Acid/Base Balance - TWU Nursing (Concepts)

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CheSuzMan
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219098
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Acid/Base Balance - TWU Nursing (Concepts)
Updated:
2013-05-11 16:23:08
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texas woman university nursing weekend program acid base balance buffer systems regulation respiratory renal imbalance hypo hyper metabolic acidosis alkalosis
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Acid/Base Balance that nurses should be familiar with
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  1. What is the normal pH range?
    7.35 - 7.45

    Acidosis is too much H+

    Alkalosis is too much bicarbonate HCO3
  2. What buffer systems help regulate acid/base balance?
    • Carbonic acid (H2CO3) system
    • Sodium bicarbonate (HCO3) system
    • Phosphate system
    • Protein system
    • Lungs and Kidney play important role
  3. Respiratory regulation?
    Carbonic acid (H2CO3) byproduct of cellular metabolism (H2O and CO2)

    Excessive carbon dioxide (CO2) detected by chemoreceptors in respiratory center of medulla

    Result: increased respiratory rate (RR) and depth to eliminate CO2

    Causes decrease of H2CO3 and shift of blood pH from acid to alkaline

    Body decreases RR rate and depth to retain CO2 and bring body back to balance
  4. Renal regulation?
    Excrete H+ and HCO3 to maintain pH balance

    Acidosis: Kidneys excrete H+ and retain HCO3 to raise pH to normal level

    Alkalosis: Kidneys retain H+ and excrete HCO3 to lower pH to normal level

    Renal regulation occurs more slowly than respiratory and may take as long as three days to restore balance
  5. What causes acid/base imbalance?
    Imbalances occur as a result of disproportionate levels of carbonic acid (H2CO3) and bicarbonate (HCO3) in the body.

    Can manifest as metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis.
  6. What are some common causes of ACIDOSIS?
    • Lactic acidosis
    • Ketoacidosis
    • Bicarbonate loss (diarrhea)
    • Acute respiratory conditions
    • Chronic respiratory conditions
    • Stroke
    • Neuromuscular diseases
    • Opiate overdose
    • Hypoventilation
  7. What are some common causes of ALKALOSIS?
    • Vomiting
    • Gastric suction
    • Excess bicarbonate administration
    • Hyperventilation
    • Fever
  8. What is METABOLIC ACIDOSIS?
    • Low pH (acidic)
    • Low plasma bicarbonate

    • CAUSED by:
    • a) increased H+
    • b) decreased HCO3-
    • c) renal failure
    • d) diabetic ketoacidosis (DKA)

    • MANIFESTS:
    • 1. Lungs initially attempt to regain balance (breathe heavy) but may not be adequate.
    • 2) Kidneys will then retain HCO3- and excrete H+.
  9. What is METABOLIC ALKALOSIS?
    • High pH (basic)
    • High plasma bicarbonate

    • CAUSED by:
    • a) decreased H+
    • b) increased HCO3-
    • c) vomiting
    • d) overuse of antacids

    • MANIFESTS:
    • 1) Body tries to retain CO2 by slow, shallow respirations and apneic periods.
    • 2) Kidneys attempt to retain H+ to lower pH.
  10. What is RESPIRATORY ACIDOSIS?
    • High PaCO2
    • (due to alveolar hypoventilation)

    • CAUSED by:
    • a) excess CO2
    • b) chronic lung disorders
    • c) CNS depression
    • d) narcotics

    • MANIFESTS:
    • 1) Increased respiration rate (to get rid of CO2)
    • 2) If 1 doesn't work, then kidneys attempt to eliminate H+ and retain HCO3- to lower pH.
  11. What is RESPIRATORY ALKALOSIS?
    • Low PaCO2
    • (due to alveolar hyperventilation or respiratory infection)

    • CAUSED by:
    • a) deficit of carbonic acid in ECF

    • MANIFESTS:
    • 1) Decreased respiration rate (to retain CO2)
    • 2) If >6hrs, kidneys increase HCO3- excretion and retain more H+ to lower pH.
  12. What diagnostics are ordered?
    • Basic Metabolic Panel (BMP, or Chem7)
    • Comprehensive Metabolic Panel (CMP)
    • Complete Blood Count (CBC)
    • Serum Osmolality (to measure serum solute concentration)
    • Urine Specific Gravity (solute concentration)
    • Urine pH
    • ABG's (acid/base balance, oxygenation)
  13. What assessments are you doing?
    •O2 sats

    •ABG’s (if ordered)

    •Respiratory (rate, pattern, auscultation)

    •LOC

    •Skin color

    •Labs

    •GI

    •Medications

    •I/O
  14. What are the nursing diagnoses?
    •Anxiety

    •Ineffective Breathing pattern

    •Impaired Gas Exchange

    •Fatigue

    •Acute Confusion

    •Knowledge Deficient

    •Risk for Falls
  15. What nursing interventions are you gonna do?
    •Teaching: breathing pattern, pursed-lip, deep breath & cough, IS

    •Relaxation techniques: guided imagery, low lights, soft music, meditation

    •ABG monitoring

    •Medications

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