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SAV NUR 406 exam 1 > week 2 content study guide > Flashcards

week 2 content study guide Flashcards

1
Q
  • Explain the relationship between hydrogen ion concentration and pH

pH is

low hydrogen =
high hydrogen =

A

pH is the concentration of hydrogen in the body
low hydrogen = high pH/basic/alkalosis
high hydrogen = low pH/acidosis

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2
Q
  • Discuss the acid/base balance in the body

Normal body pH:
body tries to stay within this range

A

7.35-7.45

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3
Q
  • Identify the 2 types of acids in the body
A

Volatile – excreted by lungs
Nonvolatile – excreted by kidneys

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4
Q
  • Identify the types of acids in the body

________ – excreted by lungs

_________ – excreted by kidneys

A

Volatile – excreted by lungs

Nonvolatile – excreted by kidneys

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5
Q
  • Identify the 2 types of acids in the body

H2CO3 (carbonic acid) is ________ bc it gets broken down to H2O and CO2 and CO2 is excreted by _____

________– excreted by ________
- Phosphoric acid
- Sulfuric acid
- Acetoacetic acid
- Beta-hydroxybutyric
- Lactic acid***

A

H2CO3 (carbonic acid) is volatile bc it gets broken down to H2O and CO2 and CO2 is excreted by lungs

Nonvolatile
kidneys

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6
Q
  • name the 3 systems that body maintains acid/base homeostasis with
A

(buffers, respiratory, & renal)

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7
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

Chemicals in the body that combine with acid or base to change pH
- they accept or release hydrogen ions
- occurs almost instantaneously (within secs)
- short lived effect

A

buffers:

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8
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)
  • in the ECF
  • with this system we focus on:
  • CO2 is a byproduct of cellular metabolism (chemical reactions that occur within a cell to maintain life)
  • CO2 is acidic and too much will = acidosis
  • CO2 combined with H20 = H2CO3 (carbonic acid)
  • carbonic acid can be broken down by carbonic anhydrase (found in lungs and kidneys)
  • in the lungs, carbonic anhydrase breaks down H2CO3 (carbonic acid) into H20 and CO2, and CO2 can be excreted
  • in the kidneys, carbonic anhydrase breaks down H2CO3 (carbonic acid) into H and HCO3, and H can be excreted and HCO3 can be retained
A
  1. bicarb - carbonic acid buffer
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9
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)
  • in the ICF
  • can’t measure b/c its intracellular
  • works by picking up a hydrogen ion to balance pH inside the cell
A
  1. phosphate buffer
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10
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

almost all proteins can function as buffers

carboxyl group (COOH) = amino acid and acetic acid
- Weak acid that gives up H+ ion

amino group (NH2-) = amino acid and ammonia
- Accepts H+ ion

hemoglobin
- Picks up CO2 (accepts) at the cellular level

A
  1. protein and hgb buffer
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11
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

the body can adjust pH by changing rate and depth of breathing

  • if acidic (low pH/high hydrogen) = increased RR and depth = exhale more CO2
  • if alkaline/basic (high pH/low hydrogen) = decrease RR and depth = hold onto more CO2
A

respiratory system

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12
Q
  • Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

Last system to kick in to balance pH

Does long term pH balance

Most effective regulator of pH

If organ fails = pH balance fails (would have to take daily bicarb)

  • Can eliminate large amounts of acid (except carbonic acid)
  • Can eliminate base when pH is too basic = body excretes bicarb
  • can conserve and produce bicarb ions –
A

renal system

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13
Q
  • Explain the bicarbonate – carbonic acid equation and how it moves back and forth

backward
CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-

A

Acidosis: If the blood becomes too acidic (low pH, high H+)
bicarbonate ions can combine with excess hydrogen ions to form carbonic acid
which can then be converted back into CO2 and water and exhaled.

