# Shared Flashcard Set

## Details

Acid-Base Balance
Acid-Base Balance
115
Nursing
11/06/2012

Term
 Acidity or alkalinity of a solution is determined by its concentration of:
Definition
 Hydrogen Ions (H+)
Term
 Acid
Definition
 A substance containing H+ that can be liberated or released, such as carbonic acid.   An acid releases H+, as follows: H2CO3 (Carbonic Acid) releases H+ to form HCO3- (Bicarbonate Base)
Term
 Base (Alkali)
Definition
 A substance that can accept or trap H+ ions, such as the bicarbonate ion.   A base traps H+, as follows: HCO3- (Bicarbonate Base) traps H+ to form H2CO3 (Carbonic Acid)
Term
 Strong acid vs. weak acid
Definition
 Strong Acid: Dissociates (separates) completely in solution & releases all of its H+ ions Weak Acid: Releases only a small number of H+ ions.
Term
 Strong Base vs. Weak Base
Definition
 Strong Base: Binds or accepts H+ ions easily. Weak Base: Accepts H+ ions less readily.
Term
 pH
Definition
 Unit of measure used to describe acid-base balance. An expression of H+ ion concentration & the resulting acidity or alkalinity of a substance. Ranges from 1-14 Neutral is 7. Ex. water Below 7= Acid Above 7= Alkaline A reflection of the balance b/t CO2 & bicarbonate. Homeostasis of pH exists when production of acids & bases equal excretion of acids & bases.
Term
 As H+ ions increase & a solution becomes more acidic, the pH becomes:
Definition
 Less than 7
Term
 When the concentration of H+ ions in a solution is reduced or accepted by another substance & the solution contains more base than acid, it's alkaline, and the pH is:
Definition
 greater than 7
Term
 pH scale of life
Definition
 Death occurs when: below 6.8 and above 7.8 Acidosis: 6.80-7.35 Normal: 7.35-7.45 Alkalosis: 7.45-7.80   *Normal value of arterial blood pH: 7.35-7.45 *Normal blood plasma is slightly alkaline and has a normal pH: 7.35-7.45
Term
 Acidosis
Definition
 the condition characterized by an excess of H ions or loss of base ions (bicarbonate) in ECF in which the pH falls below 7.35.
Term
 Alkalosis
Definition
 Occurs when there is a lack of H+ ions or a gain of base (bicarbonate) & the pH exceeds 7.45.
Term
 The normal pH is achieved through 3 major homeostatic regulators of H+ ions:
Definition
 Chemical buffer system Respiratory mechanisms Renal mechanisms
Term
 Buffer
Definition
 A substance that prevents body fluids from becoming overly acidic or alkaline. They combine w/ excess acids or bases to prevent major changes in pH, keeping the pH of body fluids as close as possible to normal (7.35-7.45)\ Can act as a base & bind or soak up H+ ion. Can act as a acid and release H+ ions.
Term
 The body has 3 buffer systems:
Definition
 The carbonic acid-sodium bicarbonate buffer system The phosphate buffer system The protein buffer system
Term
 Carbonic Acid-Sodium Bicarbonate Buffer System
Definition
 The ratio of carbonic acid (H2CO3), the most common acid in human body fluid, to the body's most common base, bicarbonate (HCO3-), is important for acid-base balance & is the most important buffer system of the body. 20:1 Ratio- Normal ECF has a ratio of 20 parts bicarbonate to 1 part carbonic acid.
Term
 Carbonic Acid-Sodium Bicarbonate Buffer System (Cont.)
Definition
 The lungs, under the control of the medulla, help by regulating the production of carbonic acid resulting from the combination of carbon dioxide and water. The kidneys assist the bicarbonate system by regulating the production of bicarbonate.
Term
 Phosphate Buffer System
Definition
 2nd buffer system is active in ICF, especially in the renal tubules. Converts alkaline sodium phosphate, a weak base, to acid-sodium phosphate in the kidneys.
