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TL acids/bases
balancing acids and bases
| Question | Answer |
|---|---|
| Can accept hydrogen ions | Base or Alkaline |
| Gives up hydrogen ions | Acid |
| Fewer hydrogen ions = _____pH | higher pH |
| More hydrogen ions = ______pH | low pH |
| Base = ______pH | higher |
| Acid = ______pH | lower |
| Normal pH of blood | 7.35 to 7.45 |
| Blood pH of below 6.8 or above 7.8 | fatal |
| A normal blood pH indicates a balance between which two ions? | Hydrogen and bicarbonate |
| Hydrogen ions increase or bicarbonate ions decrease | low pH below 7.35 = Acidosis |
| Hydrogen ions decrease or bicarbonate ions increase | High pH above 7.45 = Alkalosis |
| pH is low = Hydrogen ions are ______ | high |
| PH is high = Hydrogen ions are _______ | Low |
| What are the big three regulatory systems that come into play whenever the bodies pH rises or falls? | Chemical buffer system, Lungs, Kidneys |
| What is the reaction time of the big three regulatory systems of acid-base imbalances? | buffers/immediately; Lungs/within minutes; Kidneys/within hours or days |
| Which of the big three regulatory systems of acid-base imbalances is the most efficient? | the chemical buffer system |
| What are the main chemical buffers? | bicarbonate, phosphate, and protein |
| What is the body’s primary buffer system? | Bicarbonate buffer |
| Mainly responsible for buffering blood and interstitial fluid | bicarbonate system |
| Regulates the production of bicarbonate | The kidneys |
| Reglulates the production of carbonic acid | the lungs |
| Results from the combination of carbon dioxide and water | carbonic acid |
| Especially effective in renal tubules | Phosphate buffering system |
| Most plentiful buffers in the body, work inside and outside cells | protein buffers |
| Hemoglobin combining with hydrogen ions is an example of what kind of buffer system? | protein buffer system |
| A gas that combines with water to form carbonic acid | carbon dioxide |
| The lungs regulate blood levels of what? | carbon dioxide |
| Increased levels of carbonic acid lead ________ in pH | Decrease |
| Who notices when the pH of the blood is off and what do they do about it? | Chemoreceptors in the medulla notice the changes and vary the rate and depth of breathing to compensate. |
| What kind of breathing eliminates more carbon dioxide? | faster/deeper breathing |
| What is the result of the loss of carbon dioxide? | less carbonic acid is produced so the pH rises |
| What does the body need to make carbonic acid? | Carbon dioxide and water |
| If the lungs are blowing off plenty of carbon dioxide what happens to the production of carbonic acid? | It slows. |
| What do the lungs do if the chemoreceptors in the medulla notice that the blood pH is getting a little high? | Reduce carbon dioxide loss by breathing slower or shallow breathing. |
| When respirations go up CO2 level goes? | Down |
| Paco2 | Partial pressure of Carbon dioxide in arterial blood |
| How do we check to see if ventilation is keeping pH in check? | Paco2 |
| Normal Paco2 level | 35-45 mm Hg |
| Reflects the amount of carbon dioxide in the blood | Paco2 |
| Twice as effective as the chemical buffer system because it can handle twice the amount of acids and bases | Respiratory system |
| Responds to pH changes in minutes, but can only restore normal pH temporarily | Respiratory system |
| Responsible for long term changes to pH | Kidneys |
| Takes hours or days to make pH changes | kidneys |
| Reflects the metabolic component of acid-base balance | bicarbonate level |
| Normal bicarbonate level in ABG | 22-26 mEq/L |
| What happens in the kidneys when pH drops? | Sodium bicarbonate is reabsorbed. Hydrogen along with phosphate or ammonia is excreted. |
| What causes more bicarbonate to be formed in the kidney tubules? | Reabsorption of bicarbonate and increased excretion of hydrogen |
| What happens to the pH of the blood if bicarbonate levels rise? | PH rises too. |
| If blood has more base and less acid ph is ….? | High |
| If blood has less base and more acid ph is …? | Low |
| If blood pH is high, what does the kidney do to fix it? | excrete bicarbonate and hang on to hydrogen |
| What happens to blood and pee if the kidneys excrete bicarbonate and hangs on to hydrogen? | Blood pH level decreases and Pee pH rises |
| What does this mean? “Returning the pH to a normal level mainly involves changes in the component – metabolic or respiratory – not primarily affected by the imbalance.” | If the problem is respiratory then the metabolic system kicks in to fix it. If the problem is metabolic then the respiratory system kicks in to fix it. |
