NUR 112 - IGGY Med Surg I Ch 14.txt

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NUR 112 - IGGY Med Surg I Ch 14.txt
2012-05-03 10:19:07
acid base theory nur112

Assessment and Care of Patients with Acid-Base Imbalances
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  1. Normal ranges for PaO2 and SaO2?
    • PaO2: 80-100 mm Hg
    • SaO2: 95-100%
  2. Which electrolyte has the narrowest range of normal and the tighest controls?
    pH - the body's free hydrogen ion level
  3. pH ranges for arterial and venous blood?
    • Arterial: 7.35 - 7.45
    • Venous: 7.31 - 7.41
  4. H+ concentration?
    <0.0001 mEq/L
  5. Causes of Metabolic Acidosis?
    • Lactic acidosis - glucose breakdown without O2
    • Ketoacidosis - no glucose forces the body to breakdown fatty acids, which if excessive results in strong ketoacids
    • Ingestion of excessive alsohol, methyl alsohol, & aspirin
    • Kidney failure can result in insufficient H+ being eliminated
    • Renal or liver problems can lead to an under production of HCO3
  6. Signs of metabolic acidosis?
    • Respiratory - Rate & depth of breathing increase, ie. rapid and deep, not under volutary control and are called Kussmaul respirations.
    • Skin & Musous - warm, dry, pink
  7. Signs of respiratory acidosis?
    Skin & Musous - pale to cyanotic
  8. Acid-Base effects on PaO2?
    DEcreased only for Resp-Acid & Comb-Acid
  9. Acid-Base effects on K+?
    • INcreased for all Acid
    • DEcreased for all Alka
  10. Acid-Base effects on Ca2+?
    DEcreased ONLY for all Alka
  11. Acid-Base effects on PaCO2?
    • INcreased for Resp-Acid & Comb-Acid
    • DEcreased for Resp-Alka & Comb-Alka
  12. Meta-Acid: Unchanged & Down
    Meta-Alka: Unchanged & up
  13. Acid-Base effects on Cl-?
    UD-0U-U, U-D-D
  14. Example of combine metabolic and respiratory acidosis?
    cardiac arrest
  15. Acid-Base Control mechanisms?
    • 1st: Chemical - The bufferes that act as sponges (absorbing or releasing H+), Bicarbonate in the ECF and ICF. There are also Protein buffers, e.g. hemoglobin.
    • 2nd: Respiratory - Fast acting, but not as powerful as renal
    • 3rd: Renal - Slower acting (24-48 hrs.), but more powerful. Kidneys can (1) excrete or reabsorb HCO3, and they can also (2) make it if extra is needed. The (3) line of renal control is to allow Ammonia (NH3), a byproduct of normal protein breakdown, to combine with H+ ions to form NH4+ (ammonium), when is then excreted.
  16. What is pH
    The negative logarithm of the concentration of free H+ ions
  17. What is the factor in concentration change in a pH from 7 to 6?
    This represents a TENFOLD INCREASE.
  18. What are the effects of pH OUTSIDE the normal range?
      • Changing the shape and reducing the function of hormones and enzymes
      • Changing the distribution of other electrolytes, causing fluid and electrolyte imbalances
      • Changing excitable membranes, making the heart, nerves, muscles, and GI tract either less or more active than normal
      • Decreasing the effectiveness of many drugs
  19. What is bicarbonate?
    It is HCO3- and although it is a weak base (it does not bind with H+ very easily), it prevents major changes in body fluid pH
  20. Define a buffer in terms of acid-base.
    It can act as an acid or a base, either release or binding hydrogen ions when dissoved in a fluid, and which it does depends on the exiting acid-base of that fluid.
  21. Normal pH range?
  22. Ratio of Carbonic acid to Bicarbonate?
  23. Normal HCO3- range?
    21-28 mEq/L
  24. Usually FATAL pH range?
    < 6.9 or > 7.8
  25. Normal PaCO2 range?
    35-45 mm Hg
  26. Normal Lactate range?
    3-7 mg/dL
  27. How is Lactic Acid form?
    Incomplete metabolization of glucose from anewrobic conditions
  28. How ared Ketoacids formed?
    Incomplete breakdown of fatty acids occurs when large amounts are being metabolized.
