Term
| An opioid drug overdose would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Pulmonary Edema would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Chest trauma would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Neuromuscular disease would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| COPD would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Airway obstruction would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Pneumonia would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| TB would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Emphysema would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Asthma would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Cigarrette smoking would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Pleural effusion would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| What is pleural effusion? |
|
Definition
excess fluid that accumulates in the pleura, the fluid-filled space that surrounds the lungs
Pleural effusion is excess fluid that accumulates in the pleura, the fluid-filled space that surrounds the lungs. |
|
|
Term
| A Bowel obstruction would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Obesity (especially when laying flat) would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Liver failure would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
|
Definition
| Fluid accumulation in the abdominal cavity often associated with liver disease |
|
|
Term
| Laryngospasm would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Aspiration would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Drowning would put a patient at most risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Poison or Pesticide ingestion would put a patient most at risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Increased ICP would put a patient most at risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Botulism toxin would put a patient most at risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Excessive alcohol consumption would put a patient most at risk for what acid/base imbalance? |
|
Definition
|
|
Term
| Normal pH of arterial blood |
|
Definition
|
|
Term
| Normal pH of venous blood |
|
Definition
|
|
Term
|
Definition
|
|
Term
| (20)HCO3- + (X)H2CO3 = pH 7.0 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Body fluid pH is a measure of the body's _____________________ |
|
Definition
H+
Free hydrogen ion level |
|
|
Term
| What value has the narrowest range of normal and the tightest control mechanisms of all electrolytes? |
|
Definition
Body fluid pH
aka Free hydrogen ion level (H+) |
|
|
Term
| Changes from normal pH interfere with these four body functions: |
|
Definition
1) changing the shape & reducing teh function of hormones and enzymes
2) Changing the distribution of other electrolytes, causing fluid and electrolyte imbalances
3) Changing excitable membranes, making the heart, nerves, muscles, and GI tract either less or more active than normal
4) Decreasing the effectiveness of many drugs |
|
|
Term
| Describe the relationship between H+ level and pH |
|
Definition
Free hydrogen ion (H+) level increases = pH decreases (Body becomes more acidic)
Free hydrogen ion (H+) level decreases = pH increases (Body becomes more alkiline) |
|
|
Term
| What patients would be at a high risk for falls as a result of acid-base imbalances? Why? |
|
Definition
| Alkalosis, because alkalosis causes hypotension and muscle weakness |
|
|
Term
| Explain the concept of compensation |
|
Definition
Compensation occurs when either the respiratory system or kidneys work to overcome a pH imbalance caused by the other party.
Examples:
Kidney's reabsorb bicarbonate to increase pH in a patient suffering from respiratory acidosis
Example:
Patient with DKA has kussmauls respirations to "blow off" extra CO2, raising pH |
|
|
Term
| What is the role of the respiratory system in maintaining acid-base balance? |
|
Definition
| CO2 is exhaled during respiration, which decreases amount of free hydrogen ion (H+) levels in the body, making the body less acidic. (raising pH) |
|
|
Term
| What is the role of the kidneys in maintaining acid-base balance? |
|
Definition
Kidneys can produce acids and then excrete them in urine
Kidneys can produce bicarbonate
Kidneys can move bicarbonate from other areas (reabsorbtion) |
|
|
Term
| Acids are substances that: |
|
Definition
| release hydrogen ions when disolved in water (H2O) |
|
|
Term
| An acid in solution __________ the amount of free hydrogen ions in that solution |
|
Definition
|
|
Term
| The strength of an acid is measured by: |
|
Definition
| how easily it releases a hydrogen ion in solution |
|
|
Term
| What is an example of a strong acid (found in the human body)? |
|
Definition
|
|
Term
| The difference between a strong acid and a weak acid is that: |
|
Definition
A strong acid separates (dissociates) completely in water and readily releases all of its hydrogen ions (H+)
A weak acid does not completely separate in water; it releases only SOME of its hydrogen ions |
|
|
Term
What does this formula represent?
CH3COOH + H2O = H+ + CH3COO- + H2O |
|
Definition
When acetic acid (CH3COOH) is put into solution (Water, H2O) it does not completely separate (dissociate) It releases 1 hydrogen ion (H+), retains 3 hydrogen ions, becoming (CH3COO-) in water.
