assessment and care of patients with acid base imbalances
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______ is the result of processes that carefully regulate hydrogen ion production and elimination.
acid base balance
is a measure of the body fluids free hydrogen ion level
body fluid pH
this value has the narrowest range of normal and the tightest control mechanisms of all the electrolytes.
body fluid pH
normal pH range for arterial blood
7.35 to 7.45
normal pH range for venous blood
7.31 to 7.41
this value is calculated as the negative logarithm of the concentration in milliequivalents per liter.
the pH value
The ______ the pH value of the fluid, the ______ the level of free hydrogen ions in that fluid.
A change of 1ph unit actually represents a _____ change in free hydrogen-ion level.
- Example:the change from 7.4 to 7.3 represents a very large increase in free hydrogen-ion levels
keeping the pH of the blood within the normal range is important because changes from normal interfere with many functions. these include:
- changing the shape in 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
____ are substances that release hydrogen ions when dissolved in water.
An acid in solution ______ the amount of free hydrogen ions in that solution.
A strong acid, such as hydrochloric acid, separates completely and water and readily releases all of its hydrogen ions.
a _____ acid does not completely separate and water it releases only some of its hydrogen ions.
is a substance that binds free hydrogen ions in solution.
Bases are hydrogen acceptors that ____ the amount of free hydrogen ions in solution.
- examples of strong bases include sodium hydroxide and ammonia
weak bases bind hydrogen ions less readily.
- examples of weak bases are aluminum hydroxide and bicarbonate.
- although bicarbonate is a weak base it is very important in preventing major changes in body fluid pH
_____ are critical in keeping body fluid pH at normal levels because they can react in two ways either as an acid or as a base.
if the fluid is basic the buffer releases hydrogen ions into the fluid. if the fluid is acidic, the buffer acts as a base _____
binding some of the excess hydrogen ions.
fluids with a pH of 7 .0 are....
neutral, the amount and strength of acids and bases are equal.
liquid with a pH ranging from 1.0 to 6.99
liquids with a pH ranging from 7 .01 to 14 .0
the most common base in the human body is
the most common acid in the human body is
the body keeps these substances at a constant ratio of ____ molecules of carbonic acid to ____ free bicarbonate ions.
this equation, driven by the enzyme carbonic anhydrase, shows how hydrogen ion levels and carbon dioxide levels are directly related to one another, so that an increase in one causes an equal increase in the other.
carbonic anhydrase equation
____ is a gas that forms carbonic acid when combined with water, making _____ part of carbonic acid.
carbon dioxide content of a fluid is directly related to the amount of hydrogen ions in that fluid. Whenever conditions cause carbon dioxide to increase, more free hydrogen ions are created. Likewise,.......
whenever free hydrogen ion production increases, more carbon dioxide is produced.
____ control bicarbonate levels and the lungs control co2 levels in a healthy person, ph is also described as a function of the ____ divided by the function of the lungs.
normal metabolism of carbohydrate, protein, and fat creates.....
natural waste products.
incomplete breakdown of glucose, which occurs whenever cells metabolize under anaerobic conditions, forms
anaerobic conditions occur with......
hypoxia, sepsis, and shock.
Incomplete breakdown of fatty acids, occurring when large amounts of fatty acids are being metabolized, forms......
______ allows cell contents to be released.
- destruction of cells
- * some cell structures ie lysosomes contain acids. When these acids are released into the extracellular fluid, free hydrogen ions are dissociated.
_____, a weak base, is the main buffer of the extracellular fluid.
buffers are composed of chemicals or.......
- * by acting as hydrogen ion sponges, buffers can bind hydrogen ions with too many are present or release hydrogen ions when not enough are present.
________ are paired mixtures- usually a weak base and an acid salt.
- Chemical buffers
- * the two most common chemical buffers are bicarbonate and phosphate.
______ are the most common buffers.
- protein buffers
- * proteins and body fluids can either find or released free hydrogen ions as needed. extracellular protein buffers are I'll be a min and globulins. A major protein buffer is hemoglobin.
as the amount of co2 begins to rise above normal in brain blood and tissues, these central receptors trigger the neuron's to increase the rate and depth of breathing known as
breathing controls the amount of free hydrogen ions by controlling the amount of _______ an arterial blood.
central receptor sense low co2 levels and stop or slow the neuron activity in the respiratory centers of the brain, decreasing the rate and depth of breathing known as....