  29. pH = 7.20, PaCO2 = 60 mm Hg, HCO3- = 24.0 mEq/L
    Respiratory Acidosis Uncompensated
  30. pH < 7.35, PaCO2 > 45 mm Hg, HCO3- = 21-28 mEq/L
    Respiratory Acidosis Uncompensated
  31. pH = 7.58, PaCO2 = 27 mm Hg, HCO3- = 24.0 mEq/L
    Respiratory Alkalosis Uncompensated
  32. pH > 7.45, PaCO2 < 35 mm Hg, HCO3- = 21-28 mEq/L
    Respiratory Alkalosis Uncompensated
  33. pH = 7.10, PaCO2 = 42 mm Hg, HCO3- = 12.0 mEq/L
    Metabolic Acidosis Uncompensated
  34. pH < 7.35, PaCO2 = 35-45 mm Hg, HCO3- < 21 mEq/L
    Metabolic Acidosis Uncompensated
  35. pH = 7.60, PaCO2 = 40 mm Hg, HCO3- = 39.0 mEq/L
    Metabolic Alkalosis Uncompensated
  36. pH > 7.45, PaCO2 = 35-45 mm Hg, HCO3- > 28 mEq/L
    Metabolic Alkalosis Uncompensated
  37. pH = 7.34, PaCO2 = 60 mm Hg, HCO3- = 30 mEq/L
    Respiratory Acidosis Compensated by Metabolic Alkalosis
  38. pH < 7.35, PaCO2 > 45 mm Hg, HCO3- > 28 mEq/L
    Respiratory Acidosis Compensated by Metabolic Alkalosis
  39. pH = 7.34, PaCO2 = 28 mm Hg, HCO3- = 14.7 mEq/L
    Metabolic Acidosis Compensated by Respiratory Alkalosis
  40. pH < 7.35, PaCO2 < 35 mm Hg, HCO3- < 21 mEq/L
    Metabolic Acidosis Compensated by Respiratory Alkalosis
  41. pH = 7.46, PaCO2 = 46 mm Hg, HCO3- = 31.2 mEq/L
    Metabolic Alkalosis Compensated by Respiratory Acidosis
  42. pH > 7.45, PaCO2 > 45 mm Hg, HCO3- > 28 mEq/L
    Metabolic Alkalosis Compensated by Respiratory Acidosis
  43. pH = 7.46, PaCO2 = 22 mm Hg, HCO3- = 15.3mEq/L
    Respiratory Alkalosis Compensated by Metabolic Acidosis
  44. pH > 7.45, PaCO2 < 35 mm Hg, HCO3- < 21 mEq/L
    Respiratory Alkalosis Compensated by Metabolic Acidosis
  45. Acidotic values?
    • pH < 7.35
    • HCO3- range < 21 mEq/L
    • PaCO2 > 45 mm Hg
  46. Alkalemic values?
    • pH > 7.45
    • HCO3- range > 28 mEq/L
    • PaCO2 < 35 mm Hg
  47. 1. What does a pH measurement assess in the client?
    • A) a. Carbon dioxide in arterial blood
    • B) b. Bicarbonate in arterial blood
    • C) c. Free hydrogen ion levels
    • D) d. Hydrogen combined with oxygen
  48. 2. What is the role of bicarbonate in the blood?
    • A) a. Binds with hydrogen ions to decrease acidity
    • B) b. Competes with carbon dioxide for binding sites on hemoglobin molecules
    • C) c. Facilitates the release of hydrogen ions through the renal system
    • D) d. Increases the number of free hydrogen solutions, decreasing alkalinity
  49. 3. Compensation is the process whereby the body uses which three regulatory mechanisms to correct for changes in the pH of body fluids?
    • A) a. Acid, base, buffer
    • B) b. Cardiac, respiratory, neurologic
    • C) c. Chemical, respiratory, renal
    • D) d. Hydrogen ion, bicarbonate, carbon dioxide
  50. 4. The nurse reviews the following arterial blood gases for the client: pH, 7.36; PaCO2, 45; HCO3, 18; PaO2, 84. The nurse is most concerned with which value?
