acid base balance

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dallas.dawn
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242271
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acid base balance
Updated:
2013-10-23 23:21:03
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acid base
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  1. arterial blood gas norms 
    ph?
    pco2?
    hco3?(bicarb base) 

    increase number =basic
    • ph-7.35-7.45
    • pco2=35-45
    • HCO3=21-28
  2. ph range in humans
    • <6.8 death
    • 7.35-7.45
    • >7.8

    • heart rate will stop
    • hypothermia(heart shuts down)
    • hyper(brain shuts down)
  3. PH definitions 
    • hydrogen ion concentration 
    • -measured by ph scale
    • --log{H+}
    • -1-14
    • acidity(ph<7) lower #
    • alkalinity(ph>7) higher #
    •  more free h more acid
    • a free h will change ph
    • strong acid=fall apart easy H falls off
  4. Where do acid/base comes from? 
    • acid ingestion
    • -ASA(asprin)
    • -FeSO4(iron sulfate) 
    • -paraldehyde(antibuse-trying to break addictions)
    • *base ingestion(alkaline)-bicarbonate ph increase=alkolosis
    • -antacids-TUMS ca+ carbonate
    • -citrate(blood preservative)-blood transfusions ph will increase 
    • -lactate(counteract acidity)
  5. Where do acid/base comes from? 
    • CO2 build up
    • -co2 converted to carbonic acid (stop breathing stays in body and converts acid) 
    • *Metabolic waste products 
    • -lactic acid (carbs, protein ..anaerobic metabolism)
    • -keto acids (fats ) 

    resp arrest-lactic acids builds up(anaerobic) and co2..gives bicarbonate
  6. where do acids and base go>
    • acid loss : gastric suction, gastric vomiting 
    • alkali loss :  diarrhea(huge amounts of base)why it burns skin , intestinal vomiting
  7. regulation of acid/bases 
    • buffers 
    • -1st line of defense 
    • -temporary
    • -chemically inactivates H+
    • -always there..temporary grabs free h and binds it to something
  8. buffer systems 
    inside cells
    • phosphate*** can buffer carbonic acid
    • proteins(hemoglobin)-buffers carbonic acid
  9. buffer systems 
    inside cells
    • carbonic acid/bicarbonate system(can't buffer own components ..can do ASA, citrate can't buffer co2) 
    • -can't buffer carbonic acid
    • -important because of large amounts of co2 produced daily
  10. carbonic acid/bicarb system
    (BLOOD)
    • must maintain 
    • 20 parts HCO3 to one part H2CO3 ratio for homeostasis
    • (change ratio change ph) 
    • lungs: regulate h2CO3 (acid regulation)
    • kidneys: regulate hco3- (bicarb base regulator)
  11. LUNGS: 2nd line of defense 
    • most rapid 
    • only minutes from co2 production to co2 elimination 
    • controlled by respiratory center in medulla 

    • speed up rr to get rid of acid(exhaling more) 
    • save acid--breath slower RR , limited in how much lungs can do because of the need of 02
  12. example of mechanism 
    • exercise increase in acid production (lactic acid increases RR) 
    • medulla sense increase in acid(monitor co2 levels) 
    • tells lungs to speed up 
    • lungs blow off co2
    • acid levels drop 

    what kills people, because brain is sedated..the brain can't tell the lungs what to do , acidic..lungs are also under voluntary control
  13. taking in a deep breath causes ??
    • alkolosis -- you lose acid 
    • dizzy
  14. Kidneys: 3rd line of defense 
    • Regulate HCO3 (base) side of the equation
    • may take several days 
    • very powerful
    • act by: reabsorb HCO3, secrete h+ in urine(ammonia) (decreases acid)
  15. Respiratory disorders: ACIDOSIS 
    etiology?
    • CO2 retention 
    • -pneumonia(gas exhange) -alveoli lined with mucous ..barrel chest
    • -emphysema, burns(obstruction)
    • -chest trauma, polia(NM function) 
    • -drug overdose, etoh(medulla fx) ..medulla is sedated 

    ribs goes horizontal due to co2 levels (trapping air) -expand  to support structure of lungs ..change and ribs try to accommodate
  16. respiratory acidosis 
    sx?
    • symptoms: CNS DEPRESSION(result of ph change) 
    • -disorientation, coma 
    • dyspnea
    • -tachycardia
    • -arrhythmias
    • -co2 narcosis(excessive co2) birhgt red 
    • cause resp problem 
  17. CO2 narcosis 
    • respiratory drive becomes insensitive to long term co2 elevation 
    • medulla uses hypoxia as respiratory trigger
    • meed to maintain some degree of hypoxia to keep breathing 
    • breath runs on co2 levels co2 driver RR 
    • emphayzeema increases co2 brain then learns to respond to 02 changes ..if you give 02 the resp rate decreases ..limit amounts of 02"keep air hungry"
  18. ABG indicators of resp acidosis 