______ actions are stronger for regulating acid base balance but take longer than chemical and respiratory actions to completely respond. (24-48 hrs)
kidney movement of bicarbonate is the first kidney pH control action. It occurs in the kidney tubules in two ways:
- 1) kidney movement of bicarbonate produced elsewhere in the body
- 2) kidney movement of bicarbonate produced in the kidneys
- * 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, where it can help buffer excess hydrogen ions. In this situation, the kidney tubules can also make additional bicarbonate and reabsorb it for an increased buffer effect. When blood hydrogen-ion levels are low, to buy carbon it remains in the urine and is excreted.
formation of acid is the second kidney pH control action. It occurs through the phosphate buffering system inside the kidney of the
formation of ammonium is the third kidney pitch control action. Ammonia, which is formed during normal protein breakdown, is converted into____
- *the ammonia is first created into the urine, where it can combine with access hydrogen ions to form ammonium.
the process of _____, the body adapts to attempt to correct changes in blood pH. a pH below 6.94 or above 7.8 is usually fatal.
_____ occurs through the lungs, usually to correct or acid base imbalances from the metabolic problems.
- respiratory compensation
- * for example, when prolonged running causes buildup of lactic acid, hydrogen ion levels in the ECF increase and the pH drops. To bring the pH back to normal, breathing is triggered in response to increased carbon dioxide levels. Both the rate and depth of respiration increase.
_______ results when a healthy kidney works to correct for changes in blood pH that occur when the respiratory system is either overwhelmed or is not healthy.
- kidney compensation
- * when carbon dioxide is retained continuously, hydrogen ion levels increase, and the blood pH falls. To oppose this process, the kidney excretes more hydrogen ions and increases the reabsorption of bicarbonate back into the blood. As a result, the blood pH remains either within or closer to the normal range.
when the respiratory problem causing the acid base imbalance is so severe that the kidney actions can only _________ and that ph is not quite normal.
- partially compensate
- *partial compensation is helpful because it prevents the acid base imbalance from becoming severe or life-threatening.
in _______, the acid base balance of the blood and other extracellular fluid is upset by an excess of hydrogen ions.
acidosis, this problem is reflected as in arterial blood pH below 7.35.
acidosis can be caused by metabolic problems, respiratory problems, or both. patients at greatest risk for acute acidosis include:
those with problems that impair breathing and older adults with chronic health problems.
acidosis its not a disease; it is a condition caused by a
disorder or pathologic processes.
_______ results and acidosis by either overproducing acids or under eliminating normally produce acids- either way, more hydrogen ions are present then should be.
- actual acid excess
- * examples of problem that actually decrease acid elimination are respiratory and permit in kidney impairment.
- * examples of problems that actually increase acid production are diabetic ketoacidosis and seizures.
__________, the amount or strength of acids does not increase instead, the amount or strength of the bases decreases, which makes the fluid relatively more acidic and basic.
- relative acidosis
- * a relative acidosis is caused by either over eliminating bases ions or under producing bases.
- * examples of problems that under produce spaces are pancreatitsis and dehydration.
- * a condition that over eliminates bases is diarrhea.
_______ can occur with excessive breakdown of fatty acids, anaerobic glucose breakdown, and excessive intake of acids.
- overproduction of hydrogen ions
- * excessive break down a fatty acids occurs with diabetic ketoacidosis or starvation.
lactic acidosis occurs when cells are forced to use glucose without adequate oxygen. As result glucose is in completely broken down in forms lactic acid. lactic acid leave the cell, interest in blood, and releases hydrogen ions, causing....
- * lactic acidosis occurs when ever the body has too little oxygen to meet the metabolic oxygen demand, such as during heavy exercise, seizure activity, fever, and reduced oxygen intake.
- * agents that cause acidosis when ingested in excess include alcoholic beverages, mental alcohol, and acetylsalicylic acid (aspirin).