HCO3 + H > H2CO3 > CO2 + H20 > CO2 (acidic) exhaled

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14
Q
  • Explain the bicarbonate – carbonic acid equation and how it moves back and forth

forward
CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-

A

Alkalosis: If the blood becomes too alkaline (high pH, low H+)
carbonic acid can dissociate to release hydrogen ions
neutralizing the excess base.

CO2 + H2O > H2CO3 > H (acidic) + HCO3 > excrete HCO3 (basic)

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15
Q
  • Discuss cellular compensation and the concept of electrical neutrality with acid/base balance.
A

cellular compensation – the cells want a neutral charge
H +
K +
When an increase of H+ concentration occurs, pH is decreased causing more acidity.
H moves into cell, the K will move out into blood stream
the cell = netural
the blood stream = hyperkalemic
if the kidneys are working they will excrete excess K
when the pH goes back to normal, H moves out of cell, K moves back into cell and everything is normal
but if the kidneys excreted all the K then there will be a K deficiency

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16
Q
  • Describe the rates of correction through the various mechanisms to correct acid/base imbalance

buffers –
respiratory –
kidneys –

A

buffers – instantly
respiratory – minutes - hours
kidneys – hours - days

17
Q
  • Identify acid-base imbalances
    pH< 7.35 indicates
    pH> 7.45 indicates
A

acidosis
alkalosis.

18
Q
  • Explain the compensation mechanisms in the body

Compensation -

see what the level of compensation is by looking at pH, PCO2, HCO3:
1. pH abnormal + PCO2 or HCO3 abnormal =
2. pH abnormal + PCO2 and HCO3 abnormal =
3. pH normal + PCO2 or HCO3 abnormal =
4. pH normal + PCO2 and HCO3 normal =

A

Compensation - The body’s response to acid base imbalance (for a short time?)

see what the level of compensation is by looking at pH, PCO2, HCO3:
1. pH abnormal + PCO2 or HCO3 abnormal = uncompensated
2. pH abnormal + PCO2 and HCO3 abnormal = partial
3. pH normal + PCO2 or HCO3 abnormal = compensated
4. pH normal + PCO2 and HCO3 normal = corrected

19
Q
  • Discuss
    respiratory (lung) compensation

If underlying problem is metabolic (kidneys) we will see metabolic acidosis/alkalosis = respiratory (lung) compensation can help (within mins-hours)

  • hyperventilation = excreting CO2 = acidosis correction
  • hypoventilation = conserving CO2 = alkalosis correction

(kidneys can also attempt to correct by retaining/excreting HCO3/bicarb)

A
20
Q
  • Discuss
    respiratory (lung) compensation

Acidosis (low pH/high hydrogen):
Goal = increase pH
1. stimulates brain and arterial receptors
2. increased RR and depth (hyperventilation to blow off CO2)
3. CO2 decreases
4. carbonic acid decreases
5. pH increases

Alkalosis/basic (high pH/low hydrogen):
goal = decrease pH
1. stimulates brain and arterial receptors
2. decreased RR and depth (hypoventilation hold onto CO2)
3. CO2 increases
4. carbonic acid increases
5. pH decreases

A
21
Q

Discuss metabolic (kidneys) compensation

If underlying problem is respiratory (lungs)we will see respiratory acidosis/alkalosis = metabolic (kidneys) compensation can help (within hours to days)
- conserving/reabsorbing H2CO3/bicarb = acidosis correction
- excreting H2CO3/bicarb = alkalosis correction

A
22
Q
  • Discuss how the renal systems work to compensate

Acidosis (low pH/high hydrogen):
Goal = increase pH
1. kidneys will reabsorb bicarb (basic) back into bloodstream
2. kidneys will excrete hydrogen ions (acidic) via urine

alkalosis/basic (high pH/low hydrogen):
goal = decrease pH
1. kidneys will excrete bicarb (basic)
2. kidneys will keep H ions (acidic)