    acid =depression
    • ph- decrease 
    • co2-increase 
    • hco3-ultamilty it will save base ..increase ..kidney
  19. RESP ACIDOSIS nursing care
    • improve respiratory function
    • correct acidosis(NaHCO3-high risk of rebound alkalosis.....(overdose of base causes tetny-muscle rigidity ..begins with twitching hyper reflex ...) then give Ca+ to correct ) 
    • IV ringers lactate or NaLactate 
    • NG suction(sucking acid out of stomach) 

    Correct other electrolyte imbalance (hyperkalemia(causes arrhythmia problems) or chloride deficit 
  20. To prevent acidosis take immediate action 
    take a deep breath and relax 
  21. REspiratory ALKALOSIS 
    etiology 
    • hyperventilation 
    • overstimulation of respiratory center 
    • -pain, trauma, hyperstimulus of brain(drugs), panic 
    • -exhaling too often and too deep 
  22. resp alkalosis 
    • cns-irritable 
    • hyperreflexia- jittery, reflexes are super active 
    • paresthesia-tingling, numbness, circumoral, extremities, fingertips 

    Potassium will be low... 
  23. RESP alkalosis nursing care 
    • treat underlying disorder
    • -sedatives
    • -breath into paper bag(not if hypnotic, used for anxiety induced hyperventilation) 
    • -pain management
    • -oxygen therapy
    • -change ventilator settings(may be too high)
  24. where did the potassium go?
    k goes inside cells so H ions can come out to solve the acid deficit 
  25. METABOLIC ACIDOSIS 
    causes:
    • overproduction of acids( DM, hyperthyroid...too much metabolic..lactic acid and keto acids--breath will smell sweet) 
    • excessive ingestion( salicylate(aspirin), paraldehyde, antibus) 
    • renal disease
    • loss of alkali(base...diarrhea) 
    • tissue anoxia(anaerobic--lactic acid = shock)
  26. METABOLIC ACIDOSIS 
    sx
    • CNS is depressed
    • fruity breath=ketones..DM...can be mistaken for drunks 
    • nausea/diarrhea=causing the problem 
    • Potassium level is high=h+ going int0 cell K+ going out
    • 02 level=normal most likely 
    • co2=low-->high resp rate 
  27. Metabolic acidosis severe sx 
    • Kussmaul respirations- is a result and hyperventilation to blow of co2
    • flushed, warm, dry skin=blood vessels dilate in presence of acidosis(more blood to the lungs to exhale more) 
    • stupor.coma=dehydrated, dumps sugar into urine ..pulls water with. 
  28. metabolic acidosis nursing care 
    • restore blood volume 
    • correct bicarbonate deficit(NaHCO3) (beware of rebound alkalosis) 
    • NG suction 
    • treat electrolyte problems= increase K+, low HC03, 
    • protect from injury=dehydrated, unstable, confused 
    • dialysis-esp if renal induced problem 
    • insule/saline=used temporary fix for hyperkalemia( grabs sugar and gets into cell with a K+, temporarily lowering potassium..

    if tenty(from rebound alkalosis) give CA iv 
  29. metabolic ALKALOSIS 
    losing acid...too much base 
    • vommiting 
    • ng suction 
    • diuretics(losing acid from kidney) 
    • hypokalemia( decrease K , cause or result 
    • ingestion of bicarb(baking soda) 
    • massive blood transfusion(citrate-preservative in blood) 
  30. metabolic ALKALOSIS sx 
    • CNS- irritability , tingling in fingers 
    • polyuria-if caused by diuretics ..may add to hypokalemia 
    • dysrhythmias-low K, heart doesn't like any changes in K ..heart will increase or decrease 
    • tetany=muscle rigidity , stiff muscles, hyper reflexes, ALWAYS ON EKG 
  31. Met ALKALOSIS lab values 
    • ph=high 
    • pco2=high(lungs slow down to save acid immediately) 
    • hco3=hight 
    • o2=may be low 

    SLOW resp 
  32. Met ALKALOSIS nursing care 
    • treat primary problem
    • -ingestion
    • -volume depletion(diuretics) 
    • control alkalosis 
    • ringers solution(chloride ) 
    • ammonium chloride(beware rbc hemolysis)=last effort..acid to treat base prob
    • treat other deficits(K, NA, cl) 

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