______ leads to acidosis when hydrogen ions are produced at the normal rate but are not removed at the same rate they are produced.
- under elimination of hydrogen ions.
- * most hydrogen ion loss occurs through the lungs and kidneys.
- * kidney failure causes acidosis when the kidney tubules cannot secrete hydrogen ions into the urine.
_______ leads to acidosis when hydrogen ion production and removal are normal but too few bicarbonate ions are present to balance the hydrogen ions.
- under production of bicarbonate ions
- * because bicarbonate is made in the kidneys and in the pancreas, kidney failure and impaired liver or pancreatic function can cause a base deficit acidosis.
______ leads to acidosis when hydrogen ion production and removal are normal but too many bicarbonate ions have been lost.
- overelimination of bicarbonate ions
- * one cause of Base deficit acidosis is diarrhea
______ results when any area of respiratory function is impaired, reducing the exchange of oxygen o2 and carbon dioxide co2. this problem causes co2 retention.
- respiratory acidosis
- * unlike metabolic acidosis, respiratory acidosis results from only one cause - retention of co2, causing increased production of free hydrogen ions.
_______ results from depressed function of the brain stem neurons that trigger breathing movements. this reduces the rate and depth of breathing, which leads to pour gas exchange and retention of carbon dioxide.
- respiratory depression
- * respiration can be depressed by anesthetic agents, drugs, and poisons such as methyl alcohol, pesticides, and botulinus toxin.
- * physical depression of respiration occurs when the neurons are damaged or destroyed by trauma or when problems in the brain increase the intracranial pressure.
- * problems causing cerebral edema and respiratory depression and include brain tumors, cerebral aneurysm, stroke, and over hydration.
_____ reduces gas exchange and leads to acidosis. chest expansion can be restricted by skeletal trauma or deformities, respiratory muscle weakness, or external contraction.
inadequate chest expansion
_______ prevents air movement into and out from the lungs and leads to poor gas exchange, co2 retention, and acidosis.
_______ causes for gas exchange and leads to co2 retention and acidosis.
- reduced alveolar-capillary diffusion
- * disorders that reduce diffusion include pneumonia, pneumonitis, tuberculosis, emphysema, acute respiratory distress syndrome, chest trauma, pulmonary emboli, pulmonary edema and drowning.
______ acidosis is more severe than either metabolic acidosis or respiratory acidosis alone.
- * metabolic and respiratory acidosis can occur at the same time. for example a person who has diabetic ketoacidosis and chronic obstructive pulmonary disease has a combined metabolic and respiratory acidosis.
collecting data about risk factors related to the development of acid dosis, specifically age, nutrition, and presenting symptoms. one way of organizing data to assess acid base status is to use ________, especially activity- exercise, elimination, and the cognitive -perceptual patterns
Gordon's functional health patterns
_____ are more at risk for problems leading to acid base imbalance, including cardiac, kidney, or pulmonary impairment.
_____ changes are first seen with mild acidosis and are more severe as the condition worsens.
- *early changes include increased heart rate and cardiac output.
elevated blood potassium levels
________ changes include depression of CNS function. Problems may range from lethargy to confusion, especially in older patients.
- central nervous system
- * as acidosis worsens, the patient may become unresponsive. Assess the patient mental status.
______ changes with acid dosis include reduced muscle tone and deep tendon reflexes.
- * cause of these changes is hyperkalemia along with acidosis.
- * this muscle weakness is bilateral and can progress to paralysis.
______ changes may cause the acidosis and can be caused by the acidosis.
- * assess the patient's rate, death, and ease of breathing. use pulse ox to determine how well oxygen is being delivered to the peripheral tissues.
if acidosis is metabolic in origin, the rate and depth of breathing increases as a hydrogen ion level rises. Breaths are deep and rapid and not under voluntary control. This breathing pattern is called......
if acidosis is caused by respiratory problems, breathing efforts are reduced. Respirations are usually shallow and rapid. muscle weakness makes this problem____.
