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NURS2500 Patho/Pharma > week 11: Acid and base balance > Flashcards

week 11: Acid and base balance Flashcards

1
Q

Define if these are true or false.
Review from gas exchange that connects to acid base balance :

In order to have appropriate gas exchange it is crucial to have appropriate blood flow
- appropriate oxygen intake and carbon dioxide removal

A

all the above are true

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2
Q

_____ is going to cause those impairment in acid base balance

A

carbon dioxide

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3
Q

Does a lot of C02 indicate being acidic or alkalotic?

A

acidic

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4
Q

true or false. Sodium potassium in our blood is a must
.

A

this is true

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5
Q

What are the concepts related to acid base balance?

A

fluid and electrolytes
perfusion
gas exchange
elimination
nutrition
cognition

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6
Q

What is vital to life and circulates in our bodies ?

A

this would be hydrogen ions

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7
Q

What is hydrogen ions expressed as ?

A

they are expressed as pH

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8
Q

Hydrogen overload or excess indicate which state ?

A

this indicates they are in an acidotic state

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9
Q

hydrogen deficit indicate which state ?

A

this indicates that they are in an alkalosis state

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10
Q

Select all that is true according to the pH values :

The normal range for arterial pH is 7.35 to 7.45
if the pH is below 7.35 the client is in an alkalotic state
if the pH is above 7.45 the client is in acidotic state

A

only the first one is correct
the other two is the opposite of each

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11
Q

True or false. The more hydrogen, the less pH will be , and the less hydrogen, the higher the pH will be ?

A

yes this is true

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12
Q

A low pH or a ton of hydrogen ( hydrogen excess ) will cause our body to be acidotic which is generally created from where/

A

cellular metabolism

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13
Q

Tru or false. Increased acid can be through exercising, tomatoes and citric. these can be many influencing increase hydrogen concentration in our plasma ?

A

true

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14
Q

Define what acids are

A

substances that release hydrogen ions when dissolved in water or body fluids, increasing the amount of free hydrogen ions in that solution; are produced as end products of metabolism

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15
Q

what is this describing ?
substances that release hydrogen ions when dissolved in water or body fluids, increasing the amount of free hydrogen ions in that solution; are produced as end products of metabolism

A

this is describing acids

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16
Q

define what bases are

A

Substances that bind free hydrogen ions in solution and lower the amount of free hydrogen ions in solution

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17
Q

what is this describing ?
Substances that bind free hydrogen ions in solution and lower the amount of free hydrogen ions in solution

A

bases

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18
Q

Having kidney issues can indicate that you are having an C02 problem or HC03?

A

HC03, in other words bicarbonate problem

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19
Q

How does our body maintain acid base balance ?
this occurs through different mechanisms ( now name these mechanisms )

A
  1. chemical ( protein buffers, chemical buffers )
    2.respiratory
    3.kidneys

potassium exchange

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20
Q

what takes the longest to balance acid base ?

A

this would be through our kidney mechanism

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21
Q

what is the first line of defense in which is quick to react to acidic

A

this is called chemical ( protein buffers, chemical buffers)

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22
Q

what are the different protein buffers

A

albumin, globulins, hemoglobin

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23
Q

what are the different chemical buffers

A

bicarbonate, phosphate

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24
Q

Chemical buffers :
bicarbonate
phosphate:
define what they do

A

bicarbonate is also discussed as carbonic acid bicarbonate system

phosphate is present in cells and body fluids; it is especially active in the kidneys. The system acts like bicarbonate and neutralized excess hydrogen ions.

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25
Q

Buffers : carbonic acid- bicarbonate system
let’s break it down: under what category would carbonic acid belong ? how about bicarbonate system ?

A

carbonic acid would be common acid
bicarbonate system would be common base

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26
Q

First define if this statement is true or false.
If it is true fill in the blank, if it false, disregard it.

bicarbonate is made up of ___ and water , in which the patient is not retaining c02.

A

this is a true statement
HC03

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27
Q

Frist define if this statement is true or false.
If it is true fill in the blank, if it false, disregard it.

Carbonic acid is made up of ___ and h20 creating carbonic acid, the pH will also decrease with this circumstance.

A

c02

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28
Q

Patients who are getting rid of C02 is also known as what term ?

A

hyperventilating

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29
Q

where is carbonic acid regulated in our body ? and how about bicarbonate ?