Term
 Protein Buffer System
Definition
 The 3rd buffer system is a mixture of plasma proteins & the globin portion of hemoglobin in RBCs.  Because plasma proteins & hemoglobin possess chemical groups that can combine w/ or liberate H+ ions, they tend to maximize changes in pH & serve as buffering agents over a range of pH values working both inside & outside the cell.
Term
 If pH is low then:
Definition
 its acidic  High amount of H+ ions
Term
 If pH is high then:
Definition
 its alkaline low amount of H+ ions
Term
 Respiratory Regulation of H+ ions
Definition
 Due to the huge surface from which CO2 can readily diffuse, the lungs can bring about rapid changes in H+ when needed CO2 is constantly produced by cellular metabolism (H2CO3 yields CO2 & H2O), is excreted by exhalation. When the amt of CO2 in the blood increases, the sensitive chemoreceptors in the respiratory center in the medulla are stimulated to increase the rate & depth of respirations to eliminate more CO2.  **Lungs are the primary controller of the body's carbonic acid supply.\ Respiratory system is able to respond quickly in a healthy individual to restore the normal pH. However, this response is short term, and the response of the kidneys is needed for longterm adjustment.
Term
 Respiratory Regualation of H+ ions (Cont.) What happens as more CO2 is exahaled vs. when the blood level of CO2 decreases:
Definition
 As more CO2 is is exhaled, the H2CO3 level in the blood decreases, & the pH of the blood becomes more alkaline. (Decreases CO2-Increases pH-Decreases H+ ions) When the blood level of CO2 decreases, the respiratory center decreases the rate & depth of respirations to retain the CO2 so that carbonic acid can be formed, thereby maintaining the delicate balance. (Increases CO2-Decreases pH-Increases H+ ions)
Term
 Renal Regulation of H+ Ions
Definition
 The kidneys excrete or retain H+ ions and form or excrete bicarbonate ions in response to the pH of the blood. In the presence of acidosis, the kidneys excrete H+ ions & form & conserve bicarbonate ions, thus raising the pH to the normal range. If alkalosis is present, the kidneys retain H+ ions & excrete bicarbonate ions in an effort to return to a balanced state.  **The concentration of bicarbonate in the plasma is regualted by the kidneys.
Term
 The Renal regulation of H+ ions compared to the carbonic acid-sodium bicarbonate system or to respiratory regualtion:
Definition
 The acid-base regulation by the kidneys occurs more slowly than that which occurs by the carbonic acid-sodium bicarbonate system or by respiratory regulation.  It may take up to 3 days for a normal fluid pH to be restored by the kidneys. The ph of urine varies, depending on the H+ ions that are being excreted, but its generally b/t 4.5-8.2
Term
 Fluid Volume Deficit Hypovolemia: (Isotonic fluid loss)
Definition
 Fluid volume deficit can be caused by a loss of both water & solutes in the same proportion from the ECF space. Both osmotic & hydrostatic pressure changes force the interstitial fluid into the intravascular space in an effort to compensate for the loss of volume in the blood vessels. As the interstitial space is depleted, its fluid becomes hypertonic, & cellular fluid is then drawn into the interstital space, leaving cells without adequate fluid to function properly. Fluid volume deficits result from the loss of body fluids, especially if fluid intake is decreased simultaneously. (Intracellular Fluid loss)
Term
 Hypovolemia S&S:
Definition
 Loss of body weight Changes in input & output changes in vital signs skin changes *A 5% weight loss is considered a pronounced fluid deficit; an 8% loss or more is considered severe. A 15% weight loss is life threatening.
