Acid/Base Imbalances and Pneumonia Ch. 33 Chapter 14 9/5/12

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aiwanski
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Acid/Base Imbalances and Pneumonia Ch. 33 Chapter 14 9/5/12
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2012-09-16 14:22:58
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Acid Base Imbalances Chapter 14 12
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Acid/Base Imbalances Chapter 14 9/5/12
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  1. Define body fluid pH? 
    Body fluid pH is a measure of the body's fluid's free hydrogen ion level.  This value has the narrowest range of normal and the tightest control mechanisms of all electrolytes. 
  2. What is the normal pH range for arterial blood?
    7.35-7.45
  3. What is the normal pH range for venous blood?
    7.31-7.41
  4. _____, are substances that release hydrogen ions when disolved in water?
    Acids.

    *A strong acid, such as HCl, seperates (dissociates) completely in water and readily releases all of it's hydrogen ions. 
  5. A _____ is a substance that binds free hydrogen ions in solution?
    Base.

    Thus, bases are hydrogen acceptors that reduce the amount of free hydrogen ions in solution. 
  6. ____s, can either release a hyrdrogen ion into a fluid or bind a hydrogen ion from  a fluid. They always try to bring the fluid as close as possible to the normal body fluid pH of 7.35-7.45
    Buffers.

    Pg. 200
  7. The ratio of carbonic acid and bicarbonate level in Extra Cellular Fluid (ECF) is __:__?
    1:20
  8. as the amount of CO2 begins to rise above normal in brain blood and tissues, these central receptors trigger the neurons to increase the rate and depth of breathing, AKA _____?
    Hyperventilation.

    *As a result, more CO2 is exhaled (blown off) from the lungsand the amount of CO2 in the ECF decreases. 
  9. If the amount of ECF free hydrogen ions is too low, then the amount of Co2 also is too low.  Central receptors sense these low Co2 levels and sto[p or slow the neuron activity in the respiratory centers, decreasing the rate and depth of breathing AKA_______?
    Hypoventilation. 
  10. Lab Values:

    pH Adult?  ______to______ Arterial?

    Venous ______to________?
    Arterial: 7.35-7.45

    Venous: 7.31-7.41
  11. Lab Values:

    Normal pH for >90 Years?  _____to______Arterial?
    7.25-7.45

    (Venous value same as adult <90 years Venous: 7.31-7.41)
  12. Lab Values: pa02 stands for _______?  Normal range for adult <90 yr?
    PaO2 stands for the partial pressure of O2 in arterial blood

    80-100 mmHg
  13. Lab Values:

    Normal value of paO2 for >90 yr?
    >70-90 mmHg
  14. Lab values: PaCO2 stands for?  Normal value  _____ to _____ mmHg arterial?  Venous _____ to _____ mmHg?
    Partial Pressure of Carbon Dioxide in Arterial Blood

    Arterial: 35-45 mmHg

    Venous: 40-50 mmHg
  15. Lab values:
    Normal bicarbonate level?  Arterial ______?  Venous______?
    mEq/L
    Arterial: 21-28 mEq/L

    Venous: 24-29 mEq/L
  16. Lab values:

    Normal range of lactate ______ to _______ mg/dl arterial? 
    Venous ______ to ________ mg/dl
    Arterial: 3-7 mg/dl

    Venous: 5-20 mg/dl

    *See page 202, also measured in mmmol/L.....  Screw that!!!!
  17. What is the significance of an increase in pH in the blood?  6 things.
    • Metabolic Alkalosis
    • Loss of gastric fluids
    • decreased postassium intake
    • diuretic therapy
    • fever
    • salicylate toxicity (aspirin)
  18. What is the significance of a decrease in pH in the blood?

