Adult I: Quiz 2 Acid-Base

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Author:
oliviawise
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96231
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Adult I: Quiz 2 Acid-Base
Updated:
2011-08-05 11:00:31
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Acid Base
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  1. Range for plasma pH
    7.35 - 7.45

  2. What is the best way to measure plasma pH?
    Via arterial blood gases (ABG)
  3. Acidosis
    • LOW pH (< 7.35)
    • High H+ concentration
    • HCO3- BELOW normal
  4. Alkalosis
    • HIGH pH (> 7.45)
    • Low H+ concentration
    • HCO3- ABOVE normal
  5. Arterial Blood Gases (ABG) -- 7.40/40/90/26/98%
    • pH = 7.35 - 7.45
    • paCO2 = 35 - 45 mm Hg
    • paO2 = 80 - 100 mm Hg
    • HCO3- = 21 - 28 mEq/L
    • Oxygen Saturation = 95% - 100%
  6. Regulation of Acid-Base
    • Chemical buffer system: proteins & chemicals (bicarb & phosphate)
    • Lungs
    • Kidneys
  7. Acid-Base Ratio
    • CO2 + H2O = H2CO3
    • H2CO3 = H+ + HCO3-
    • Normal Ratio: 20 HCO3- to 1 H2CO3-
    • (Bicarbonate 20 parts/Carbonic acid 1 part)
    • If ratio is disturbed - imbalance will occur & pH will be changed
    • It is the ratio that is important, NOT the absolute values
  8. Regulation with the Lungs
    • Very large surface area from which CO2 can diffuse
    • Lungs remove CO2 from the body in response to increases in H+ concentration
    • CO2 has the most profound effects on respirations
    • Hyperventilation: CO2 is "blown off"
  9. Regulation with the Kidneys
    • Works slowly
    • Powerful & efficient
    • Major function: HCO3- regulation
    • Vital role in pH regulation
  10. Metabolic Acidosis
    • Decrease in pH
    • HCO3- deficit OR H+ excess
    • Causes: CRF, aspirin OD, ketoacidosis, diarrhea
    • Manifestations: H/A, confussion, increased RR, N/V
    • Interventions: correct underlying problem, IV HCO3-, observe for hyperkalemia
  11. Metabolic Acidosis
    • High pH
    • HCO3- excess OR loss of H+
    • Causes: vomitting, gastric suction, antacids
    • Manifestations: dizziness, irritability, tingling of the digits, decreased RR
    • Intervention: reverse underlying disorder, increase Cl- to absorb Na+ resulting in excretion of HCO3-, observe for hypokalemia
  12. Respiratory Acidosis
    • H2CO3- Excess (CO2 Excess)
    • Causes: cardiac/respiratory arrest, COPD, OD of sedatives
    • Manifestations: mental changes, H/A, feeling of fullness in head, dizziness, coma
    • Interventions: IMPROVE VENTILATION! (bronchodilators, mechanical ventilation, CPT, hydration); administering bicarbonate is questionable
  13. Respiratory Alkalosis
    • H2CO3- deficit (low CO2 levels)
    • Causes: hyperventilation, aftermath of severe exercise, anxiety
    • Manifestations: "Hyperventiation Syndrome" (palpitations, lightheadedness, sweating, dry mouth, N/V, epigastric pain)
    • Interventions: eliminate cause, control breathing, breath into a closed system
  14. Uncompensated
    Normal value in the CO2 or HCO3
  15. Partially Compensated
    No normal values
  16. Completely Compensated
    A normal value in pH with other abnormal values
  17. ABG Analysis "Arrow Method"
    • 1. Look at the pH: if arrow UP = alkalosis; if arrow DOWN = acidosis
    • 2. Look at CO2 and HCO3: determine if levels are elevated or down, place up or down arrows
    • 3. Determine compensation: partial, complete, or uncompensated
    • 4. Determine the type of imbalance: if all arrows (CO2, HCO3, and pH) are in the SAME direction = METABOLIC imbalance.. If CO2 and HCO3 are OPPOSITE the pH = RESPIRATORY imbalance

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