Term
 Hypovolemia Third-Space Fluid Shift:
Definition
 Refers to a distributional shift of body fluids into the transcellular compartment, such as the pleural (abdomen), peritoneal (ascites), or pericardial areas; joint cavaties; the bowel; or an excess accumulation of fluid in the interstitial space. The fluid moves out of the intravascular spaces (plasma) to any of these spaces. Once trapped in these space, the fluid is not easily exchanged w/ ECF. A deficit in ECF volume occurs. (ECF fluid loss-Fluid loss can't be measured)
Term
 Hypovolemia Third Space Fluid shift related to:
Definition
 Shifts related to a disruption in the colloid osmotic pressure (decreased albumin), increased fluid volume (excess IV fluid replacement, renal dysfunction), increased capillary hydrostatic pressure (hear failure), hyponatremia, or an increase in the permeability of the capillary membrane (gross tissue trauma). A third space fluid shift may occur as a result of a severe burn, a bowel obstruction, or hypoalbuminemia. S&S: pailor, cold limbs, weak/rapid pulse, hypotension, LOC
Term
 Fluid Volume Deficit Hypovolemia (Isotonic Fluid loss)   Risk Factors:
Definition
 GI: vomiting, diarrhea, suction, fistula Excessive sweating Skin trauma, burns, draining wounds Third space fluid shift excessive laxative or diuretic use Polyuria from renal disease or diuretics Hyperglycemia Hemorrhage Change in mental status Liver failure
Term
 Fluid Volume Deficit Hypovolemia (Isotonic Fluid loss)   Assessments:
Definition
 Thirst Weight loss over short period Weakness, fatigue, anorexia Dry mucous membranes Poor skin & tongue turgor sunken eyes flat neck veins urine output <30 mL/hr Increase urine specific gravity, hematocit, BUN, serum sodium
Term
 Fluid Volume Deficit Hypovolemia (Isotonic Fluid loss)   Nursing Interventions:
Definition
 Assess for presence or worsening of FVD Administer oral fluids if indicated Provide fluids to meet body needs. (oral fluids or IV solutions) Monitor I&O and volumetic solution (VS) Monitor pt's response to fluid intake, either oral or parenteral. Be alert for signs of fluid overload. Provide oral and skin care.
Term
 Fluid Volume Excess Hypervolemia: (Excess of Isotonic)
Definition
 Excessive retention of water & sodium in ECF in equal proportions resulting in fluid volume excess. Due to increased extracellular osmotic pressure from the retained sodium & water, fluid is pulled from the cells to equalize the tonicity. By the time the intracellular & extracellular spaces are isotonic to each other, an excess of water & sodim is in the ECF, whereas the cells are nearly depleted. The excessive ECF may accumulate in either the intravascular compartments or interstitial spaces.
Term
 Fluid Volume Excess Hypervolemia Causes:
Definition
 Causes: Malfunction of the kidneys, causing an inability to excrete the excess, & failure of the heart to fuction as a pump, resulting in accumulation of fluid in the lungs and dependent parts of the body.
Term
 Fluid Volume Excess Hypervolemia Edema:
Definition
 Accumulation of fluid in the interstitial space. Can be observed around the eyes, fingers, ankles, & sacral space, & can also accumulate in or around body organs.  Accumulation of fluid may result in weight gain in excess of 5%. The amt or severity of edema is typically graded.
Term
 Fluid Volume Excess Hypervolemia   Risk Factors:
Definition
 Comprised regulatory mechanisms: renal failure, CHF, cirrhosis of liver, Cushing's syndrome. GI irrigation w/ hypotonic fluid. Excess IV fluids w/ sodium Excessive ingestion of sodium-containing substances in diet or sodium-containing medications Corticosteroid therapy
Term
 Fluid Volume Excess Hypervolemia   Assessments:
Definition
 Weight gain over short period. Shortness of breath crackles & wheezes in lungs Pulmonary edema Decreased BUN, hematocrit, serum sodium, urine specific gravity Increase BP
Term
 Fluid Volume Excess Hypervolemia   Nursing Interventions:
Definition
 Assess for presence or worsening of FVE. Avoid OTC drugs or check w/ physician or pharmacist about sodium content. Administration of diuretics & monitor response. Promote rest. Use semi-Fowler's position for orthopnea. Promote adherence to fluid restrictions & pt teaching related to sodium & fluid restrictions.