A

carbonic acid is very regulated in our respiratory system, and respiratory system has chemical mediator to detect in our brain , receptor will detect if it’s out of optimal function.

bicarbonate= kidneys

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30
Q

This is the primary buffer system in the body

A

carbonic acid bicarbonate system

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31
Q

Buffers : carbonic Acid- Bicarbonate system
The system maintains a pH of 7.4 with ratio of 20 parts bicarbonate to 1 part of carbonic acid ? Is this a true statement?

A

yes this is a true statement

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32
Q

Buffers: Carbonic Acid- bicarbonate system
what does this 20: 1 ratio determines ?

A

this determines the hydrogen ion concentration (pH) of body fluid.

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33
Q

Buffers: Carbonic Acid- bicarbonate system
How is carbonic acid concentration controlled?

A

it is controlled by the excretion of C02 in the lungs, the rate and depth of respiration change in response to the changes in C02.

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34
Q

Which organ controls the bicarbonate concentration in the buffer carbonic acid bicarbonate system ? and define what it’s role

A

the kidneys control the bicarbonate concentration and selectively retain or excrete bicarbonate in response to bodily needs.

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35
Q

When we think about carbonic acid excess, what type of issue are we initially thinking right from the start ?

A

we think of respiratory issue ( acidic )

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36
Q

When we think about base bicarbonate deficit, what type of issue are we initially thinking right from the start ?

A

metabolic issue ( this is outside of respiratory issue ) –> alkaline

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37
Q

What is the second defense of the body and interacts with the buffer system to maintain acid base balance?

A

respiratory

38
Q

True or false. Respiratory system is under control of central nervous system that allows chemoreceptors we have in our brain to detect C02. If it detects that it’s too high, we are given signals to excrete those C02 ( e.g exercsing: we begin to hyperventilate)

A

true

39
Q

Our drive to breathe is based on what ? name an example

A

it’s based on C02, ( e.g when we are exercising we are making more acid in our body, C02 is increasing which is causing our pH level to decrease –> usually this is why we hyperventilate when we exercise )

40
Q

true or false. Respiratory defense mechanism to maintain acid base balance , activate only hydrogen ions carried by carbonic acid

A

false. it inactivates it.

41
Q

When the body is in state of acidosis, what does the respiratory do in terms of balancing the acid base balance?

A

When the body is in state of acidosis the lungs increase the body’s respirations to excrete C02.

42
Q

true or false. The second line of defense for acid base balance is respiratory and one of the mechanism it does is not change the rate nor the depth of our breathing.

A

bruh false duh obviously we are changing it.

43
Q

define if this is a true statement under the category of respiratory in balancing acid and base.
- In alkalosis, the pH increases, and the respiratory rate and depth increases, C02 is retained, and carbonic acid increases to neutralize and decrease the strength of excess bicarbonate

A

false, respiratory and depth does not increase, it would decrease because you are trying to retain that carbonic acid NOT get rid off it.

44
Q

How long does the process of correcting an acid base deficit or excess take when using the second line of defense ( respiratory)

A

only 10-30 seconds to complete!

45
Q

determine how the lungs help in state of alkalosis when using respiratory in an acid base imbalance, what about acidosis what would the lungs contribute?

A

the lungs will either hold hydrogen ions in state of alkalosis

changing hydrogen ions to water molecules to be exhaled with C02 in states of acidosis

46
Q

define if this is true or false.
The respiratory system, including the lungs, acts relatively quickly to make short-term adjustments, while the kidneys provide longer-term regulation by excreting or conserving bicarbonate ions.

A

true

47
Q

These defense are strong when maintaining the acid base ( or balancing ) however they do the job slower ( takes about a day to get a respond)

A

kidenys

48
Q

Define the characteristics that undergoes kidneys in balancing acid and base

A
  • The renal correction of an acid- base imbalance is slower but is provides a more inclusive corrective response.
  • Compensation (correcting) can take a few hours to several days
  • The kidneys restore bicarbonate by excreting hydrogen ions and retaining bicarbonate ions.
  • Excess hydrogen ions are excreted in the urine in the form of phosphoric acid.
49
Q

Acidosis and alkalosis imbalances can indicate that there is an imbalance where ?

A

potassium imbalance

50
Q

In situations we have patients who are acidotic meaning that there is extra hydrogen ions, ( refer to slide 14) for the diagram, there is less hydrogen ions inside of the cell, the hydrogen ions will try to move into the cell to neutralize their charge when this happens the cell will try to push the potassium to balance the change that is occurring. In this case what can we say our patient would become ?

