Respiratory Wk 6 NRS 222 (pH/acid-base) Flashcards


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1

What ion must be kept within a narrow range within body fluids to maintain homeostasis?

Hydrogen (H+)

2

What does the balance of hydrogen ions in the body determine?

Relative Acidity

3

Why does hydrogen determine relative acidity?

Acids release hydrogen, and bases accept them

4

What is another word for a "Base"?

alkalis

5

As hydrogen ion concentration rises, pH ________

Falls

6

The relationship between pH and hydrogen concentration is __________

inverse

7

As hydrogen concentration falls, pH ___________

rises

8

What pH balance is neutral?

7

9

Healthy human pH is between what?

7.35-7.45

10

What pH can result in death?

Below 7

Above 7.6

11

What is a volatile acid?

An acid that can be eliminated from the body as a gas

12

What is the ONLY volatile acid in the body

carbonic acid (H2CO3)

13

What is carbonic acid made from?

water and carbon dioxide

14

After carbonic acid dissociates, how is it expelled?

as carbon dioxide and water in the lungs

15

All acids in the body aside from carbonic acid are:

nonvolatile

16

How must nonvolatile acids be excreted?

they must be metabolized or excreted in fluid

17

What is metabolized down to phosphoric acid?

phospholipids & phosphoproteins

18

What is metabolized down to lactic acid?

dead ass cells

19

What is metabolized through oxidation down to sulfuric acid?

sulfur containing amino acids

20

What does it mean for acids and bases in the body to be weak?

they neither release or retain very many H+ ions

21

Are most bases in the body weak or strong?

weak

22

What are the three systems that regulate pH in the body?

THE BUFFER SYSTEM

renal

respiratory

23

What are buffers?

substances that pick up hydrogen ions to prevent major acidotic changes

24

What are the three subsystems of the buffer system?

bicarb-carbonic acid

phosphate

protein

25

In plain words, how do buffers work?

They either release or bind to hydrogen to prevent major pH changes

26

What is a normal serum bicarb level?

22-26 mEq/L

27

What is a normal serum carbonic acid level?

1.2 mEq/L

28

What is the normal bicarb-carbonic acid ratio?

20:1

29

What is more important, the bicarb-carbonic acid ratio, or their specific serum levels?

the ratio

30

When the bicarb-carbonic acid ratio is appropriate, what is the body's pH expected to be?

7.35-7.45

31

Is bicarb a strong base?

No

32

Is carbonic acid a weak acid?

yes

33

How does the respiratory system maintain the body's pH?

By retaining or releasing carbon dioxide, which can be combined with water to form carbonic acid

34

How does the brain respond acute increases in carbon dioxide or hydrogen?

the respiratory center causes the body to take deeper, more frequent breaths in order to "blow it off"

35

When the body is in alkalosis, how does the body use its respiratory center to correct this?

depressing rate a depth of breathing to retain co2

36

What type of pH regulation is the renal system responsible for?

long term

37

what do the kidneys excrete to avoid acidosis?

nonvolatile acids

Hydrogen

38

What produces the nonvolatile acids that the kidneys filter and excrete?

The body's metabolism

39

Which organ system does all the bicarb stuff?

renal

40

The kidneys excrete or hold onto which ions in response to pH changes?

hydrogen

41

What do the kidneys produce to buffer an excess of acids in the body?

BICARB

42

In alkalosis, the kidneys excrete _________ and retain _________

bicarb

hydrogen

43

In acidosis, the kidneys excrete _________ and retain _________

hydrogen

bicarb

44

WHat is the body's pH when there is an above normal hydrogen concentration?

<7.35

45

WHat is the body's pH when there is a below normal hydrogen concentration?

>7.45

46

In METABOLIC acidosis or alkalosis, what is the primary change?

bicarb concentration

47

What can cause metabolic acidosis?

excessive nonvolatile acids

bicarb losses

48

What labs represent metabolic acidosis?

Bicarb under 24 mEq/L

pH <7.35

49

What labs represent metabolic alkalosis?