    (7)
    • Metaboic acidosis
    • Respiratory acidosis
    • ketosis
    • renal failure
    • starvation
    • diarrhea
    • hyperthyroidism
  19. What is the significance of an increase in PaO2 (3)?
    • Increased ventilation
    • oxygen therapy
    • exercise
  20. What is the significance of a decrease in PaO2 (5)?
    • Respiratory depression
    • high altitude
    • carbon monoxide poisoning
    • decreased cardiac output
  21. What is the significance of increased PaCo2 (5)? 
    Respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression. 
  22. What is the significance of decreased PaCo2 (3)?
    • Respiratory alkalosis
    • excessive ventilation
    • diarrhea
  23. What is the significance of increased bicarbonate (2)?
    • Bicarbonate therapy
    • metabolic alkalosis
  24. What is the significance of decreased bicarbonate (3)?
    • Metaboic acidosis
    • diarrhea
    • pancreatitis
  25. What is the significance of increased lactate (5)?
    • Hypoxia
    • Exercise
    • Insulin Infusion
    • Alcoholism
    • Pregnancy
  26. What is the significance of decreased lacatate (1)?
    Fluid overload
  27. Acid-Base Regulatory Mechanisms

    Chemical 2 types of buffers?
    • Protein buffers
    • Chemical buffers
  28. Protein Buffers include (3)
    • Albumin
    • Globulins
    • Hemoglobin
  29. Chemical Buffers include (2)?
    • Bicarbonate
    • Phosphate
  30. Acid-Base Regulatory Mechanisms.  Key characteristics of: Chemical.  (Informational)
    Very rapid response.  Provide immediate response to changing conditions.  Can handle relatively small fluctuations in hydrogen ion production and elimination encountered under normal metabolic conditions. 
  31. Acid-Base Regulatory mechanisms

    Respiratory: Increased hydrogen ions or increased carbon dioxide stimulates central respiratory neurons leading to ______ which leads to _____?
    increased rate and depth of breathing, causing more carbon dioxide to be lost and decreasing the hydrogen ion concentration. 
  32. Acid-Base Regulatory Mechanisms:

    Respiratory: Decreased hydrogen ions or decreased Co2 inhibits central respiratory neurons, leading to
    Decreased rate and depth of breathing, causing normally produced carbon dioxide to be retained, increasing the hydrogen ion concentration.

    *Primarily assist buffering systems when the fluctuation of hydrogen ion concentration is acute. 
  33. Acid-Base Regulatory Mechanisms

    Renal: 2 mechanisms to decrease pH?
    • Increased renal excretion of bicarbonate
    • Increased renal reaborption of hydrogen ions. 
  34. Acid-Base Regulatory Mechanisms

    Renal: 2 mechanisms to increase pH?
    • Decreased renal excretion of bicarbonate
    • Decreased renal reabsorption of hydrogen ions

    *The most powerful regulator of acid-base balance .  Respond to large or chronic fluctuations in hydrogen ion production or elimination .  Slowest response (hours to days).  Longest duration.
  35. Name the 3 lines of defense in order for compensatory mechanisms to maintain pH?
    • Buffers
    • Respiratory
    • Renal
  36. In the process of _______, the body adapts to attempt to correct changes in the blood pH.  A pH below____ or above ____ is usually fatal.
    • Compensation
    • <6.9 or >7.8
  37. Patients at greatest risk for developing acidosis are patients who: (2)
    • Problems that impair breathing
    • Older adults with chronic health problems.

    **Also, diabetic ketoacidosis, seizures, respiratory impairment, and renal impairment. 
  38. See chart at bottom of pg. 205 for differences between respiratory acidosis and metabolic acidosis. 
    See chart at bottom of pg. 205 for differences between respiratory acidosis and metabolic acidosis.
  39. Unlike ______acidosis, _____acidosis results from only one mechanism--retention of Co2.
    • Metabolic Acidosis
    • Respiratory Acidosis
  40. Breaths that are deep and rapid and not under voluntary control are called____________?
    Kussmaul Respirations
  41. Carbon dioxide is 20 times more able than oxygen to diffuse across the alveolar membrane.  Therefor a decreased ____ usually occurs before an increased _____?
    • Pao2
    • Paco2
  42. For patients with COPD (as evidenced by a high PaCo2 level), use caution when giving O2. Why? 
    The only breathing trigger for these patients is a decreased arterial oxygen level.  Giving to much oxygen to these patients decreases their respiratory drive and may lead to respiratory arrest. 
  43. Most problems of alkalosis are related to: (3)
    increased stimulation of the nervous, neuromuscular, and cardiac systems. 