Term
 Hyponatremia
Definition
 Refers to a sodium deficit in ECF caused by a loss of sodium or gain of water. Serum Sodium <135 mEq/L Sodium may be lost through vomiting, diarrhea, fistulas, sweating, or the use of diuretics.
Term
 Process of Hyponatremia:
Definition
 Decrease in Na causes fluid to move by osmosis from the less concentrated ECF compartment to the ICF space. This shift of fluid leads to swelling of cells, w/ resulting confusion, hypotension (low bp), edema, muscle cramps, weakness, dry skin.
Term
 Hyponatremia Risk Factors:
Definition
 Loss of sodium, as in: loss of GI fluids, use of diuretics, adrenal insufficiency. Gains of H2O, as in: Excessive administration of D5W, H2O intoxication Disease states associated w/ SIADH (a form of hyponatremia) Pharmocologic agents that may impair H2O excretion
Term
 Hyponatremia Assessments:
Definition
 Anorexia Nausea & vomiting Lethargy confusion muscle cramps coma seizures Poor skin turgor
Term
 Hyponatremia Nursing Interventions:
Definition
 Monitor fluid losses & gains Monitor of dietary sodium & fluid intake identification and monitoring of at-risk patients  the effects of medications (diuretics and lithium) Check urine specific gravity
Term
 Hypernatremia
Definition
 Refers to a surplus of sodium in ECF caused by excess water loss or an overall excess of sodium. Serum sodium >145mEq/L) Causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions, diarrhea
Term
 Process of Hypernatremia:
Definition
 Fluids move from the cells because of the increased extracellular osmotic presssure, causing them to shrink & leaving them without sufficient fluid. The cells of the CNS are affected, resulting in signs of neurological impairment, including restlessness, weakness, disorientation, delusion, & hallucinations. Brain damage can occur.
Term
 Hypernatremia Risk Factors:
Definition
 Water deprivation Increased sensible & insensible water loss ingestion of large amts of salt excessive parenteral administration of Na-containing solutions Profuse sweating diabetes insipidus
Term
 Hypernatremia Assessments:
Definition
 Thirst Elevated body temp tongue dry & swollen, stiky mucous membranes Disorientation & hallucinations Restlessness & weakness
Term
 Hypernatremia Nursing Interventions:
Definition
 Monitor fluid losses & gains. Oberve for excessive intake of high Na foods Monitor for changes in behavior such as restlessness, lethargy, & disorientation Look for excessive thirst & elevated body temp. assess for over-the-counter (OTC) sources of sodium offer and encourage fluids to meet patient needs, and provide sufficient water with tube feedings
Term
 Hypokalemia
Definition
 Refers to a potassium deficit in ECF & is a common electrolyte abnormality. Serum potassium <3.5 mEq/L Causes: vomiting, gastric suction, alkalosis, diarrhes, use of diuretics
Term
 Proccess of Hypokalemia:
Definition
 When the extracellular k level falls, k moves from the cell, creating an intracellular k deficiency Na & H ions are then retained by the cells to maintain isotonic fluids. These electrolyte shifts influence normal cellular functioning, the pH of ECF, & the functions of most body systems, including the cardiovascular system.
Term
 Hypokalemia Risk Factors:
Definition
 Diarrhea Vomiting or gastic secretions K-wasting diuretics Poor intake as in anorexia nervosa, alcoholism, k-free parenteral fluids
Term
 Hypokalemia Assessment:
Definition
 Fatigue Anorexia, nausea, vomiting Muscle weakness Decreased bowel motility cardiac arrhythmias Postural hypotension Paresthesias or tender muscles
Term
 Hypokalemia Nursing Interventions:
Definition
 Encourage extra k intake if possible. Educate about abuse of laxatives & diuretics. Be knowledgeable about danger of IV k administration  Monitor k level.
