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F & E / Acid Base

Kamhoot lecture: NP2

What percentage of our body weight is fluids? 60%
Of our body fluids, ___% are extracellular, while ___% are intracellular 34% ECF 66% ICF
List some interstitial fluids and the percentage that makes up our body fluids. Is interstitial fluid intra or extracellular? * ISF includes lymph, CSF, GI secretions * 27% of our total body fluids * extracellular
What fluid comprises the plasma within our blood vessels? What percentage of our body fluids is this? Intravascular fluid * 7%
Edema usually involves which body fluid? What can it caused by? *Interstitial fluid (ECF) * Caused by venous hydrostatic pressure... pooling
List 5 functions of water. * transportation of nutrients * maintenance of blood volume * lubrication of tissues * maintenance of acid-base balance * heat regulation via evaporation
What is the daily water intake & output? 2500 mL
How is water loss replenished? * by ingestion of food/fluids * metabolism of food/body tissues
If total water intake is 2500 mL, how many mL can be accounted for in food, from oxidation, & as liquid? * FOOD: 1000 mL * OXIDATION: 300 mL * LIQUID: 1200
What is the removal of electrons from an atoms or molecules? oxidation
Fluid output includes sensible & insensible loss. In what 4 ways can water be lost via those regular pathways and how many mL are lost via each? (Remember: 2500 mL lost total) Insensible: * SKIN: 500 mL * LUNGS: 350 mL Sensible: * FECES: 150 mL * URINE: 1500 mL
Infants are ___-___% water & ___-___% solids. 70-80% water 20-30% solids
Adults are ___-___% water & ___-___% solids. 50-60% water 40-50% solids
Geriatrics are ___-___ water & ___-___% solids. 45-55% water 45-55% solids
Fluid Volume Deficit is often called what? Fluid lost is mainly from what type of fluid? * Hypovolemia * Intravascular fluid
Fluid volume deficit is hypo/hyper/iso(tonic)? isotonic: the body loses electrolytes and water in similar proportions
Causes of Hypovolemia? * abnormal water loss thru the skin, GI tract, or kidneys * decreased intake of fluid * bleeding * movement of fluid into a 3rd space (unavailable for use: may shift back and risk hypervolemia: not often evident)
Signs & symptoms of fluid volume deficit? * thirst * dizziness * weakness * poor skin turgor * weight loss * elevated, weak heart rate * postural hypotension * decrease urine output * mental status change * dry mucous membranes * flat neck veins * increased BUN * increased specific gr
How does one measure postural hypotension? * Take B/P of client while laying down, and then after standing them up. * A positive result: - decrease in systole: > 20 mm Hg - decrease in diastole: 10 mm Hg - 10-20% decrease in heart rate
Treatment/Nursing Interventions for Fluid Volume Deficit: * Assess for FVD evidence * Monitor weight & V/S * Assess neuro status (LOC) * Assess turgor * Monitor I & Os * Monitor lab findings: Na, BUN, Hct * Admin IV & oral fluids * Mouth care * Blood transfusion? * Address safety issues: decub/fall risk
Fluid volume excess, also known as ___, is hypo/hyper/isotonic? * Hypervolemia * isotonic
Causes of hypervolemia: * excessive intake of fluids * excessive intake of NaCl * abnormal retention of fluids * interstitial to plasma fluid shift * admin of sodium-containing infusions too rapidly * dz processes that alter regulatory mechs (heart/renal/liver failure)
Signs & symptoms of FVE (hypervolemia): * edema * increased heart rate & B/P * tachypnea, dyspnea * distended veins * weight gain * I>O * crackles in lungs * pulmonary edema
Treatment/Implementation for fluid volume excess: * Diuretics * Fluid restriction * Sodium restriction * Monitor weight & V/S * Assess for edema * Assess/monitor breath sounds * Place in Fowler's position
List reasons geriatrics are at increased risk for dehydration: * fat replaces lean muscle * decreased fxn of thirst mechanism * kidney fxn for concentrating urine decreases * incontinent * over salt foods * mild disorientation * orthostatic hypotension * constipation * decrease in mobility decreases thirst