Since the CH3COOH (Acetic acid) released only 1/4 of its hydrogen ions (H+), it is a weak acid
worded differently:
CH3COOH, a wak acid, contains a total of four hydrogen molecules. When acetic acid combines with water, it releases only one of its four hydrogen molecules. The other three hydrogen molecules remain bound to the acetic acid molecule (CH3COO-) |
|
|
Term
|
Definition
|
|
Term
|
Definition
A substance that binds free hydrogen ions in solution
Bases are "hydrogen acceptors"
Bases lower the amount of free hydrogen ions in solution |
|
|
Term
| What makes a base a strong base? |
|
Definition
| Strong bases bind hydrogen ions easily |
|
|
Term
|
Definition
sodium hydroxide
A strong base |
|
|
Term
|
Definition
|
|
Term
| What are two examples of strong bases in the human body? |
|
Definition
NaOH (sodium hydroxide)
NH3 (ammonia) |
|
|
Term
|
Definition
| bind to hydrogen ions less readily. |
|
|
Term
|
Definition
aluminum hydroxide
A weak base |
|
|
Term
|
Definition
|
|
Term
| What are two examples of weak bases in the human body? |
|
Definition
AlOH3 (aluminum hydroxide)
HCO-3 (bicarbonate) |
|
|
Term
|
Definition
Buffers can react in two ways:
either as an acid (releasing a hydrogen ion) or as a base (binding as a hydrogen ion)
A buffer always tries to bring the fluid as close to possible to the normal body fluid pH of 7.35-7.45 |
|
|
Term
| What would a buffer do in a basic fluid? |
|
Definition
| release hydrogen ions into the fluid |
|
|
Term
| What would a buffer do in an acetic fluid? |
|
Definition
| bind some of the excess hydrogen ions |
|
|
Term
What does this formula represent?
HCl + H2O = H+ + Cl- + H2O |
|
Definition
| A strong acid, such as hydrochloric acid (HCl) separates (dissociates) completely in water and readily releases all of its hydrogen ions |
|
|
Term
When A = Acid and B = Base
what does this concept represent?
AAABBB |
|
Definition
Neutral pH
acid-base balance |
|
|
Term
When A = Acid and B = Base
what does this concept represent?
AAAABBB |
|
Definition
Actual acidosis
Acid excess |
|
|
Term
When A = Acid and B = Base
what does this concept represent?
AAABB |
|
Definition
Relative acidosis
Base deficit |
|
|
Term
When A = Acid and B = Base
what does this concept represent?
AAABBBB |
|
Definition
Actual alkalosis
Base excess |
|
|
Term
When A = Acid and B = Base
what does this concept represent?
AABBB |
|
Definition
Relative alkalosis
Acid deficit |
|
|
Term
| (x)H2CO3 + (y)HCO3- = normal ratio |
|
Definition
x = 1
y = 20
ratio of
1 carbonic acid to 20 bicarbonate
maintains acid-base balance |
|
|
Term
What does this formula represent?
CO2 + H2O = H2CO3 = HCO3- + H+ |
|
Definition
This is the carbonic anhydrase equasion
The concentration of carbon dioxide is directly related to the concentration of hydrogen ions |
|
|
Term
| Based on the carbonic anhydrase equation, an increase in carbon dioxide would cause a proportionate increase in what? |
|
Definition
|
|
Term
| What is the most common base in the human body fluid? |
|
Definition
|
|
Term
| What is the most common acid in the human body? |
|
Definition
|
|
Term
|
Definition
| Carbonic acid (H2CO3) is formed when carbon dioxide gas is combined with water |
|
|
Term
| Increased carbon dioxide content of a fluid causes increased ___________ in that fluid |
|
Definition
hydrogen ions
which causes a drop in pH
(Acidic) |
|
|
Term
| When free hydrogen ions are produced in a fluid more _________________ is produced |
|
Definition
|
|
Term
| Carbohydrate metabolism forms _______________ |
|
Definition
|
|
Term
| Protein breakdown forms________________ |
|
Definition
|
|
Term
| Fat breakdown forms _____________ and ____________ |
|
Definition
| Fatty acids and ketoacids |
|
|
Term
| Incomplete breakdown of glucose occurs when? |
|
Definition
| when cells are metabolizing glucose under anaerobic (no oxygen) conditions |
|
|
Term
| Anaerobic breakdown of glucose forms ____________ |
|
Definition
|
|
Term
| What medical conditions cause anerobic metabolic states? |
|
Definition
|
|
Term
| When does incomplete breakdown of fatty acids occur? |
|
Definition
| When large amounts of fatty acids are being metabolized |
|
|
Term
| What does the destruction of cells release? What part of the cell in particular is high in this stubstance? |
|
Definition
| Destruction of cells releases acids. Lysosomes contain acids |
|
|
Term
| What is the main buffer of the ECF? |
|
Definition
|
|
Term
| Where does Bicarbonate come from? |
|
Definition
Intestinal absorbtion of ingested bicarbonate
Pancreatic production of bicarbonate
Movement of cellular bicarbonate into the ECF
Kidney reabsorbtion of filtered bicarbonate
breakdown of carbonic acid |
|
|
Term
| What would the significance be of an arterial pH level higher than 7.45? |
|
Definition
Metabolic alkalosis: loss of gastric fluids, decreased potassium intake, diuretic therapy, fever, salicylate toxicity.
