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Terms in this set (110)
disorder of balance between acids and alkali or bases in the body
any substance that can donate a hydrogen ion
any substance that can accept or combine with a hydrogen ion, bases include bicarbonate ions (HCO3)
What does the acid-base balance optimize?
: enzymatic function, nerve conduction, synaptic transmission, and muscle contaction
H+ ions indicates the means of the pH scale
degrees of acidity to alkalinity
What is the range of the pH scale
1-14. 7 neutral level
What are the pH values?
1-7 is acidic. 7 and greater is alkaline
If there is an abnormal increase in H+ ions or a decrease in bicarbonate ions what does this result in?
Results in Acidosis and a pH below 7.35
If there is an abnormal decrease H+ ions or an increase in bicarbonate ions what does this result in?
Results in alkalosis and pH above 7.45
(pH of body fluids) Fluid?
pH of gastric juice?
pH of urine?
pH of arterial blood?
pH of venous blood?
pH of cerebrospinal fluid?
pH of pancreatic fluid?
Do human cells function normally within a broad or narrow range of pH?
How does the body maintain proper pH?
Using buffers and homeostatic regulations by the lungs and kidneys
What are the different types of buffers?
HCO3, phosphates, ammonia, and proteins
What is the major buffer system in the body?
bicarbonate (HCO3) buffer sysytem
What do buffers do?
maintain stable pH
How do buffers correct acid-base imbalance?
removing or releasing H+ ions **
What is acidosis: excess acid with a pH below 7.35, what do the buffers bind with?
The buffers bind with H+ ions
What does the buffer release when excess base (alkaline) pH greater than 7.45?
Buffer releases H+ ions
Bicarbonate Buffer System
H + HCO³ ̄«-» H²CO³ «-» H²O + CO²
Bicarbonate- carbonic acid buffer system
in order to maintain proper pH balance, the body attempts to maintain a ration of 20:1 ( bicarbonate to carbonic acid)
What regulates Acid Base balance?
lungs and kidneys
How do the lungs regulate Acid-Base balance?
lungs: regulate amount of CO2 in the body
kidneys: regulate hydrogen and bicarbonate ions concentration
What will the kidneys do if the body is acidic?
The kidneys will excrete Hydrogen and retain bicarbonate to return the body's pH back to normal . Renal process is slow
What will the kidneys do if the body is alkaline?
kidneys will retain H+ and excrete bicarbonate to return body's pH back to normal. Renal process is slow
What does pH measure:
free hydrogen ion concentration
What is PaCO2?
measures partial pressure of arterial CO2
What is the normal value of PaCO2?
35-45 mm HG
What does the PaCO2 less than 35 indicate?
What does the PaCO2 greater than45 indicate?
What is PaO2?
measures the partial pressure of oxygen in arterial blood
What is the normal value of PaO2?
What is the normal level of HCo3?
If the HCO3 is less than 22 what does that indicate?
If the HCO3 is greater than 26 what does that indicate?
What does arterial blood gases interpret?
whether pH value is normal, whether PaCO2 is normal, whether HCO3 is normal or if all three show acidosis or alkalosis
What else does the arterial blood gas levels interpret?
determines whether pH values match the PaCO2 (respiratory) or the HCO3 (metabolic) value
Acid Base Imbalances
-pH 7.26, PaCO2 49 mmHg, HCO3 22 mEq/L
-pH 7.48, PaCO2 32 mmHg, HCO3 24 mEq/L
-pH 7.29, PaCO2 38 mmHg, HCO3 20 mEq/L
-pH 7.49, PaCO2 37 mmHg, HCO3 30 mEq/L
What is ROME?
Respiratory Opposite/Metabolic Equal
What is the RO?
-pH is high, PaCO2 is down (alkalosis)
-pH is low, PaCO2 is up (acidosis)
What is the ME?
-pH is high, HCO3 is high (alkalosis)
-pH is low, HCO3 is low (acidosis)
What is RAMS?
What are the classifications of Acid- Base Imbalance?
- the four acid-base imbalance
- mixed acid-base imbalance
-acute vs. chronic imbalance
- compensation for acid- base imbalance
What are the 4 simple acid-base imbalance?
-metabolic acidosis or alkalosis
-respiratory acidosis or alkalosis
What is respiratory acidosis also known as?
carbonic acid excess or hypercapnea
What causes respiratory acidosis?
acid-base imbalance caused by a decrease in pulmonary ventilation
What does hypoventilation lead to?