A

our patient will become hyperkalemia ( acidosis stage )

51
Q

Potassium exchange :
define the characteristics under normal conditions

A

the intracellular potassium content is much greater than that of the extracellular fluid. The concentration of hydrogen ions is low in both compartments.

52
Q

Potassium exchange
define the characteristics of acidosis

A

the extracellular hydrogen ions content increases and the hydrogen ions move into the intracellular fluid. TO keep the intracellular fluid electrically neutral, an equal number of potassium ions leave the cell, creating a relative hyperkalemia

53
Q

Potassium exchange :
Define the characteristics of alkalosis

A

more hydrogen ions are presenting intracellular fluid than in the extracellular fluid. Hydrogen ions move from the intracellular fluid into the extracellular fluid. To keep the intracellular electrically neutral, potassium ions move from the extracellular fluid not the intracellular fluid, creating a relative hypokalemia

54
Q

Acid base imbalances name them and the sub categories that undergo the main imbalances.

A

acidosis –> respiratory acidosis and metabolic acidosis
alkalosis–> respiratory alkalosis and metabolic alkalosis

55
Q

Define this statement:
tons of hydrogen and this is a condition due ot another disease or pathological process

A

acidosis

56
Q

Define this statement :
pH is very high but very low of hydrogen ions ,result of a condition that is happening.

A

alkalosis

57
Q

Respiratory and renal responses to disrupted acid base balance :
stimulus : too much carbonic acid ( respiratory acidosis)

respiratory response : what would be the cause of problem ? what would be the correction?

what would the renal response be ?

A

cause problem would be hypoventilation
correction would be hyperventilation

renal response :
compensation : increased secretion of H and more NH3 production ( ammonia)

58
Q

Respiratory and renal responses to disrupted acid base balance :
stimulus : too little carbonic acid (respiratory alkalosis)

Respiratory response : what would be the cause of problem? what would be the correction?

what would the renal response be ?

A

cause of problem would be hyperventilation
correction wold be hypoventilation

renal response :
compensation : decreased secretion of H less NH3 production

59
Q

Respiratory and renal responses to disrupted acid base balance :
stimulus : Too much metabolic acid (metabolic acidosis)

what would be the respiratory response ?

what is the renal response ?

A

respiratory response : compensation hypeventilation

renal response :
cause of problem : more metabolic acid than kidneys can excrete

correction : increased secretion of H and more NH3 production

60
Q

Respiratory and renal responses to disrupted acid base balance :
stimulus : Too little metabolic acid (metabolic alkalosis)

what would be the respiratory response ?

what is the renal response ?

A

repsitaory response :
compensation hypoventilation

renal response :
cause of problem : more bicarbonate than kidneys an excrete ( too little metabolic acid )
correction c: decreased secretion of H and less NH3 production

61
Q

what is respiratory acidosis?

A

this is retaining CO2 decreasing pH (increased Carbonic acid production)

62
Q

what is the cause of respiratory acidosis?

A

pt is hypoventilating or is a CO2 retainer (COPD)

63
Q

what is the treatment of respiratory acidosis?

A

Fix what is causing hypoventilation (antidotes, drugs, airway)​

64
Q

is there compensation within respiratory acidosis?

A

yes! kidneys reabsorb bicarbonate into blood stream, and will increase excretion of H+ (into urine) and produce more ammonia​

65
Q

what is metabolic acidosis?

A

Too much acid or too little bicarbonate​

66
Q

what is the cause of metabolic acidosis?

A

Acid excess (exercise/fever), Bicarbonate deficit (kidney failure)​

67
Q

what is the correction for metabolic acidosis?

A

Reabsorb bicarbonate into blood and increased excretion of H+ (into urine)​

68
Q

is tis true: you need to remove the excess CO2 - deep breaths

A

true

69
Q

what is this inquiring: Respiratory compensation results in deep and rapid breaths (to get rid of carbonic acid through CO2 lowering pH)​

A

metabolic acidosis

70
Q

what are some clinical manifestations for acidosis? CV, CNS, NM, Resp, Integ

A

1 - cardiovascular signs and symptoms:

Ranges from bradycardia to heart
block
* ECG Changes
* Hypotension
* Thready peripheral pulses

central nervous system:
Depressed activity (lethargy, confusion, stupor, coma)

neuromuscular:
hyporeflexia
Skeletal muscle weakness
Flaccid paralysis

resp:
Kussmaul respirations (respiratory
compensation in metabolic acidosis)
* !!!!Variable respirations (cause respiratory acidosis)!!!! (hyperventilation but shallow in COPD, otherwise generally hypoventilation)

integ:
Warm, flushed, dry skin in metabolic acidosis
Pale-to-cyanotic and dry skin in respiratory acidosis

71
Q

what is the cause of resp alkalosis?