Respiratory alkalosis: Hyperventilation |
|
|
Term
| What would the significance be of an arterial pH level lower than 7.35? (7.25 for an individual over 90 years old) |
|
Definition
| Metabolic or respiratory acidosis: Ketosis, renal failure, starvation, diarrhea, hyperthyroidism |
|
|
Term
| What is a normal arterial pH level for a patient over 90 years old? |
|
Definition
|
|
Term
| What is the first line of defense against changes in the amount of free hydrogen ions? Why? |
|
Definition
Buffers - because they are always present in body fluids, and can respond quickly.
Buffers bind to hydrogen ions when too many are present & release hydrogen ions when not enough are present |
|
|
Term
| What can buffers be made of? |
|
Definition
|
|
Term
| What are chemical buffers? |
|
Definition
| Paired mixtures. Typically a weak base and an acid salt. |
|
|
Term
| What are the two most common chemical buffers? Where can each be found? |
|
Definition
Bicarbonate (ECF & ICF)
Phosphate (ICF) |
|
|
Term
| What are protein buffers? |
|
Definition
| Proteins in body fluids that can either bind or release free hydrogen ions as needed |
|
|
Term
| What are the most common type of buffers? |
|
Definition
|
|
Term
| What are two extracellular protein buffers? |
|
Definition
|
|
Term
| What is a major cell protein buffer? |
|
Definition
|
|
Term
| What is the second line of defense against pH changes? |
|
Definition
|
|
Term
| How does breathing control the amount of free hydrogen ions ? |
|
Definition
| by controlling the amount of CO2 in arterial blood. |
|
|
Term
| Is the pressure of CO2 higher in capillary blood or in the air? |
|
Definition
| Much higher in capillary blood. This allows the CO2 to diffuse freely from the blood into the alveolar air |
|
|
Term
| Does CO2 continue to be exhaled when breathing is impaired? |
|
Definition
| Yes. Because the pressure of CO2 in the atmospheric air is nearly zero, CO2 usually continues to be exhaled even when breathing is impaired |
|
|
Term
| What controls the respiratory regulation of acid-base balance? |
|
Definition
|
|
Term
| Special receptors in the respiratory areas of the brain are sensitive to what? |
|
Definition
| Changes in the amount of CO2 in brain tissues |
|
|
Term
| What happens as the amount of CO2 begins to rise above normal in brain blood & tissues? |
|
Definition
| Central receptors trigger neurons to increase the rate and depth of breathing (hyperventilation) |
|
|
Term
| What happens as the amount of CO2 falls below normal levels in brain tissues? |
|
Definition
| Central receptors stop or slow the neuron activity in the respiratory centers of the brain, decreasing the rate and depth of breathing (hypoventilation) |
|
|
Term
| How long does it take for the respiratory system to respond to an acid-base imbalance? |
|
Definition
| Rapid response. Within minutes. |
|
|
Term
| What is the third line of defense against wide changes in body fluid pH? |
|
Definition
|
|
Term
| How long does it take for full response from the kidneys when persistant pH changes occur? |
|
Definition
|
|
Term
| Is the response of the kidney's to pH changes more powerful or less powerful than the response of the respiratory system? |
|
Definition
| More powerful, but much slower. |
|
|
Term
| What are the three functions of the kidneys in maintaining pH? |
|
Definition
Movement of bicarbonate
Formation of Acids
Formation of ammonium |
|
|
Term
| Where does kidney movement of bicarbonate take place? |
|
Definition
|
|
Term
| How does the kidney move bicarbonate made in other areas of the body? |