Term
 Hyperkalemia
Definition
 Refers to an excess of k in ECF. Serum potassium >5 mEq/L Causes: renal failure, hypoaldosteronism, use of certain medications (Potassium chloride, heparin, ACE inhibitors, NSAIDS & k-sparing diuretics) Nerve conduction & muscle contractility can be affected. Skeletal muscle weakness & paralysis may occur. Cardiac irregularities (cardiac arrest)
Term
 Hyperkalemia Risk Factors:
Definition
 Decreased k excretion: renal failure, k-sparing diuretics hypoaldosteronism high k intake, especially in presence of renal insufficency Shift of k out of cells (acidos, tissue trauma, malignant cell lysis)
Term
 Hyperkalemia Assessment:
Definition
 Vague muscle weakness Cardiac arrhythmias GI symptoms: nausea, intermittent intestinal colic, diarrhea Problems w/ breathing (respiratory impairment) Anxiety
Term
 Hyperkalemia Nursing Interventions:
Definition
 Follow rules for safe administration of k Avoid giving pts w/ renal insufficency k-saving diuretics, k supplements, or salt substitutes. Caution about foods high in k content Monitor medication effects and k levels Na and medications may contain k
Term
 Hypocalcemia
Definition
 Refers to a calcium deficit in ECF Serum level less than 8.5 mg/dL Causes: inadequate calcium intake, impaired calcium absorption, & excessive calcium loss.
Term
 Hypocalcemia Risk Factors:
Definition
 Surgical hypoparathyroidism malabsorption Vit D deficiency Acute pancreatitis Excessive administration of citrated blood Alkalotic states
Term
 Hypocalcemia Assessment:
Definition
 Trousseau's & chvostek's signs Numbness & tingling of fingers & toes. mental changes seizures spasm of laryngeal muscles ECG changes Cramps in muscles of extremities
Term
 Hypocalcemia Nursing Interventions:
Definition
 IV of calcium gluconate calcium and vitamin D supplements weight-bearing exercises to decrease bone calcium loss patient teaching related to diet and medications nursing care related to IV calcium administration
Term
 Hypercalcemia
Definition
 Refers to an excess of calcium in ECF. Serum level >10.5 mg/dL Causes: cancer & hyperparathyroidism
Term
 Hypercalcemia Risk Factors:
Definition
 Hyperparathyroidism Malignant neoplastic disease large doses of vit D overuse of calcium supplements prolonged immobilization-bone loss
Term
 Hypercalcemia Assessment:
Definition
 Muscular weakness tiredness, lethargy constipation anorexia, nausea, vomiting Decrease memory & attention span Renal stones cardiac arrest
Term
 Hypercalcemia Nursing interventions:
Definition
 administer fluids encourage ambulation fluids of 3 to 4 L/d provide fluids containing sodium unless contraindicated and fiber for constipation Safety precautions Force fluids to prevent renal stones
Term
 Hypomagnesemia
Definition
 Refers to a magnesium deficit in the ECF Serum level < 1.8 mg/dL Causes: nasogastic suction, diarrhea, withdrawal from alcohol, administration of tube feedings or parenteral nutrition, sepsis, or burns.
Term
 Hypomagnesemia Risk Factors:
Definition
 Chronic alcoholism intestinal malabsorption diarrhea enteral or parenteral feeding deficient in magnesium
Term
 Hypomagnesemia Assessment:
Definition
 Neuromuscular irritability (Twitch): increased reflexes, coarse reflexes, seizures cardiac manifestations: increased susceptibility to digitalis, toxicity disorientation, mood changes
Term
 Hypomagnesemia Nursing Interventions:
Definition
 Assess for magnesium deficit because it predisposes pt to digitalis toxicity take seizure precautions if needed educate pt if abuse of diuretics or laxatives is a problem If you have hypomagnesemia; you will have hypocalcemia. nursing care related to IV magnesium sulfate
Term
 Hypermagnesemia
Definition
 Refers to a magnesium excess in the ECF. Serum level > 2.7 mg/dL Causes:Occurs w/ renal failure when the kidneys fail to excrete magnesium or from excessive magnesium intake
Term
 Hypermagnesemia Risk Factors:
Definition
 renal failure adrenal insufficiency excessive mag administration during treatment of eclampsia Hemodialysis w/ hard water or dialysate high in mag content
Term
 Hypermagnesemia Assessment:
Definition
 Flushing & sense of skin warmth hypotension depressed respirations drowsiness; hypoactive reflexes, muscular weakness cardiac abnormalities ECG changes
Term
 Hypermagnesemia Nursing Interventions:
Definition
 Be alert for bp & shallow respirations, lethargy, drowsiness, & coma Dont give mag-containing meds to pt w/ renal failure or compromised renal function Be cautious of OTC drugs check deep tendon reflexes frequently IV calcium gluconate
Term
 Hypophosphatemia
Definition
 Refers to a below normal concentration of phosphorus in the ECF, Serum level <2.5 mg/dL Causes: administration of calories to malnourished pts, alcohol withdrawal, diabetic ketoacidosis, hyperventilation, insulin release, absorption problems,diuretic use.