A
23
Q
  • Know the normal values of an arterial blood gas
  • pH = 7.35-7.45
  • CO2 = 35-45
  • pO2 = 80-100
  • HCO3 = 24-29
  • O2 sat = 95-100%
A
24
Q
  • Explain the components of an arterial blood gas
    pH – concentration of H ions

PaCO2 - tells you the partial pressure of CO2 in artery
PvCO2 - tells you the partial pressure of CO2 in vein

pO2 partial pressure of oxygen - amount of oxygen dissolved in the blood

HCO3 – “bicarb” but is reported as CO2 serum levels on chemistry panel

O2 sat - % of hemoglobin in the blood that is saturated with oxygen

A
25
Q
  • Discuss the differences between a primary event, a primary disorder, and compensation mechanisms

Primary event = what causes imbalance

Primary disorder = what occurs based on event

Ex:
Primary event (hypoventilation) = primary disorder (respiratory acidosis)
Primary event (vomiting) = primary disorder (metabolic alkalosis)

A
26
Q
  • Define the four types of imbalances and how to identify the imbalances

Respiratory acidosis or alkalosis
- increase or decrease in CO2
- changes in ventilation

Metabolic acidosis or alkalosis
- changes in H ion or bicarb ions

We think ROME
If CO2 and pH are moving in opposite directions = respiratory issue
If bicarb and pH are moving in same direction = metabolic issue

A
27
Q
  • Explain the common causes for each type of imbalance
    Common causes of metabolic acidosis
  • kidney failure
  • fistulas
  • DMT1 DKA
  • lactic acidosis
  • prolonged diarrhea = loss of HCO3 increases acid
  • starvation = body using fat for energy = ketosis
  • med OD – ASA
  • shock
  • cardiac arrest

Causes of metabolic alkalosis
- consuming excess base/basic (ex: baking soda, alka-seltzer) = causes hypokalemia which causes H ions to shift out of cell and potassium to go into cell
- prolonged vomiting
- NG tube
- diuretics

Causes of respiratory acidosis
- hypoventilation (retains too much CO2)
- acute = respiratory arrest (kidneys don’t have time to compensate)
- chronic = COPD (kidneys have time to compensate)
- cardiopulmonary arrest
- head injury
- narcotics/sedatives
- anesthesia
- pulmonary disorders – acute asthma, COPD exacerbation, PNA, respiratory failure
- pain
- abdominal distension
- airway obstruction
- chest wall deformities
- neuromuscular problems

Causes of respiratory alkalosis
- hyperventilation (blowing off too much CO2)
- anxiety/panic attack – anything causing hyperventilation
- increased metabolic demands – fever, sepsis
- medications
- hypoxia
- PE or lung disease
- CNS lesions
- ventilator setting

A
28
Q
  • Discuss the clinical manifestations for each type of imbalance
    s/s of metabolic acidosis
  • CNS depression
  • Lethargy, drowsy
  • Confusion
  • Tremors, cramps
  • Paresthesia – finger/toes tingle
  • hypotension
  • Hyperkalemia
  • deep breathing – kussmaul respirations (w/ DKA)
  • fruit breath odor (w/ DKA)

s/s of respiratory acidosis
- CNS depression
- hypoventilation
- dyspnea
- respiratory depression
- shallow respirations
- h/a
- restlessness
- confusion
- tachycardia, arrythmias
- decreased LOC, stupor, coma
- “can’t catch my breath”

s/s of metabolic alkalosis
- CNS over excitability
- confusion
- tremors
- muscle cramps
- paresthesia – fingers and toes tingle
- coma
- n/v/d
- respiratory depression – lungs are holding onto CO2
s/s of respiratory alkalosis
- CNS overexcitability
- tachypnea
- light headedness
- confusion
- blurred vision
- paresthesia – fingers and toes tingle
- hyperactive reflexes
- seizures
- coma

A

SAV NUR 406 exam 1 (3 decks)

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