|
Definition
| Much of the bicarbonate made in other body areas is excreted in the urine. When blood hydrogen ion levels are high, this bicarbonate is reabsorbed from the kidneys back into circulation |
|
|
Term
| How does the the kidney produce bicarbonate? |
|
Definition
| Kidney tubules can make additional bicarbonate and reabsorbe it for an increased buffer effect |
|
|
Term
| What happens to bicarbonate in the kidneys when hydrogen ion levels are low? |
|
Definition
| Bicarbonate is filtered into the urine, not reabsorbed by the kidney tubules, remains in the urine, and is excreted |
|
|
Term
| Does formation of acids by the kidney raise or lower pH levels? |
|
Definition
| Kidney's form acid which is excreted in the urine, removing acid from the body. This causes pH to go up (become more alkaline) |
|
|
Term
| How does formation of acids by the kidneys work? |
|
Definition
| Bicarbonate made in the kidney cells is reabsorbed into the blood along with SODIUM. This leaves the urine with an excess of anions, including phosphate. The negatively charged fluid draws hydrogen ions into the urine, which bind with phosphate, and are exreted in the urine |
|
|
Term
|
Definition
| during normal protein breakdown |
|
|
Term
|
Definition
| Combination of ammonia (end product of protein metabolism) with hydrogen ions. This takes place in the urine. |
|
|
Term
| Does formation of ammonium by the kidney raise or lower pH ? |
|
Definition
| raises pH. Ammonia (end product of protein metabolism) combines with hydrogen ions, forming ammonium, which is then excreted in the urine. This causes the body to become more alkaline, raising the pH |
|
|
Term
|
Definition
| The body adapts to attempt to correct changes in blood pH. |
|
|
Term
| What pH levels are usually fatal? |
|
Definition
|
|
Term
| Respiratory compensation is most usually triggered to correct what kind of acid-base imbalance? |
|
Definition
| Metabolic acid-base imbalance |
|
|
Term
| Kidney compensation is most usually triggered to correct what kind of acid-base imbalance? |
|
Definition
| Respiratory acid-base imbalance |
|
|
Term
| What does "fully compensated" mean |
|
Definition
| The efforts of the backup actions are completely effective, and blood pH returns to normal EVEN THOUGH the levels of oxygen and bicarbonate may be ABNORMAL |
|
|
Term
| What does "partial compensation" mean |
|
Definition
| Efforts of the compensitory effort are not strong enough to bring the blood pH back into normal range, however they help to bring it closer. This can prevent the acid-base imbalance from becoming severe or life threatening. |
|
|
Term
|
Definition
| The body pH is below normal |
|
|
Term
|
Definition
| the Body pH is above normal |
|
|
Term
| What patients are at greatest risk for acute acidosis? |
|
Definition
| Those with problems that impair breathing. Older adults with chronic health problems. |
|
|
Term
| What is an actual acid excess? |
|
Definition
| Acidosis from either an overproduction of acids (and release of hydrogen ions) or underelimination of normally produced acids (retention of hydrogen ions.) More hydrogen ions are present than should be |
|
|
Term
| What are examples of conditions that would cause an actual acid excess acidosis? |
|
Definition
Diabetic ketoacidosis
Seizures
Respiratory impairment
Kidney impairment |
|
|
Term
| What is relative acidosis? |
|
Definition
The amount of acids remains the same, but the strength or amount (or both) of the bases decreases. There is a base deficit.