Bicarb >28 mEq/L

pH >7.45

50

In RESPIRATORY acidosis or alkalosis, what is the primary change?

carbonic acid concentration

51

What occurs when carbon dioxide is retained by the body?

the increasing carbonic acid results in respiratory acidosis

52

What PaCO2 signifies respiratory acidosis?

>45 mmHG

53

What is PaCO2?

the pressure exerted by dissolved carbon dioxide in the blood

54

What PaCO2 signifies respiratory alkalosis?

<35 mmHG

55

What can cause a loss of excessive amounts of carbon dioxide?

Hyperventilation

56

Why does hyperventilation cause respiratory alkalosis?

The body does not have time to absorb appropriate amounts of CO2

57

What is a PRIMARY acid-base disorder?

A disorder with one cause

(ie respiratory failure)

58

What is a MIXED acid-base disorder?

occurring due to mixed metabolic & respiratory issues

(ie cardiac arrest)

59

In primary metabolic acid-base disorders, which subsystem compensates?

the pH change effects the rate and depth of breathing

60

In primary respiratory acid-base disorders, which subsystem compensates?

the pH change triggers the kidneys to adjust bicarb conservation and hydrogen elimination

61

How quickly does respiratory compensation take effect?

within minutes

62

What is the downside to respiratory compensation?

it becomes less effective as time goes on

63

the renal system takes longer to compensate for respiratory acid-base disorders. What is the upside?

it is longer lasting

64

When the ABG reflects acid base alterations, but pH is restored to normal it is considered__________

compensated

65

If ABG reflects compensation for acid base issues, but the pH is still all fucked, it is considered __________

partially compensated

66

What typically causes acid-base issues?

Critical illnesses of many kinds

67

Low pH

Low HCO3

Low PaCo2

Metabolic acidosis

68

High pH

High HCO3

High PaCo2

Metabolic alkalosis

69

Low pH

High HCO3

High PaCo2

Respiratory acidosis

70

High pH

Low HCO3

Low PaCo2

Respiratory alkalosis

71

How can acid-base issues lead to cardiac arrest?

by decreasing tissue perfusion

72

What is the main focus in preventing acid-base issues?

Proper hydration--fluid balance

73

What should patients be assessed for to determine general risk for acid base disturbance?

respiratory/renal/metabolic disorders

-anything that can cause a net gain/loss of acids and bases

74

What is a very common outward sign of acid-base disturbance?

decreased LOC

75

Ultimately, what is metabolic acidosis?

Bicarb deficit

76

Ultimately, what is metabolic alkalosis?

Bicarb excess

77

S & S for metabolic acidosis?

Hyperventilation

decreased LOC

headache/weakness/fatigue

N/V

78

S & S for metabolic alkalosis?

respiratory failure

seizures

hypoTN

tetany

confusion

79

S & S for acute respiratory acidosis?

decreased LOC

irritability- altered mental status

headache

Cardiac arrest

80

S & S for chronic respiratory acidosis?

dull headache

personality changes

impaired memory

weakness

81

S & S for respiratory alkalosis?

hyperventilation

anxiety-panic

palpitations

dizziness/decreased LOC

tetany

82

If it is metabolic, which lab ranges are pertinent?

pH

bicarb

PaCO2

83

If it is respiratory, which lab ranges are pertinent?

pH

HCO3

PaCO2

84

What is a normal PaCO2 reading?

35-45 mmHG

85

What is an acceptable PaO2 reading when there is concern for acid-base imbalance?

75-100mmHG

(However, less than 80 is considered hypoxemia)

86

What percentage of blood is transported in solution, and is available for cell use because it is dissolved?

3%

87

What is an acceptable HCO3 reading when there is concern for acid-base imbalance?

24-28 mEq/L

88

Peripheral O2 sat of 90% should correlate to what PaO2 reading?

60 mmHG

89

What is the gold standard for determining blood oxygen concentration?

