Describe Buffer System
- bind c H+ when excess acid is present
- release H+ if body fluids are too basic
Focus on _____ _____ as the main buffer
Bicarbonate HCO3
CO2 + H2O =
carbonic acid
3 major buffer systems
- Bicarbonate-Carbonic Acid
- Phosphate
- Protein
Describe Respiratory System:
- Regulates carbonic acid by…
- CO2 is potential acid when…
- Increase in CO2 or H+…
- Regulates carbonic acid by eliminating or retaining Co2
- CO2 is potential acid when combined with water
- Increase in CO2 or H+ stimulates respiratory center
Describe Respiratory System with Acidosis:
- Rate & depth of respiration
- CO2 and Carbonic Acid
- pH
retained CO2 and excess of carbonic acid
- increasing rate and depth of respiration increase
- eliminates CO2 and carbonic acid
- you need to increase pH to normal range
Describe Respiratory System with Alkalosis:
- rate and depth of respiration
- CO2
- CO2 & H2O
- Carbonic acid
- pH
Loss of CO2 and deficient carbonic acid
- decreases rate and depth of respiration
- CO2 retention
- CO2 combines with H2O
- restores carbonic acid levels
- pH back to normal
Describe Renal system:
- Long-term regulation of…
- Kidneys eliminate…
- Regulate _____ in ECF
- faster or slower?
- selectively excrete or retain _____ to…
- Long-term regulation of acid-base balance
- kidneys eliminate nonvolatile acids
- regulate bicarbonate (HCO3) in ECF
- slower
- selectively excrete or retain H+ to maintain pH
How is acid-base balance assessed?
by measuring arterial blood gasses (ABGs)
PaCO2 measures…
pressure of dissolved CO2 in blood
PAO2 measures…
pressure of oxygen dissolved in plasma
Serum HCO3 reflects…
regulation of acid-base balance
Normal ABG Value:
PaCO2
35-45
Normal ABG Value:
HCO3
21-28
Normal ABG Value:
PaO2
80-100
Effect on ABGs with Metabolic acidosis:
- pH
- HCO3
- PaCO2
- decrease pH
- decrease HCO3
- decrease PaCO2
Effect on ABGs with Metabolic alkalosis:
- pH
- HCO3
- PaCO2
- increase pH
- increase HCO3
- increase PaCO2
Effect on ABGs with Respiratory acidosis:
- pH
- HCO3
- PaCO2
- decrease pH
- increase HCO3
- increase PaCO2
Effect on ABGs with Respiratory alkalosis:
- pH
- HCO3
- PaCO2
- increase pH
- decrease HCO3
- decrease PaCO2
Severe acidosis (pH of 7.0 or less) depresses myocardial cantractility which leads to _____ _____ _____
decreased cardiac output
acid-base imbalance also affect _____ _____
electrolyte balance
In acidosis, _____ is retained as the kidney excretes excess hydrogen ions. Excess hydrogen ions also enter the cells, displacing _____ from the intracellular space to maintain the balance of cations and anions with cells. The effect of both processes is to _____ _____ _____ _____.
potassium
potassium
increase serum potassium levels
Cause of metabolic acidosis
excess nonvolatile acids; bicarbonate deficiency
Cause of metabolic alkalosis
bicarbonate excess
Cause of respiratory acidosis
retained CO2 and excess carbonic acid
Cause of respiratory alkalosis
loss of CO2 and deficient carbonic acid
T/F: Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another.
T
In acidosis, _____ is released from its bonds with plasma proteins, increasing the amount of ionized (free) _____ in the blood. Magnesium levels may _____ in acidosis.
calcium
calcium
fall
Metabolic alkalosis: a client may experience numbness around the mouth and tingling of the fingers. This may be explained due to the fact that alkalosis increases binding of _____ _____ to _____ _____ _____ levels. As a result, _____ _____ increases, and manifestations similar to hypocalcemia develop. These manifestations include circumoral and distal extremity parasthesias.
extracellular calcium
reducing ionized calcium
neuromuscular excitability
Compensations for metabolic acidosis
rate and depth of respirations increase, eliminating additional CO2
Compensation of metabolic alkalosis
rate and depth of respirations decrease, CO2 is retained
Compensation of respiratory acidosis
kidneys conserve bicarbonate to restore carbonic acid:bicarbonate ratio of 1:20
Compensations of respiratory alkalosis
kidneys excrete bicarbonate and conserve H+ to restore carbonic acid:bicarbonate ratio
A client who is fasting is at risk for development of _____ _____. The body recognizes fasting as starvation and begins to metabolize its own proteins into _____, which are metabolic acids.
metabolic acidosis
ketones
_____ is a disorder that can result in metabolic acidosis due to hyper-metabolic state
Hyperthyroidism
Biggest disease with Bicarbonate loss (metabolic acidosis)
Chronic Renal Failure
Metabolic alkalosis due to loss of _____ _____ which usually occurs because of vomiting or gastric suction.
hydrogen ions
T/F: Encouraging fluids for an infant who is actively vomiting will not improve fluid balance status
T
*and neither juice nor glucose water is the best choice of fluid
Frequent use of _____ _____ and daily use of _____ can cause metabolic alkalosis.