Term
 Hypophosphatemia Risk Factors:
Definition
 Glucose administration refeeding after starvation hyperalimentation alcohol withdrawal diabetic ketoacidosis respiratory alkalosis
Term
 Hypophosphatemia Assessments:
Definition
 Cardiomyopathy acute resp failure seizures decrease tissue oxygenation joint stiffness increased susceptibility to infection
Term
 Hypophosphatemia Nursing Interventions:
Definition
 aware of greater risk for infection Administer IV phosphate products cautiously Introduce hyperalignmentation cautiously in pts who are malnourished sudden increase in serum phosphate level can cause hypocalcemia. encourage foods high in phosphorus introduce calories for malnourished patients receiving parenteral nutrition
Term
 Hyperphosphatemia
Definition
 Refers to above-normal concentrations of phosphorus in the ECF. Serum level >4.5 mg/dL Causes: impaired kiney excretion & hypoparathyroidism
Term
 Hyperphosphatemia Risk Factors:
Definition
 Renal failure chemotherapy large intake of milk excessive intake of phosphate containing laxatives large vit D intake Hyperthyroidism Chemotherapy
Term
 Hyperphosphatemia Assessment:
Definition
 Short term consequences: symptoms of tetany, such as tingling of fingertips & ard the mouth, numbness, & muscles spasms Long term consequences: precipitation of calcium phosphate in nonosseous sites such as the kidneys, joints, arteries, skin, or cornea.
Term
 Hyperphosphatemia Nursing Interventions:
Definition
 Monitor for signs of tetany. Signs of hypocalcemia Instruct pt that use of phosphate-containing laxatives can result in hyperphosphatemia Avoid foods high in phosphorus content.
Term
 (hyponatremia and hypernatremia) Sodium:
Definition
 controls and regulates volume of body fluids Aldosterone secretion & dietary intake control Na levels Normal concentration:135 – 145 mEq/l Provides nerve impulse transmission Regulation of acid-base balance Participates in cellular reactions
Term
 (hypokalemia and hyperkalemia) Potassium:
Definition
 chief regulator of cellular enzyme activity and water content Renal excretion and dietary intake regulate K Normal concentration: 3.5 – 5 mEq/l Regulates metabolic activities Transmission & conduction of nerve impulses Smooth muscle contraction (cardiac muscle)
Term
 (hypocalcemia and hypercalcemia) Calcium:
Definition
 nerve impulse, blood clotting, muscle contraction, B12 absorption Dietary intake primarily regulates Ca Normal concentration found in the bone Bone and teeth formation Cell membrane integrity Cardiac and nerve impulse transmission
Term
 (hypomagnesemia and hypermagnesemia) Magnesium:
Definition
 metabolism of carbohydrates and proteins,vital actions involving enzymes Dietary intake, parathyroid secretions and renal function maintain Mg level Provides cardiac and muscle excitability Provides neuro-chemical activities Provides enzyme activities
Term
 (hypophosphatemia and hyperphosphatemia) Phosphorus:
Definition
 involved in important chemical reactions in body, cell division, and hereditary traits Dietary intake, renal excretion, intestinal absorption and parathyroid hormone control phosphate. Provides buffer in the ICF, assists w/ acid-base balance Promotes neuromuscular action and carbohydrate metabolism Calcium and Phosphorous are inversely related
Term
 Acid-Base parameters for Arterial Blood Gas (ABG) Studies
Definition