ABG

(pulse ox can be affected by disease causing garbage peripheral perfusion)

90

Due to the fluid balance component of acid-base issues, what should a nurse do with the pt?

-I&Os

-daily weights

-assess LOC

-assess renal function

91

Due to the oxygenation component of acid-base issues, what should a nurse do with the pt?

-vitals, yo

-assess neurological function and LOC

-assess respiratory function

-maintain patent airway

92

What is the ultimate result of severe, untreated metabolic acidosis?

-myocardial depression

-shock/multiorgan failure

-seizures

93

What is the main concern with using sodium bicarb to treat acidosis?

overcorrecting-- it works fast

94

What symptoms must be watched for in administration of sodium bicarb?

weakness

cyanosis

irritability & confusion

slow respirations

irregular pulse

95

What symptoms should be seen in a pt who is about to recieve sodium bicarb?

hypoventilation

sleepiness/coma/disorientation/dizziness

headache

seizures

96

When can sodium bicarb be used?

ONLY if pH is under 7.2

97

Why should sodium bicarb be avoided if possible in the presence of cardiac and renal disease?

all dat sodium

98

Sodium bicarb can speed up the excretion of acids and alkalinize the urine. Which medication toxicities and side effects can be treated this way?

-certain chemos (methotrexate) --side effects

-aspirin--toxicity

-phenobarbital --toxicity

99

What is ion trapping?

when bicarb is used to trick the kidneys into not resorbing acids because the urine registers as alkaline

100

Because sodium bicarb is literally baking soda, what do cardiac pts accidentally do to themselves?

take an ass ton of it to treat "heartburn" that is really a cardiac emergency

--then they get the double whammy of cardiac emergency+systemic alkalosis

101

When is intubation typically indicated for a pt in respiratory distress?

-pH 7.2

-PaCO2 >77 mmHG

-PaO2 <60 mmHG

102

What can correcting CHRONIC hypercapnia (ie COPD) do to a pt?

metabolic alkalosis due to sudden retention of an assload of bicarb

103

What acid-base problem can hypernatremia cause?

Metabolic acidosis

104

What does lactic acidosis come from?

tissue hypoxia--> anaerobic metabolism --> lactate/hydrogen ions produced --> lactic acid formed

105

What causes ketoacidosis?

starvation/lack of insulin forces body to use fats---> fatty acid breakdown produces ketones

106

Why does lack of insulin have the same effect as starvation?

Water everywhere but not a drop to drink

(glucose cannot be moved into the cells)

107

What are some ingestible substances that break down and raise the body's acidity or stimulate production of metabolic acids?

aspirin/salicylates (salicylic acid)

methanol

ethylene (antifreeze/solvents)

108

What is high anion gap acidosis?

buffering of excess acids by bicarb

109

Loss of stomach acid causes alkalosis for obvious reasons, loss of what digestive fluids can cause acidosis?

bicarb rich pancreatic secretions

(Loss of GI fluid below the level of the duodenum )

110

What can cause acidosis from the loss of the bicarb in pancreatic fluid?

intestinal suction

fistulas

ileostomy over-drainage

severe diarrhea

111

When does the anion gap remain normal in the presence of metabolic acidosis?

loss of bicarb

OD of sodium

112

Why does acidosis affect neuromuscular function?

it wrecks cell membrane excitability

increases calcium by fucking up protein binding

113

What does wrecked cell permeability and increased calcium result in when pH gets down to 7?

Garbage myocardial contractility--decreased CO

114

In normal kidney function, what is done to deal with decreased cell membrane excitability and excess calcium in metabolic acidosis?

increased production of ammonia

flushing out acids/H+

115

Why is hyperkalemia common in acidosis?

Hydrogen enters cells, displacing potassium because of natural maintenance of the balance of cations and anions

116

How does metabolic acidosis induced protein binding fuckery result in increased free serum calcium?