    • A) a. pH
    • B) b. PaCO2
    • C) c. HCO3
    • D) d. PaO2
  51. 5. The client is in the intensive care unit. Which arterial blood gas value might be the first noticeable change in acid-base balance that precedes acidosis?
    • A) a. Decreased O2
    • B) b. Increased CO2
    • C) c. Increased HCO3
    • D) d. Increased pH
  52. 6. To decrease the risk of acid-base imbalance, what goal must the client with diabetes mellitus strive for?
    • A) a. Checking blood glucose levels once daily
    • B) b. Drinking 3 L of fluid per day
    • C) c. Eating regularly, every 4 to 8 hours
    • D) d. Maintaining blood glucose level within normal limits
  53. 7. The client in the intensive care unit is in distress. The nurse obtains arterial blood gases as follows: pH, 7.52; PaCO2, 48; HCO3, 32; PaO2, 78. Based on these findings, what condition does the nurse suspect that the client has?
    • A) a. Metabolic acidosis
    • B) b. Metabolic alkalosis
    • C) c. Respiratory acidosis
    • D) d. Respiratory alkalosis
  54. 8. In assessing the client's acid-base status, the nurse concludes that the client has acidosis based on which arterial blood gas value?
    • A) a. pH of 7.27
    • B) b. PaCO2 of 30
    • C) c. HCO3 of 40
    • D) d. PaO2 of 79
  55. 9. Which intervention is the initial priority for the client with anxiety-induced respiratory alkalosis?
    • A) a. Encouraging fluids
    • B) b. Encouraging slow deep breathing
    • C) c. Finding the source of the anxiety
    • D) d. Instituting stress reduction techniques
  56. 1. Which of these patients would be appropriate to assign to the new graduate RN working on the unit?
    • A) a. A patient with diabetic ketoacidosis who has a pH of 7.28
    • B) b. A patient with emphysema and a PaCO2 level of 55 mm Hg
    • C) c. A patient with reactive airway disease and a PaO2 level of 62 mm Hg
    • D) d. A patient with a small bowel obstruction and a bicarbonate level of 26 mEq/L
  57. 2. The nurse is caring for a patient with hypoxemia and respiratory acidosis. Which of these tasks can be delegated to the experienced nursing assistant who is helping with the patient's care?
    • A) a. Assess the patient�s respiratory pattern.
    • B) b. Increase the IV normal saline to 120 mL/hr.
    • C) c. Titrate O2 to maintain an O2 saturation of 95% to 100%.
    • D) d. Repeat peripheral pulse oximetry reading in 1 hour.
  58. 3. A new graduate RN is caring for a patient who has these arterial blood gases (ABGs): pH 7.30; PCO2 60 mm Hg; PO2 90 mm Hg; bicarbonate 24 mEq/L; and O2 saturation 96%. Which of these actions by the new RN best indicates understanding of the implications of the patient's ABGs?
    • A) a. The new graduate encourages the patient to take deep breaths and cough.
    • B) b. The new graduate administers oxygen to the patient using the PRN oxygen prescription.
    • C) c. The new graduate asks the physician for a prescription for IV sodium bicarbonate.
    • D) d. The new graduate states that the ABGs indicate no changes in therapy are needed.
  59. 4. When caring for a patient with a pulse oximetry level of 89%, which action should the nurse take first?
    • A) a. Elevate the head of bed.
    • B) b. Apply oxygen as prescribed.
    • C) c. Notify the patient�s physician.
    • D) d. Auscultate the breath sounds.
  60. 5. Which of these actions should the nurse take first for the patient who is admitted to the emergency department (ED) with a panic attack and whose blood gases indicate respiratory alkalosis?
    • A) a. Encourage the patient to take slow breaths.
    • B) b. Obtain a prescription for a fluid and electrolyte infusion.
    • C) c. Administer oxygen using the ED standard orders.
    • D) d. Place an emergency cart close to the patient�s room.
  61. 6. Which of these nursing actions included in the plan of care for a patient admitted with metabolic acidosis can the nurse delegate to an experienced nursing assistant?
    • A) a. Ask about medications used at home.
    • B) b. Check the patient�s extremity strength.
    • C) c. Obtain a diet history for the past 3 days.
    • D) d. Place the patient on a cardiac monitor.