 pH: Normal=7.35-7.45/ Acid= <7.35/ Base= >7.45 PaCO2: Normal=35-45mm Hg/ Acid= >45mm Hg/ Base= <35mm Hg  HCO3: Normal=22-26mEq/L/ Acid= <22mEq/L/ Base= >26mEq/L
Term
 Acid Base Imbalances
Definition
 pH <7.35=Respiratory acidosis/ Metabolic acidosis pH >7.45=Respiratory alkalosis/Metabolic alkalosis PaCO2 >45=Respiratory acidosis PaCO2 <35=Respiratory alkalosis HCO3 <22=Metabolic acidosis HCO3 >28=Metabolic alkalosis
Term
 PaCO2 -Reflects depth of respiratory ventilation Normal Range: 35 to 45 mm Hg
Definition
 < 35 hyperventilation (Base) > 45 hypoventilation (Acid) Rate and depth of respiration determines how much CO2 is retained or lost Hyperventilation – rate & depth increases, PaCO2 decreases Hypoventilation – rate & depth decreases, PaCO2 increases
Term
 PaO2
Definition
 < 60 mm Hg leads to anaerobic (living w/out air) metabolism = lactic acid production Hypoxemia -> hyperventilation -> Respiratory alkalosis Normal range 80 to 100 mm Hg
Term
 O2 saturation
Definition
 Point at which hemoglobin is saturated with O2 Saturation level drops when < 60 mm Hg PaO2 Normal range 95 to 99 %
Term
 Base Excess
Definition
 The amount of blood buffer that exists Normal range:  +2 Alkalosis can occur by ingesting large amounts of antacids
Term
 Bicarbonate
Definition
 The major renal component of acid-base balance The principal buffer of the ECF Normal range:  22 to 26 mEq/l < 22 Metabolic acidosis >28 Metabolic alkalosis
Term
 Acid-Base Imbalance Homeostasis:
Definition
 At homeostasis HCO-3 and CO2 are stable
Term
 Metabolic Acidosis
Definition
 Low pH (increase H+ concentration) & a low plasma bicarbonate concentration due to gain of H or loss of bicarbonate. A proportionate deficit of bicarbonate in ECF. Can occur in the results of an increase in acid components or an excessive loss of bicarbonate.  Can be produced by a gain of H+ ions or loss of bicarbonate. Lungs – increase rate and depth of respirations = decreased PaCO2 Kidneys – retain bicarb and excrete hydrogen ions
Term
 Metabolic Acidosis Hyperkalemia:
Definition
 With metabolic acidosis, hyperkalemia may occur as potassium shifts out of the cell As acidosis is corrected, potassium shifts back into the cell and potassium levels decrease Monitor potassium levels, for hyperkalemia Serum calcium levels may be low with chronic metabolic acidosis and must be corrected before treating the acidosis
Term
 Metabolic Acidosis (Base bicarbonate Deficit) Risk Factors:
Definition
 Diarrhea Intestinal Fistulas Renal Failure
Term
 Metabolic Acidosis Assessments:
Definition
 Headache Confusion Drowsiness Increase respiratory rate & depth Nausea & vomiting
Term
 Metabolic Acidosis Nursing Interventions
Definition
 Treatment is directed toward correcting the metabolic deficit. If the cause of the problem is excessive intake of chloride, treatment obviously focuses on eliminating the source.  When necessary, bicarbonate is administered. Check pt pH level.
Term
 Metabolic Alkalosis
Definition
 High pH & a high plasma bicarbonate concentration due to a gain of bicarbonate or a loss of H. Associated w/ excess of HCO3, a decrease in H+ions, or both, in the ECF. Result of excessive acid losses or increased base ingestion or retention. Lungs – retain CO2 by decreasing resp/rate Respirations become slow & shallow, & periods of no breathing may occur.  Kidneys attempt to excrete excess H2O & NA ions w/ the excessive bicarbonate & retain H+ ions.