Calcium is released from plasma proteins

117

Which electrolyte may be decreased in metabolic acidosis?

mag

118

What diseases are risk factors for metabolic acidosis?

anorexia (w/ cachexia)

laxative abuse/severe diarrhea

DKA

renal/hepatic failure

severe sepsis

salicylate overuse

119

What are the GENERAL manifestations of metabolic acidosis?

weakness/fatigue

malaise

headache

120

What are the GASTROINTESTINAL manifestations of metabolic acidosis?

N/V

decreased appetite

ab pain

121

What are the NEUROLOGICAL manifestations of metabolic acidosis?

decreased LOC

---stupor

------coma

122

What are the potential CARDIAC and RESPIRATORY manifestations of metabolic acidosis?

dysrhythmia

bradycardia

dyspnea

hyperventilation

123

Why might certain skeletal problems result in chronic acidosis?

phosphate and calcium are released from the bones

124

What are kussmaul respirations evidence of compensation for?

acidosis

125

What is the primary focus in treating metabolic acidosis?

treating the disorder that led to it

126

What are the two biggest concerns when treating a metabolic acidosis pt?

reducing cardiac damage

ensuring oxygenation

127

Which electrolyte imbalance resulting from metabolic acidosis is the greatest concern?

hyperkalemia

128

How is metabolic acidosis difinitively diagnosed?

ABG

serum electrolytes

(+ tests indicated by causative disorder)

129

What can be given to a metabolic acidosis pt other than bicarb to alkalize?

(ie what metabolizes down to bicarb?)

lactate

citrate

acetate

130

In acute metabolic acidosis, bicarb/acetate/lactate/citrate is given IV. How is it given in chronic cases?

PO

131

Why might bicarb use in treating acidosis lead to cardiac dysrhythmias if not carefully monitored?

K shifts back into cells at too fast a rate

132

When is bicarb not used to treat metabolic acidosis?

when the underlying condition can be treated instead

(DKA--insulin/fluids)

(crush injuries--perfusion enhancement)

133

What is the most common cause of metabolic acidosis in babies?

severe diarrhea

134

Why do older adults have an increased risk of metabolic acidosis?

-more chronic disease (DM, renal, metabolic)

-Polypharmacy (aspirin, diuretics, ACE inhibitors, etc)

135

Patients with underlying disease that puts them at risk of metabolic acidosis should be taught what?

metabolic acidosis presents with vague symptoms, like a virus, and they need to be seen if they develop them

136

In the patient with metabolic acidosis, what should slow cap refill and/or diminished peripheral pulse strength cause concern for?

decreased CO

137

In the patient with metabolic acidosis, what should widened QRS complex cause concern for?

potential cardiac arrest

increasing risk of dysrhythmias

138

Why can diminished cardiac output intensify the degree of a pt's metabolic acidosis?

decreased tissue perfusion leading to lactic acidosis

139

What can administration of sodium bicarb cause in relation to fluid balance?

hyperosmolality

hypernatremia

volume excess

(because, sodium)

140

Decreasing LOC should make one expect a decreasing _________ as well, in acid-base issues

pH

141

In metabolic alkalosis, what do the lungs do to compensate?

slow respirations in an attempt to hold onto CO2, which can be combined with water to make carbonic acid

142

When metabolic alkalosis occurs due to a loss of hydrogen, what is typically the cause?

vomiting or gastric suction-- loss of highly acidic gastric secretions (pH 1-3)

143

Why is bicarb paradoxically retained in metabolic alkalosis resulting from a loss of gastric secretions?

Large amounts of chloride are lost, which are an important component in the cation-anion balance in extracellular fluid. Bicarb can be used to replace chloride's spot as an anion in this situation.

144

Why can hypokalemia cause metabolic alkalosis?

-as the kidneys try to conserve potassium, hydrogen may be lost instead.

-lack of potassium ions in cells may result in hydrogen ions shifting into them instead

145

In cases of metabolic alkalosis that are NOT due to acid loss, what has typically occurred?

excessive ingestion of bicarb through things like antacids

146

In acidosis, protein binding is reduced, causing hypercalcemia. What happens to calcium in alkalosis?