A

often hyperventilation (breathing out too much CO2)

71
Q

what is respiratory alkalosis?

A

too little carbonic acid (to little CO2)

72
Q

what is the treatment for respiratory alkalosis?

A

Fix what is causing hyperventilation

73
Q

where is corrections done and how is it done in respiratory alkalosis?

A

Correction by kidneys: Excreting bicarbonate in
urine

74
Q

what is this describing: Too little acid or too much bicarbonate

A

metabolic alkalosis

75
Q

what is the cause for metabolic alkalosis ?

A

intake of antacids, prolonged vomiting

76
Q

what is the compensation for metabolic alkalosis?

A

done by resp system: hypoventilation (hold onto CO2)

77
Q

where is the correction done for metabolic alkalosis?

A

in the kidneys: excrete bicarbonate through urine

78
Q

what are the clinical manifestations for alkalosis? CV, CNS, NM, Resp

A

cardio:
increased hr
normal or low bp

cns:
increased activity
anxiety, irritability, seizures
parenthesis

NM:
hyperflexia
muscle cramping and twitching
skeletal muscle weakness

resp:
hyperventilation (cause) in respiratory alkalosis !!!!!
hypoventilation (resp compensation in metabolic alkalosis)

79
Q

what is pH (components of an arterial blood gas)?

A

Refers to the balance of hydrogen ions in the arterial blood. A high pH indicates a solution is alkaline (low H+ concentration) and a low pH indicates a solution is acidic (high H+ concentration)

80
Q

what is PaCO2 (components of an arterial blood gas)?

A

stands for partial pressure of Co2: measures the amount of carbon dioxide in the arterial blood. Indicates how well the lungs are excreting carbonic acid.

81
Q

what is HCO3 (Components of an arterial blood gas)

A

bicarbonate: Measures the amount of bicarbonate in the arterial blood. Indicates how well the kidneys are excreting metabolic acid.

82
Q

what is Pao2? Components of an arterial blood gas?

A

partial pressure of O2: Measures the amount of oxygen in the arterial blood. Let’s us know what is happening at the level of the tissue.

83
Q

what is bass excess (Components of an arterial blood gas)?

A

An indicator of how well the buffers are managing metabolic acid (we will introduce but not test this concept of base excess)

84
Q

what are the normal limits for pH, PaCO2 and HCO3? dont really need to memorize will be given on exam

A

pH - 7.35 - 7.45
PaC02- 35-45 mmhG lungs
HCO3 - 21-28 mmol/L kidneys

85
Q

where would acidosis and alkalosis be closer to with pH, Paco2 and HCO3 level?

A

acidosis 7.35-7.45 alkalosis
paCO2- alkalosis 35 - 45 mmHg acidosis
HCO3 - acidosis 21 - 28 mmol/L alkalosis

86
Q

select if all is true for ABG analysis:
pH acidosis or alkalotic
PaCO2 resp acidotic or alkalotic (makes carbonic acid)
HCO3- met acidosis or alkalosis
match pH to either 2 or 3
is there compensation? is other parameter going in opposite direction
assess PaO2 and O2 sat

A

all true

87
Q

true or false: resp acidosis = too much carbonic acid in the lungs

A

true

88
Q

what is compensation?

A

The body may attempt to compensate for the pH change

89
Q

true or false: if the parameter that does NOT match the pH is moving in the OPPOSITE direction the body is trying to compensate

A

true

90
Q

what is this an example of?
pH 7.20 (acidotic)
PaCO2 30 mmHg (alkalotic)
HCO3- 16 (acidotic)

A

compensation!!

91
Q

select the partial and full compensation from the examples, also if its acidosis or alkalosis:
* pH 7.35
* PaCO2 30 mmHg (alkalotic)
* HCO3- 16 (acidotic)

  • pH 7.20 (acidotic)
  • PaCO2 30 mmHg (alkalotic)
  • HCO3-16 (acidotic)
A

both metabolic acidosis

first one full compesation
second partial compensation

NURS2500 Patho/Pharma (16 decks)

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