    **See page 211 chart 14-7 for Alkalosis manifestations**
  44. Pneumonia Slides Begin

    Pathophysiology: 2 types of pneumonia?
    Community Aquired Pneumonia (CAP)

    Hospital Aquired Pneumonia (HAP)
  45. The most common type of Hosptial Aquired Pneumonia is?
    Ventilator Aquired Pneumonia (VAP)
  46. Community Aquired Pneumonia is typically a complication of?
    Influenza
  47. Hospital Aquired Infections are also known as?
    Nosocomial Infections
  48. 6 Risk factors for Community Aquired Pneumonia (CAP)
    • Older Adult
    • No pneumococcal vaccination or received it more than 6 years ago
    • No influenza vaccine in the previous year
    • Chronic Health Problem
    • Exposure to respiratory viral or influenza infections
    • Tobacco, alcohol, or secondhand smoke. 
  49. Risk Factors for Healthcare Aquired Pneumonia (10)?
    • -Older Adult
    • -Chronic Lung Disease
    • -Gram-negative colonization
    • -Altered level of consciousness
    • -Recent Aspiration Event
    • -Endotracheal, tracheostomy, or NG tube
    • -Nutrition
    • -Immunocompromised
    • -Increased gastric pH(ex. antacids result in less bacteria killed off)
    • -Mechanical Ventilation
  50. Ventilator Associated Pneumonia Prevention (VAP) 6?
    • Oral Care
    • Jewelry
    • Wash Hands
    • Suctioning
    • Head of the bed elevated 30 degrees
    • Confirm the placement of any nasogastric tube (chest xray)
  51. How do you perform Tactile Fremitus?
    tactile fremitus is a vibration that you can feel with the palm of your hands when someone says "blue moon" or "99". increased fremitus is a sign of consolidation. decreased fremitus is a sign of pneumothorax or pleural effusion. think of physics and impedence.
  52. ABG Interpretation

    Respiratory Acidosis ____pH and ______Co2?
    • Low pH
    • High Co2
  53. ABG Interpretation

    Metabolic Acidosis _____pH and ________HCo3-?
    • Low pH
    • Low HCo3-
  54. ABG Interpretation

    Respiratory Alkalosis: _____pH and _____ Co2?
    • High pH
    • Low Co2
  55. ABG Interpretation

    Metabolic Alkalosis: _____pH and _____HCo3-
    • High pH
    • High HCo3-
  56. HCo3- is?

    Normal value ____-_____ mEq/L?
    Bicarbonate

    21-28 Meq/L
  57. s/s of respiratory alkalosis (6)?
    • Hyperventilation
    • Fear
    • Anxiety
    • Mechanical Ventilation
    • Shock
    • Early stage acute pulmonary problems
  58. Signs of Metabolic Acidosis (10)?
    • Ketoacidosis
    • Starvation
    • Renal Failure
    • Hypermetabolic-fever, ischemia, heavy exercise
    • Salicylate
    • Ethanol/methanol
    • Dehydration
    • Pancreatitits
    • Diarrhea
    • Bowel Obstruction
  59. s/s of metabolic alkalosis (9)
    • Antacids
    • Na bicarbonate
    • TPN
    • Transfusion
    • Vomiting
    • NG tube suctioning
    • Diuretics
    • Cortisolism
    • Aldosteronism

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