Binding is enhanced, potentially leading to HYPOcalcemia

147

What is the cause of most symptoms of metabolic alkalosis?

Decreased calcium ionization

(basically hypocalcemia)

148

Hypokalemia can cause metabolic acidosis, but it can also BE caused by metabolic acidosis. How?

Hydrogen ions shift out of cells in an attempt to restore pH, and potassium replaces them, removing them from the extracellular space

149

High pH _______________ the respiratory system

depresses

150

What are causes of PRIMARY metabolic alkalosis?

lactate administered during dialysis

ingestion of antacids

too much bicarb

151

What are SECONDARY causes of metabolic alkalosis?

hypochloremia

hypokalemia

NG suctioning/excessive vomiting

hyperaldosteronism

loop diuretics

152

What age group is at the greatest risk of metabolic alkalosis and why?

older adults because of their fragile fluid balance

153

What happens if a chronic hypercapnia pt (ie COPD) pt's PaCO2 levels are reduced too quickly?

Metabolic alkalosis

154

Since outward s&s of metabolic alkalosis results from decreased calcium ionization, and present like hypocalcemia, what might be present in an alkalosis pt?

-numbness/tingling around mouth, fingers, toes

-dizziness

-trousseau sign

-muscle spasm

155

What is trousseau sign?

-spasm of hand and fingers due to occlusion of blood supply

156

What does respiratory compensation for metabolic acidosis ultimately lead to over time?

respiratory failure

respiratory acidosis

157

Which electrolyte imbalance EKG pattern might be seen in the metabolic alkalosis?

that of hypokalemia

158

What does pharmacological treatment of moderate metabolic alkalosis entail?

potassium chloride and sodium chloride

159

How do chloride solutions help correct metabolic acidosis?

chloride encourages excretion of bicarb

160

What does pharmacological treatment of severe metabolic alkalosis entail?

dilute hydrochloric acid or ammonium chloride

(acidifying solutions)

161

What are the most likely causes of metabolic alkalosis in children?

prolonged vomiting

cardiac surgery

CF

NG suctioning

162

How can a nurse help treat the respiratory issues that come alongside metabolic alkalosis?

-LOC/neuro checks

-ABG

-positioning that facilitates respiration--prevents aspiration

-assessment of RR and depth

163

Why is vomiting more likely to cause metabolic alkalosis in older adults than younger adults?

Diminished sense of thirst--> may already be dehydrated or borderline

164

When can dehydration cause alkalosis?

When hypokalemia is present

165

Aside from whatever the underlying cause is, what is a priority problem with metabolic alkalosis?

impaired gas exchange

(due to respiratory compensation)

166

When should O2 sat on a metabolic alkalosis pt be reported, unless otherwise specified?

<95%

167

What bicarb level is found in respiratory acidosis?

Why?

>28 mEq

renal compensation

168

What potentially fatal phenomenon often follows respiratory acidosis?

hypoxemia

169

What typically causes ACUTE respiratory acidosis?

-chest trauma

-choking

-sedative/narcotic OD

-acute pneumonia

** anything that fucks up o2-co2 exchange severely enough**

170

Why does PaCO2 rise and pH fall so quickly in acute respiratory acidosis?

the causative factor causes rapid onset hypoventilation

171

Why is there no evidence of renal compensation during most acute cases of respiratory acidosis?

they are either short lived or result in death, and the kidneys take hours or days to compensate

172

What might one find in an integumentary assessment of a pt with metabolic acidosis?

warm, flushed skin

173

What sudden failure does acute respiratory acidosis result from?

failure of ventilation

exchange of o2 and co2

174

Where do the vision problems associated with respiratory acidosis come from?

Intercranial pressure eventually inflames the optic nerve

175

Cerebral vasodilation due to respiratory acidosis leads to headaches and visual problems, what does it do peripherally?

lowers BP, triggering the heart to increase pulse rate

176

What is chronic respiratory acidosis associated with?