Overuse of _____ can be associated with metabolic acidosis.
calcium carbonate
furosemide
aspirin
The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis, the client should be taught to refrain from the use of _____ _____ when prone to metabolic alkalosis.
sodium antacids
The client with Cushing’s syndrome is at risk for developing severe metabolic alkalosis that causes _____ and limits _____ _____
hypoxemia
energy reserves
The client receiving _____ _____ is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse.
sodium bicarbonate
Clients of _____ ages are at risk for respiratory acidosis when alveolar hypoventilation occurs
all
Those with _____ are at highest risk for respiratory acidosis
COPD
Respiratory alkalosis is usually always a result of _____
hyperventilation
Major risk factor for respiratory acidosis
use of narcotics
*Morphine, oxycodone is a narcotic and generally acts to decrease or suppress respirations; therefore, client may hypo- ventilate causing CO2 retention, building up acid as the CO2 mixes with water to make carbonic acid
_____ _____ from aspiration or other causes would put the client at risk for respiratory acidosis.
acute pneumonia
_____ _____ diseases other than COPD, such as asthma, croup and cystic fibrosis put the child/ adult at risk for respiratory acidosis
Chronic lung
*Having only one functioning or partially functioning lungs could put a client at risk
The manifestations of acute and chronic respiratory acidosis _____. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.
differ
_____ _____ increase the risk for the acid-base imbalance respiratory alkalosis, due to hyperventilation that accompanies anxiety and panic attacks.
Anxiety disorders
_____ can trigger increased respirations which can lead to respiratory alkalosis
Hypoxemia
The client with a _____ overdose ( ASA or aspirin) is at risk for hyperventilation, which can lead to respiratory alkalosis due to over compensating for metabolic acidosis from the salicylate acid (asa)
Hyper-metabolic states can lead to increased respirations as well ( fever, thyrotoxicosis)
salicylate
Symptoms of metabolic acidosis:
- drowsiness
- lethargy/weakness
- confusion = NO HIGH FOWLER’S!
- CNS depression leading to coma
Care:
prevent injury
Infants and children are at high risk for _____ and _____ _____ because of immature kidneys
fluid and electrolyte imbalance
infants have high respiratory rates, which can lead to _____ _____
insensible losses
Older adults are at risk for F&E imbalances because of _____ kidney function, _____ sensations, and levels of _____ _____
decreased
thirst
intracellular fluid
Define:
PaCO2 > 45
high = resp. acidosis
- less CO2 is being exhaled than normal
Define:
PaCO2 < 35
low = resp. alkalosis
- more CO2 is being exhaled than normal
Define:
HCO3 > 26
high = metabolic alkalosis
Define:
HCO3 < 22
low = metabolic acidosis
Define:
IS Compensation Present
PaCO2 & HCO3 are abnormal or nearly in opposite direction (1 acidic & 1 basic)
Define:
IS compensation absent
1 component is abnormal and 1 is normal (acuter problem)
Goal of treatment:
restore of maintain normal body balance
Respiratory Acidosis:
The client with respiratory failure would benefit most from the _____-_____ or _____ _____ to increase ventilation
semi-Fowler’s or Fowler’s position
Respiratory Acidosis:
_____ _____ _____ is the priority nursing diagnosis for the client with respiratory acidosis.
Impaired Gas Exchange
Respiratory Alkalosis:
A method that is often used to control breathing for client’s experiencing hyperventilation is _____ _____ with the nurse during breathing exercises
eye contract
Patients with metabolic alkalosis often have an accompanying _____ _____ _____. With the fluid volume deficit, the client would experience _____.
fluid volume deficit
hyperthermia
Metabolic Alkalosis: The client is at risk for injury because of the associated _____ _____ _____ _____
muscle spasms and dizziness
Metabolic Alkalosis:
The depressed respiratory drive that often accompanies metabolic alkalosis can lead to _____ and _____ _____ of the tissues, so monitoring oxygen saturation is an important intervention.
hypoxemia
impaired oxygenation
Metabolic Alkalosis:
Oxygen saturation levels of less than _____ indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of _____.
90%
hypoxia
Treatment of metabolic alkalosis includes restoring normal _____ _____ and administering _____ _____
fluid volume
potassium chloride
Taking too many _____ is associated with metabolic alkalosis, so the client needs teaching related to this concept
antacids
_____ _____ _____ : A drop in oxygen will change the client’s level of responsiveness, so always monitor for cognition
Low oxygen levels
Metabolic acidosis affects cardiac output by _____ contractility, _____ the heart rate, and _____ the risk for dysrhythmias.
decreasing
slowing
increasing
The client with metabolic acidosis will be at risk for developing an _____ _____ _____, due to administration of sodium Bicarbonate to help correct the acidosis which can lead to _____ and then Fluid Vol excess.
Excessive Fluid Volume
hypernatremia
Metabolic alkalosis:
The ECG pattern may shows changes similar to those seen with _____.
hypokalemia
Goal in acidosis:
reverse the effects of excess acids & return pH to norma levels quickly
Metabolic Acidosis:
Education concerning the connection that: Taking a potassium supplement may cause _____, which _____ cardiac output and _____ metabolic acidosis
hyperkalemia
decreases
worsens
Sodium bicarbonate is administered only if the bicarbonate level is _____: because: Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is an order that the nurse should question before providing
low
DO NOT USE ANY ANTACID FOR MORE THAN…
2 weeks
The client receiving _____ _____ is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse.
sodium bicarbonate
When to use intubation
if PaCO2 is > 77 mmHg, pH < 7.20
Quick correction of chronic hypercarbia (increased levels of CO2) may cause…
metabolic alkalosis (body overcompensates with HCO3 kidney retention)
If a client is exhibiting respiratory acidosis bases on low ph. and high PaCO2 levels, then the client needs to “blow off” more CO2; therefore, the respiratory rate would be _____ on the machine
increased
For a client being mechanically ventilated, the only way to reduce rapid respirations might be to provide a _____
sedative