| What do the lungs do to help the metabolic system if it has too much bicarbonate ( high pH/alkalosis)? | The rate of respirations decrease. |
| What do the lungs do to help the metabolic system if it has too little bicarbonate (low pH/acidosis)? | The rate of respirations increase. |
| What action by the lungs gets rid of carbon dioxide? | increased rate of respiration |
| How do the kidneys help the lungs out if the Paco2 level is off? | The kidneys alter the levels of bicarbonate and hydrogen |
| A diagnostic test that assesses the effectiveness of breathing and overall acid-base balance from a sample of arterial blood | ABG |
| Does an ABG tell us all we need to know about a patient’s acid-base balance/respiratory effectiveness? | Nope. ABG is used in conjunction with a full assessment |
| A measure of hydrogen ion concentration | pH |
| A measure of carbon dioxide in arterial blood | PaCo2 |
| Indicates the effectiveness of breathing | PaCo2 |
| Moves in the same direction as pH | Bicarbonate |
| Moves in the opposite direction as pH | PaCo2 |
| Represents the metabolic component of acid-base balance | bicarbonate |
| Normal SaO2 Range | 95% to 100% |
| What is SaO2? | Arterial oxygen saturation |
| What are the 5 steps for interpreting ABG results? | pH; Paco2; bicarbonate; compensation; oxygen -Pa02 and Sa02 |
| ABG results that indicate respiratory alkalosis | High pH and low Paco2 |
| ABG results that indicate respiratory acidosis | Low pH and High paco2 |
| If ABGs show that pH and bicarbonate levels are increased, what does this indicate? | Metabolic alkalosis |
| If ABGs show that pH and bicarbonate levels are low, what does this indicate? | Metabolic acidosis |
| High pH and Low Paco2 | respiratory alkalosis |
| Low pH and High Paco2 | respiratory acidosis |
| What ABG results indicate metabolic alkalosis? | pH and Bicarbonate levels are increased |
| What ABG results indicate metabolic acidosis? | PH and Bicarbonate levels are decreased |
| Give an example of ABGs that indicate respiratory compensation for metabolic acidosis. | pH below 7.35 Bicarbonate below 22 mEq/L and Paco2 below 35 mm Hg |
| Give an example of ABGs that indicate metabolic compensation for respiratory alkalosis. | pH above 7.45, Paco 2 below 35mm Hg, and bicarbonate below 22 mEq/L |
| Helps differentiate among various acidotic conditions | Anion gap |
| Accounts for more than 90% of the circulating cations in the body | Sodium |
| What two ions account for 85% of the anions that counter balance sodium? | Chloride and bicarbonate |
| What is the formula for figuring anion gap? | Sodium – (chloride + bicarbonate) = anion gap |
| What does the anion gap measure? | Extracellular anions not usually measured in ABG like sulfates, phosphates, proteins, Lactic acid and ketone acid. |
| What is the normal range for anion gap? | 8-14 mEq/L |
| What does the anion gap measurement look like for a patient with lactic acidosis or ketoacidosis? | >14mEq/L |
| What are the rare conditions under which a patient may have a lowered anion gap? | hypermagnesemia and paraprotein enemia states. |
| Give two examples of paraprotein enemia states. | Multiple myeloma and Waldenstrom’s Macroglobulinemia |
| What would an anion gap look like for a patient with hyperchloremic acidosis, renal tubular acidosis, or severe bicarbonate wasting conditions? | Normal = between 8 and 14 mEq/L |
| Give 3 examples of severe bicarbonate wasting conditions. | biliary or pancreatic fistulas or poor ileal loop function |
| What is an ileal loop? | Using a piece of the intestine for an artificial bladder. Ureters connect to the intestine with an ostomy created to the abdomen. |
| What is the measurement of carbon dioxide in the blood called? | PaC02 = partial pressure of carbon dioxide in arterial blood |
| Where are the chemoreceptors located that adjust breathing to compensate for pH is that is either too high or too low? | In the medulla |
| What kind of relationship exists between arterial carbon dioxide levels (PaCO2) and Blood pH? | Inverse |
| Represents metabolic component of the body's acid-base balance | Bicarbonate |
| Represents the respiratory component of the body's acid-base balance | PaC02 = partial pressure of carbon dioxide in arterial blood |
| SaO2 | Arterial oxygen saturation |
| PaO2 | Partial pressure of oxygen dissolved in arterial blood |
| What are the normal levels for SaO2? | 95 to 100% |
| What is the normal range for PaO2? | 80 to 100 mm Hg (Maybe less than 80 for folks older than 60 without signs and symptoms) |
Created by:
Perseverandovercome
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