-Chronic respiratory and neuromuscular disorders that impact o2-co2 exchange severely enough

MS, CF, COPD etc etc

177

Why does pH remain relatively normal in cases of chronic respiratory acidosis?

the kidneys compensate by consistently resorbing lotsa bicarb

178

What happens to the respiratory center chemoreceptors when co2 is chronically high?

becomes less sensitive to gas as a stimulant of increased respiratory drive

179

What is carbon dioxide narcosis?

when chemoreceptors in the brain become less sensitive to Co2 due to chronic acidosis, too much supplemental oxygen suppresses the respiratory drive

--they breathe in response to minor hypoxia, and become dependent on it

180

For chronic respiratory acidosis pts, what PaO2 can trigger carbon diocide narcosis?

70mmHG or higher

181

What are the common clinical manifestations of hypercapnia induced vasodilation?

Headache

mental cloudiness

irritability

blurred vision

182

What is the ultimate outcome of untreated respiratory acidosis?

progressive decrease in LOC

ventricular fib

potential lethal dysrhythmia

183

What method of breathing may help a chronic respiratory acidosis pt?

pursed lip

semi-fowler or fowler positioning

184

How can respirations in respiratory acidosis be assisted mechanically?

CPAP

185

How might chronic respiratory acidosis impact electrolyte balance?

Hypochloremia

186

Respiratory alkalosis is ALWAYS caused by

hyperventilation

187

What is the most common cause of respiratory alkalosis?

anxiety-induced hyperventilation

188

Other than anxiety, what are common causes of respiratory alkalosis?

**anything that causes hyperventilation**

-high fever

-gram-negative bacteremia

-thyrotoxicosis

-hypoxemia

189

Why is respiratory alkalosis common in pregnancy?

progesterone stimulates the respiratory center, leading to hyperventilation

190

Why might respiratory alkalosis occur during surgery?

mechanical ventilation during anesthesia is overdone

191

In chronic respiratory alkalosis, bicarb level is often __________

decreased due to long term renal compensation

192

Like metabolic alkalosis, respiratory alkalosis encourages the binding of calcium to proteins (albumin), and this process causes a reduction in

ionized calcium

193

Like metabolic alkalosis, respiratory alkalosis causes symptoms of hypo-

calcemia

194

The lack of cO2 present in respiratory alkalosis leads to ____________

vasoconstriction, causing neurological symptoms

195

Symptoms of respiratory alkalosis include:

anxiety

lightheadedness/tinnitus

difficulty concentrating

(hypocalcemia--trousseau/chovstek/paresthesias/tingling)

chest tightness

seizures and loss of consciousness

196

Why is the paper bag method no longer used to treat hyperventilation/respiratory alkalosis?

increased co2 can increase anxiety

may cause hypoxia

197

What can a nurse do to help treat anxiety induced hyperventilation/respiratory alkalosis?

Coach slow, regular breaths into cupped hands

198

Which symptom of respiratory alkalosis is often particularly concerning to children and parents?

paresthesia

199

What symptoms are especially common in older adults with respiratory alkalosis?

chest pain

respiratory distress

200

What is often the best treatment fo respiratory alkalosis?

stress reduction

--manipulation of the environment

201

Respiratory alkalosis induced chest tightness, palpitations, pain and dyspnea often cause anxiety because the patient fears what?

having a heart attack

202

What is congenital acquired renal tubular acidosis?

A condition in which the kidneys excrete too much bicarb, and sometimes potassium

203

Where do circumoral paresthesias, as seen in respiratory alkalosis, occur?

around the mouth

204

How can the discomfort of paresthesias be treated in infants?

-swaddling

-calm quiet voice

-gentle touch

205

How can the discomfort of paresthesias be treated in preschoolers?

-singing songs

-stuffed animal

-talking quietly

206

How can the discomfort of paresthesias be treated in school aged children?

-reading familiar book

-supportive listening

-talking

207

How can the discomfort of paresthesias be treated in older children and adolescents?

-music and videos

-coping mechanisms

-reassurance