Low pH accompanied by an increased arterial concentration of carbon dioxide; CO2 is retained
What doe the kidneys do in Respiratory Acidosis?
kidneys compensate by reducing the amount of bicarbonate ions being released
Respiratory Acidosis can be acute or chronic? True of false?
What is the most common cause of Respiratory Acidosis?
Does the renal system compensate?
Yes, but it is a slow process
What is Chronic (respiratory) acidosis mostly associated with?
COPD,Obesity-hypoventilation syndrome (Pickwickian syndrome) and neuromuscular disorders
What are the airway causes of respiratory acidosis?
Chronic obstructive pulmonary disease
Emphysema, severe asthma, chronic bronchitis
Severe pneumonia, pulmonary edema, & Pneumothorax
Aspiration of foreign objects
Mechanical ventilation (inadequate)
Neuromuschular diseases causing respiratory acidosis?
Amyotrophic lateral sclerosis (ALS), Diaphragm paralysis, Guillain-Barre' syndrome, Myasthenia gravis
What are the CNS depression that causes respiratory acidosis?
Drug overdose: narcotics, benzodiazpines, other CNS depressants
What are the neurological disorders that cause respiratory acidosis?
Encepalitis, brainstem disease, trauma
What are the clinical CNS manifestations of respiratory acidosis?
lethargy to confusion progressing on to stuporous and unresponsiveness
What are the neuromuscular system clinical manifestations of respiratory acidosis?
Decreased muscle tone and reflexes
Muscle weakness to flaccid paralysis
What are the cardiovascular system clinical manifestations of respiratory acidosis?
Tachycardia and increased cardiac output
What are the respiratory system clinical manifestations of respiratory acidosis?
Initally increased respiratory rate followed by shallow respirations and apnea
What are the medical interventions of respiratory acidosis?
-Directed primarily at correcting underlying cause and improving ventilation
Sodium Bicarbonate infusion (rarely indicated)
-Assisting or increasing ventilation
-Narcan for narcotic overdose
What are the nursing interventions of respiratory acidosis?
-Identify patients at risk for respiratory acidosis
-Identify factors that increase the risk of hypoventilation
-Assess respiratory status every 2-4 hours
-Maintain an open airway-
What are other nursing interventions of respiratory acidosis?
-Semi-Folwers' position, keep objects within the patient's reach, balance rest with activity
Relieve post-operative pain and monitor respirations while -using PCA or Epidural therapy, give Narcan if necessary
-Encourage DB and Coughing, suction when necessary, CPT, push fluids
-Low flow oxygen with chronic respiratory patients
What is respiratory alkalosis also known as?
carbonic acid deficit or hypocapnia
What is respiratory alkalosis?
an acid-base imbalance caused by increased pulmonary ventilation rate
What are the characteristics of respiratory alkalosis?
low PaCO2 and elevated pH
What does hyperventilation cause?
"blowing off" of carbon dioxide
When it comes to resp alk, what do kidnehs compensate?
Kidneys compensate by increasing renal excretion of bicarbonate
What are the causes of respiratory alkalosis?
Extreme anxiety (common cause)
Acute hypoxia: pneumonia, asthma, pulmonary edema
Chronic hypoxia: pulmonary fibrosis, cyanotic heart, high altitudes
Excessive mechanical ventilation
Aspirin overdose (early phase)
What are the clinical CNS manifestations of respiratory alkalosis?
-Lightheadedness, agitation, confusion, and hyperreflexia
-Tingling or numbness around the mouth, hands, and toes
What are the clinical neuromuscular system manifestations of respiratory alkalosis?
-Skeletal muscle cramps, twitches, deep tendon hyperreflexia
-Tetany (Positive Chvostek's and Trousseau's) = hypocalcemia
What are the clinical cardiovascular system manifestations of respiratory alkalosis?
-Tachycardia and palpitations
What are the clinical respiratory system manifestations of respiratory alkalosis?
Rapid, deep respirations
Name medical interventions for respiratory alkalosis?
-Correct underlying cause
-Instruct patient to breathe slowly
-Breathe into a paper bag
-Antibiotics to treat respiratory infections
-Medications to treat fever, seizures, or irregular heart rhythms
What are some other medical interventions for respiratory alkalosis?