Caused by either overeliminating bases or underproducing bases |
|
|
Term
| Examples of problems that could lead to relative acidosis |
|
Definition
pancreatitis
dehydration
diarrhea |
|
|
Term
| An increase in hydrogen ions creates imbalances of other positively charged electrolytes, especially __________________ |
|
Definition
|
|
Term
| Early manifestations of acidosis first appear in the: |
|
Definition
| musculoskeletal, cardiac, respiratory, and central nervous systems. |
|
|
Term
| Drugs are _____________ effective during acidosis |
|
Definition
|
|
Term
| What are the four processess that can result in metabolic acidosis? |
|
Definition
Overproduction of hydrogen ions
underelimination of hydrogen ions
underproduction of bicarbonate ions
overelimination of bicarbonate ions |
|
|
Term
| Overproduction of hydrogen ions occurs with: |
|
Definition
excessive breakdown of fatty acids
excessive intake of acids |
|
|
Term
| Ketoacidosis is an example of what kind of acid-base imbalance? |
|
Definition
|
|
Term
| Starvation would put a patient at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| A patient performing heavy excersize would be at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| A patient experiencing seizure activity would be at risk for what acid-base imbalance? Why? |
|
Definition
| Metabolic Acidosis (body has too little oxygen to meet metabolic oxygen demands creating lactic acidosis) |
|
|
Term
| A patient with a high fever would be at risk for what acid-base imbalance? Why? |
|
Definition
| Metabolic Acidosis (body has too little oxygen to meet metabolic oxygen demands creating lactic acidosis) |
|
|
Term
| What agents, when ingested, can cause metabolic acidosis? |
|
Definition
Alcoholic beverages
Methyl alcohol
Acetylsalicylic acid (aspirin) |
|
|
Term
| A patient with kidney failure woudl be at risk for what acid-base imbalance? Why? |
|
Definition
Metabolic acidosis
Kidney tubules cannot secrete hydrogen ions into the urine. Too many hydrogen ions are retained.
Underelimination of hydrogen ions) |
|
|
Term
| A patient with impaired pancreatic function would be at risk for what acid-base imabalance? why? |
|
Definition
Metabolic acidosis.
underproduction of bicarbonate ions. (base deficit) |
|
|
Term
| A patient with severe diarrhea would be at risk for what acid-base imbalance? why? |
|
Definition
Metabolic acidosis
Overelimination of bicarbonate ions (base deficit) |
|
|
Term
| Respiratory acidosis results when: |
|
Definition
Any area of respiratory function is impaired, reducing the exchange of Oxygen and Carbon Dioxide.
Retention of CO2 |
|
|
Term
| A patient with depressed breathing caused by anesthetic agents would be at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| A patient using opioid drugs would be at risk for what acid-base imbalance? |
|
Definition
| Respiratory acidosis (depressed respiration) |
|
|
Term
| Botulinus toxin would put a patient at risk for what acid-base imbalance? |
|
Definition
| Respiratory acidosis (depressed respiration) |
|
|
Term
| Physical depression of respiration occurs when: |
|
Definition
| Neurons are damaged or destroyed by trauma or when problems in the brain increase ICP. This increase causes edema, which presses on the respiratory centers located in the brainstem. |
|
|
Term
| A patient with cerebral edema would be at risk for what acid-base imbalance? |
|
Definition
Respiratory acidosis
caused by physical respiratory depression |
|
|
Term
| A patient with a cerebral aneurysm would be at risk for what acid-base imbalance? |
|
Definition
Respiratory acidosis
caused by physical respiratory depression |
|
|
Term
| Respiratory muscle weakness caused by electrolyte imbalances would put a patient at risk for what acid-base imbalance? |
|
Definition
Respiratory acidosis
caused by inadequate chest expansion |
|
|
Term
| Obesity (particularly when laying down) would put a patient at risk for what acid-base imbalance? |
|
Definition
Respiratory acidosis
caused in inadequate chest expansion |
|
|
Term
| Inadequate chest expansion would put a patient most at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| ascites would put a patient most at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| What things cause airway obstruction? |
|
Definition
| aspiration of foreign objects, bronchoconstriction, mucous, and edema |
|
|
Term
| Airway obstruction would put a patient most at risk for what acid-base imbalance? |
|
Definition
|
|
Term
| TB would put a patient at most risk for what acid-base imbalance? |
|
Definition
Respiratory acidosis
caused by reduced alveolar-capillary diffusion |