Term
 Metabolic Alkalosis Risk Factors:
Definition
 Vomiting or gastric secretion Hypokalemia Renal loss of H+
Term
 Metabolic Alkalosis Asessments:
Definition
 Dizziness Tingling of fingers & toes Hypertonic muscles Hypokalemia may be present. Decreased respirations
Term
 Metabolic Alkalosis Nursing Interventions
Definition
 Treatment is aimed at reversal of the underlying disorder. Sufficient chloride must be supplie for the kidney to absorb Na w/ chloide (allowing the excretion of excess bicarbonate). Treatment alos includes administration of NaCl fluids to restore normal fluid volume.
Term
 Respiratory Acidosis
Definition
 High PaCO2 due to alveolar hypoventilation. Excess of carbonic acid in the ECF. Produced by inadequate excretion of CO2 w/ inadequate ventilation, resulting in elevated plasma CO2 & increased levels of carbonic acid. Decrease in alveolar ventilation results in retention of CO2.  Increased CO2 stimulates the medulla in the resp center to increase the resp rate.  Increased resp rate, CO2 is expelled & the CO2 level of the blood is reduced. NaHCO3: buffers the free acids & reduces CO2 levels.
Term
 Respiratory Acidosis Risk Factors:
Definition
 Acute Respiratory disease: pulmonary edema, cardiac arrest Chronic Respiratory Disease: Emphysema, bronchial asthma, cystic fibrosis
Term
 Respiratory Acidosis Assessments:
Definition
 Acute resp acidosis: mental cloudiness, dizziness, muscular twitching, unconsciousness Chronic resp acidosis: weakness, dull headache
Term
 Respiratory Acidosis Nursing Interventions:
Definition
 Treatment is directed at improving ventilation; pharmocologic measures, pulmonary hygiene measures, adequate hydration, supplemental O2 Mechanical ventilation may be necessary to correct disorder but must be used cautiously to decrease PaCO2 slowly.
Term
 Respiratory Alkalosis
Definition
 Low PaCO2, due to alveolar hypertension. A primary deficit of carbonic acid in the ECF. Result of hyperventilation breathing that's faster & deeper, & the consequent increase in the elimination of CO2. Loss of CO2 leads to a decrease in the carbonic acid level in the plasma & an increase in the pH. Chemoreceptors in the medulla sense the increase in pH & the presence of less carbonic acid & stimulate the body to breath either more slowly or less deeply.  Kidney attempt to alleviate the imbalance by increasing the bicarbonate excretion & by retaining more H to correct the imbalance.
Term
 Respiratory Alkalosis Risk Factors:
Definition
 Hyperventilation Extreme anxiety (most common cause) Hypoxemia (decrease O2 & CO2 exchange)
Term
 Respiratory Alkalosis Assessments:
Definition
 Lightheadedness Hyperventilation syndrome: Tinnitus, palpitations, sweating, dry mouth, tremulousness, convulsions & loss of consciousness
Term
 Respiratory Alkalosis Nursing Interventions
Definition
 If anxiety is the cause, encourage pt to breathe more slowly (causes accumulation of CO2) or breathe into a closed system (paper bag). Sedative may also be necessary in extreme anxiety. Treatment of other causes is directed at correcting the underlying problem.
Term
 Metabolic Acidosis
Definition
 decrease pH, decrease HCO3-, Normal PaCO2, (Acidic) Increased H+ ions
Term
 Metabolic Alkalosis
Definition
 Increase pH, Increase HCO3-, Normal PaCO2 (Base) Decrease H+ ions
Term
 Respiratory Acidosis
Definition
 Decreased pH, Inceased PaCO2, Normal HCO3- (Acidic) H+ ions increased
Term
 Respiratory Alkalosis
Definition
 Incrased pH, Decreased PaCO2, Normal HCO3- (base) H+ ions decreased
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