-Monitor electrolyte values; especially Potassium and Calcium
-Give Calcium Gluconate for tetany and Potassium replacements
What are the nursing interventions for respiratory alkalosis?
-Identify patients at risk
-Assess patient's anxiety level
-Assess respiratory status
-Encourage slow, deep breathing (use a paper bag or re-breathing mask if necessary)
-Administer a sedative if ordered, monitor respiratory status
What is metabolic acidosis also known as?
base bicarbonate deficit
What causes metabolic acidosis?
-increased accumulation of metabolic acids (lactic acid or ketoacids) that rise in proportion to bicarbonate, resulting in decreased arterial pH
-A loss of bicarbonate (base) also causes acidosis because the acid-base imbalance is offset by the greater amount of acids present
What are the characteristics of metabolic acidosis?
a low pH and a low bicarbonate level
When does compensation occur with metabolic acidosis?
as the respiratory system increases its ventilation rate to blow off more acids (CO2) in an attempt to eliminate excess acid and move pH toward normal
What is a condition that causes metabolic acidosis when there is an increased acidic production?
Lactic acidosis, Diabetic acidosis, fasting and starvation, aspirin poisoning(late stage), kidney failure or dysfunction
What is another condition that causes metabolic acidosis when there is an increase bicarbonate loss?
Diarrhea, intestinal suctioning, intestinal or biliary fistulas, and renal tubular necrosis
What are the clinical CNS manifestations of metabolic acidosis?
Lethargy, drowsiness, confusion, headache
What are the clinical respiratory system manifestations of metabolic acidosis?
Kussmaul respirations (deep and rapid)
What are the clinical cardiac system manifestations of metabolic acidosis?
Bradycardia and decreased cardiac output
What are the clinical electrolyte manifestations of metabolic acidosis?
What are the medical interventions of metabolic acidosis?
-Correct underlying cause
-IV insulin and IV fluids
-Administer NaHCO- if bicarbonate levels are low
What are the nursing interventions of metabolic acidosis?
-Identify patients at risk
-Monitor cardiac status
-Correct electrolyte imbalance
-Administer meds for nausea and diarrhea
-Safety and seizure precautions
What is metabolic alkalosis also known as?
base bicarbonate excess
What is metabolic alkalosis?
An acid-base imbalance caused by an increased loss of acid (most often from the stomach or kidneys) or an accumulation of a base
What are the characteristics of metabolic alkalosis?
high pH and HCO3
What happens with metabolic alkalosis when respiratory compensation occurs?
As respiratory compensation occurs, the PaCO2 levels rise to buffer the higher-than-normal HCO3
What causes metabolic alkalosis when there is an increase in base?
---Oral ingestion of bases (antacids & milk alkali syndrome)
-Parenteral base administration
-Blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN)
What causes metabolic alkalosis when there is a decrease of acid?
-Prolonged vomiting & nasogastric suctioning
What are the clinical CNS manifestations of metabolic alkalosis?
-Increased activity, anxiety, irritability, tetany seizures
-Positive Chvostek's and Trousseau's sign= hypocal
What are the clinical neuromuscular system manifestations of metabolic alkalosis?
-Hyperreflexia, muscle cramping and twitching
-Skeletal muscle weakness= hypokalemia
Medical Interventions for metabolic alkalosis:
-Correct underlying cause
-Avoid administration of alkaline products
-Monitor and treat electrolyte imbalances
-IV hydration (Sodium chloride)
Nursing interventions for metabolic alkalosis:
-Identify patients at risk
-Assess patient for signs of metabolic alkalosis esp. respiratory, electrolyte, and ABG changes
-Give IV ammonia chloride (acidic agent)
What is compensation?
-The return of an abnormal pH to a normal pH
-The unaffected system (metabolic or respiratory) is responsible for returning the pH to normal
What happens with compensation in respiratory acidosis?
with a high PaCo2, the kidneys compensate by retaining bicarbonate
What happens with compensation in respiratory alkalosis?
with a low PaCO2, the kidneys compensate by excreting bicarbonate
What happens with compensation in metabolic acidosis?
with a low HCO3, the lungs compensate through hyperventilation, which lowers PaCO2 and returns the pH to normal
What happens with compensation in metabolic alkalosis?
with a high HCO3, the lungs compensate through hypoventilation, which increases Paco2 and returns the pH to normal
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