|
|
Term
| Pneumonia would put a patient at most risk for what acid base imbalance? |
|
Definition
Respiratory acidosis
caused by reduced alveolar capillary diffusion |
|
|
Term
| Reduced alveolar capillary diffusion puts a patient at most risk for what acid-base imbalance? |
|
Definition
|
|
Term
| What is an example of a patient suffering from both metabolic and respiratory acidosis at the same time? |
|
Definition
| A person with diabetic ketoacidosis and COPD |
|
|
Term
| Are combined acidosis more or less severe than metabolic or respiratory acidosis alone? |
|
Definition
|
|
Term
| What are three natural conditions effecting older adults that put them at greater risk for developing acid-base imbalance? |
|
Definition
| Cardiac, kidney, or pulmonary impairment |
|
|
Term
| What are two kinds of drugs that put older people at higher risk of developing acid-base imbalance? |
|
Definition
|
|
Term
| Specific risk factors to inquire about in a patient suspected of acid-base imbalance |
|
Definition
Breathing problems
Kidney failure
Diabetes mellitus
Diarrhea
Pancretis |
|
|
Term
| Acidosis reduces the_________________ |
|
Definition
| ability of excitable membranes to respond appropriately, especially in cardiovascular tissue, neurons, skeletal muscle, and GI smooth muscle. |
|
|
Term
| Early cardiovascular changes seen with acidosis |
|
Definition
Increased heart rate
Increased cardiac output |
|
|
Term
| Cardiovascular changes seen as acidosis worstens and patient develops kyperkalemia |
|
Definition
Heart rate decreases
T waves become tall and peaked
QRS complexes are widened
Peripheral pulses may be hard to find and are easily blocked
Hypotension (result of vasodilation) |
|
|
Term
| CNS changes seen with acidosis |
|
Definition
Lethargy
Confusion
Really bad = unresponsive |
|
|
Term
| Neuromuscular changes seen with acidosis |
|
Definition
| Reduced muscle tone & deep tendon reflexes |
|
|
Term
| Respiratory changes seen with acidosis that is metabolic in origin |
|
Definition
Rate and depth of breathing increases. Breaths are deep and rapid and not under voluntary control. This is called
Kussmaul respiration |
|
|
Term
| Respiratory changes seen with acidosis that is respiratory in origin |
|
Definition
Breathing efforts are reduced.
Respiratorys shallow and rapid. |
|
|
Term
| Skin changes with respiratory acidosis |
|
Definition
| Skin & mucous membranes are pale to cyanotic |
|
|
Term
| Skin changes seen with metabolic acidosis |
|
Definition
| Vasodilation causes skin and mucous membranes to be warm, dry, & Pink |
|
|
Term
| The first manifestations of acidosis may be: |
|
Definition
|
|
Term
| Lab values for metabolic acidosis |
|
Definition
pH less than 7.35
Bicarbonate less than 21 mEq/L
Pao2 Normal or slightly decreased
Serum potassium level is high |
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Term
| Why are serum potassium levels high during acidosis? |
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Definition
| Body attempts to maintain electroneutrality during buffering. Hydrogen ions moving into cells causes potassium ions to leave cells to maintain electric neutrality. This causes an increase in blood potassium level. |
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Term
| Lab values for respiratory acidosis |
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Definition
pH less than 7.35
Pao2 is low
paco2 is high
Serum potassium levels high for acute, normal to low for chronic
Bicarbonate level depends on how long the respiratory acidosis has been happening and wheather or not the kidneys have had time to compensate |
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Term
| Hallmark lab value of respiratory acidosis |
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Definition
| Decreasing Pao2 with rising paco2 |
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Term
| Why does a decreased Pao2 appear before an increased paco2? |
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Definition
| Because carbon dioxide is 20 times more able than oxygen to diffuse across the alveolar membrane |
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Term
| When is bicarbonate administered? |
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Definition
| Only when serum bicarbonate levels are low |
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Term
| What are nursing priorities for a patient with metabolic acidosis |
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Definition
Monitor the patient for changes that indicate response to treatment or worstening acidosis.