_____ occur with metabolic or respiratory after doses. with metabolic acidosis this causes vasodilation and makes skin and mucous membranes warm, dry, and pink. with respiratory acidosis, breathing is ineffective and skin and mucous membranes are pale to cyanotic.
it is vital to complete a _______, because behavioral changes maybe the first manifestations of acidosis.
arterial blood pH is the laboratory values to confirm acidosis. this is present when arterial blood pH is less than 7 .35. However, this test alone does not indicate what is causing the acidosis......
manifestations of metabolic acidosis and respiratory acidosis are similar, but their treatments are different. Therefore it is critical to obtain and interpret other laboratory data, such as arterial blood gas values and blood levels of electrolytes.
_______ is reflected by several changes in ABG values. The pH is low because buffering and respiratory compensation are not adequate to keep the amount of free hydrogen ions normal levels.
the serum _____ level is often high in acidosis as the body attempts to maintain electronneutrality during buffering.
_______ is reflected by several changes in ABG values. The pH is low because of the increased amount of free hydrogen ions in the blood. Buffering and kidney compensation are not adequate to keep the amount of free hydrogen ions at a normal level.
Nursing safety priority- critical rescue
assess the cardiovascular system first in any patient at risk for acidosis.
the hallmarks of respiratory acidosis are a
decreasing pao2 coupled with a rising paco2
priority problems for the patient experiencing acidosis are associated with decreased function of excitable membranes. These problems include:
hypotension and decreased perfusion, impaired memory and cognition, and increased risk for falls.
interventions for metabolic acidosis include hydration and drugs or treatment to control the problem causing the acidosis.
for example if the acid dosis is the result of diabetic ketoacidosis, insulin is given to correct the hyperglycemia and halt the production of ketone bodies.
bicarbonate is administered only if
serum bicarbonate levels are low.
Nursing priorities include
continuously monitoring the patient for changes that indicate either he or she is responding to the treatment or the acidosis is becoming worse.
_______ is focused on improving the installation and oxygenation rather than directly on altering arterial pH.
- drug therapy
- *the major categories of drugs useful for respiratory problems that lead to acidosis this include bronchodilators, anti inflammatories, and mucolytics.
_______ helps promote gas exchange for patients with respiratory acidosis.
- oxygen therapy
- *however, use caution when giving oxygen to patients with COPD and co2 retention.
- * giving too much oxygen to these patients decreases the respiratory drive and may lead to respiratory arrest.
_______ with mechanical ventilation may be needed for patient who cannot keep their oxygen saturation at 90 percent or who have respiratory muscle fatigue.
________ is a nursing priority when caring for a patient with respiratory acidosis.
- preventing complications
- * monitoring breathing status an intervention when changes occur are critical in preventing complication. for patients who have chronic respiratory acidosis,assess breathing status every 2 hours.
alkalosis is a _______ and the free hydrogen ion level of the blood and is reflected by an arterial blood pH above 7.45.
- * alkalosis can be caused by metabolic problems, respiratory problems, or both.
In _____ alkalosis, the actual amount or strength of bases does not increase instead, the amount or strength of the acids decreases, creating an acid deficit and making the blood more basic than acidic.
________ alkalosis is caused by any condition that creates the acid base imbalance through either an increase of bases or a decrease of acids.
the hallmark of a base excess acidosis
is an ABG result with an elevated pH and an elevated bicarbanate level along with normal oxygen and carbon dioxide levels.
________ alkalosis is usually caused by excessive loss of co2 through hyperventilation.
the hallmark of respiratory alkalosis......
is an ABG result with an elevated pH coupled with a low carbon dioxide level.
low calcium levels
. low potassium levels
_______ changes are caused by over excitement of the nervous system. Patients have dizziness, agitation, confusion, and hyperreflexia, which may progress to seizure activity.
central nervous system
continuous tractions of muscle groups
______ changes are related to hypo calcemia and hyperkalemia that occur with alkalosis.
_________ changes occur because alkalosis increases myocardial irritability, especially when a company by hypokalemia.
_______ changes especially increases in the rate of breathing, there are main causes of respiratory alkalosis.
interventions are planned to prevent further losses of hydrogen, potassium, calcium, and chloride ions; to restore fluid balance; to monitor changes; and to provide for......
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