Cardiovascular system and skeletal muscle systems are most sensitive, so they are the systems to monitor
Interpret ABG results |
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Term
| What techniques fall under the category pulmonary hygiene? |
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Definition
| Positioning and breathing techniques to clear airways and encourage gas exchange |
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Term
| Oxygen therapy as an intervention to correct respiratory acidosis needs to be used with caution in what type of patients? Why? |
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Definition
| COPD patients, because their only breathing trigger is arterial oxygen levels, and giving too much O2 decreases their respiratory drive |
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Term
| How often should patients with chronic respiratory acidosis be monitored? |
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Definition
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Term
| What should be included in a respiratory assessment? |
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Definition
Breath sounds
Assess how easily air moves in and out of the lungs
Check for muscle retractions, use of accessory muscles, (especially the neck muscles)
Wheather breathing produces a sound audible without a stethescope
Color of nail beds and mucous membranes |
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Term
| What is decreased blood cation |
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Definition
| Decreased level of positively charged particles in the blood |
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Term
| What are most problems of alkalosis related to? |
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Definition
| Increased stimulation of the nervous, neuromuscular, and cardiac systmes |
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Term
| Excessive use of oral antacids cause what? |
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Definition
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Term
| citrate excesses during amssive blood transfusion would put a patient at risk for what acid-base imbalance? |
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Definition
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Term
| Hallmark lab values for base-excess acidosis |
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Definition
Elevated pH
Elevated bicarbonate level
Normal oxygen level
Noraml carbon dioxide level |
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Term
| Prolonged vomiting would put a patient at risk for what acid-base imbalance? |
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Definition
Metabolic alkalosis
caused by acid deficit |
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Term
| Excess cortison would put a patient at risk for what acid-base imbalance? |
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Definition
Metabolic alkalosis
caused by acid deficit |
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Term
| hyperaldosteronism would put a patient at risk for what acid-base imbalance? |
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Definition
Metabolic alkalosis
caused by acid deficit |
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Term
| thiazide diuretics would put a patient at risk for what acid-base imbalance? |
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Definition
Metabolic alkalosis
caused by acid deficit |
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Term
| Prolonged gastric suctioning would put a patient at risk for what acid-base imbalance? |
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Definition
metabolic alkalosis
caused by acid deficit |
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Term
| What is respiratory alkalosis usually caused by> |
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Definition
| excessive loss of CO2 through hyperventilation (rapid respirations) |
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Term
| Why do patients hyperventilate? |
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Definition
| Response to anxiety, fear, improper settings on mechanical ventilators, direct stimulation of central respiratory centers because of fever, CNS lesions, and salicylates |
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Term
| Hallmart lab values of respiratory alkalosis |
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Definition
Elevated pH
Low CO2 level
Normal O2 level
Normal Bicarb level |
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Term
| Symptoms of both metabolic and respiratory alkalosis are caused by? |
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Definition
| hypocalcemia & hypokalemia |
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Term
| CNS changes caused by alkalosis |
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Definition
| dizziness, agitation, confusion, hyperreflexia, seizure activity, tingling or numbness around the mouth/toes |
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Term
| Positive Chvostek sign would be a symptom of |
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Definition
| alkalosis with hypocalcemia |
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Term
| Positive Trousseau's sign would be a symptom of |
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Definition
| alkalosis with hypocalcemia |
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Term
| Neuromuscular changes seen with alkalosis |
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Definition
| muscle cramps, twitches, charley horses, hyperactive deep tendon reflexes. tetany of muscle groups. |
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Term
| Tetany of muscle groups in a patient with alkalosis would indicate what? |
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Definition
| A rapidly worsening condition |
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Term
| Muscle strength with alkalosis becomes _________________ |
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Definition
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Term
| Cardivascular changes seen with alkalosis include |
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Definition
increased heartrate
thready pulse
hypotension
increased risk for digoxin toxicity |
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Term
| What acid-base imbalance would put a patient at greater risk for digoxin toxicity? Why? |
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Definition
| alkalosis. Due to hypokalemia |
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Term
| Respiratory changes seen with alkalosis |
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Definition
| increased breathing rate are the main cause of respiratory alkalosis |
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Term
| What is the nursing care priority during correction of alkalosis? |
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Definition
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Term
| What about a patient with alkalosis puts them at greater risk for falls? |
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Definition
| muscle wewakness and hypotension. |
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Term
| A patient with metabolic alkalosis caused by diuretic therapy will be treated with? |
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Definition
| fluid and electrolyte replacement. Diuretic therapy will be stopped (at least temporarily) |
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Term
| A patient with metabolic alkalosis caused by prolonged vomiting will be treated with? |
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Definition
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Term
| A patient with metabolic alkalosis caused by prolonged gastric suctioning will be treated with? |
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Definition
| Drug therapy. Gastric suctioning will be discontinued |
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