What is the glomerular filtration rate? How many L of urine are excreted per day? * nephrons filter blood at a rate of 125 mL / min or about 180 L / day * 1-2 L / day
The kidneys must excrete a minimum of ___mL/hr of urine to eliminate waste products from the body 30
The kidneys react to fluid excesses by excreting a more or less dilute urine to rid the body of excess fluid & conserve electrolytes? more
A weight loss/gain of 1 kg (2.2 lbs) will reflect a loss/gain of ___L of body fluid? 1
When a substance enters the body, the first fluid it travels through is intra or extracellular? extracellular
Diffusion, osmosis, and filtration are all active/passive transport processes? passive transport
When osmolality and osmolarity are high, there are more or less particles than water? more
When osmolality and osmolarity are low, there are more or less particles than water? less
Osmolality or osmolarity is used to describe fluids inside the body? i.e. serum Osmolality
Osmolality or osmolarity is used to describe fluids outside the body? i.e. urine Osmolarity
A ____ is a substance dissolved in a liquid. solute
A ____ is a component of solution that dissolves a solute. solvent
The movement of particles (solutes) in all directions thru a solution or gas from areas of high concentration to low concentration, resulting in equal distribution of solutes w/i the 2 areas is... and give one example Diffusion; Oxygen
What is the movement of water from an area of lower concentration to an area of higher concentration thru a semipermeable membrane? Osmosis
One type of diuretic that works by osmosis and is assisted by osmotic pressure is...? Lasix (Furosemide)
What type of solution (hyper/hypo/isotonic) pulls fluid from cells, causing cells to crenate, and has a higher osmolality (solute concentration) than body fluids? Hypertonic solution
What type of solution (hyper/hypo/isotonic) has the same osmolality of body fluids & has capacity to expand body's fluid volume w/o causing a fluid shift? Isotonic solution
What type of solution has a lower osmolality (solute concentration) than body fluids & causes fluid to move into cells, causing them to swell & eventually lyse? Hypotonic solution
D5W: 5% dextrose in water, LR: lactated ringers NS: 0.9% NaCl - all examples of what type of solution? Isotonic solution
D10W: 10% dextrose D5LR: 5% dextrose in lactated ringers D5NS: 5% dextrose in 0.9% NaCl D5 1/2NS: 5% dextrose in 0.45% NaCl - all examples of what type of solution? Hypertonic solution
D2.5W: 2.5% dextrose 1/2NS: 0.45% NaCl - all examples of what type of solution? Hypotonic solution
This describes the power of a solution to draw water across a semipermeable membrane. This force PULLS fluid toward higher concentrated compartments. (esp toward the vascular space) Osmotic pressure
Pressure exerted by a fluid within a fluid compartment: i.e. the force exerted by blood against vascular walls: fluids move from areas of greater pressure to those of lesser pressure; PUSHES fluid out of vascular space Hydrostatic pressure
This pressure, exerted by plasma proteins, pulls water from the interstitial space into the vascular compartment... maintains vascular volume. Oncotic/Colloid osmotic pressure
This type of diffusion involves carrier molecules, but requires no ATP. Facilitated diffusion
This is the passive transfer of H2O & dissolved substances from an area of higher pressure to one of lower pressure (via hydrostatic pressure)... Heart pump causes H2O & electrolytes to move from capillaries to interstitial fluid. Filtration
On the arterial side, ____ pressure moves fluid/particles out, while on the venous side, ____ pressure moves fluid/particles back in. hydrostatic, osmotic
This hormone, synthesized by the hypothalamus and secreted by the posterior pituitary, is released when a decrease in B/P decreases water volume in body. Antidiuretic hormone (ADH)
When B/P increases, too much water inhibits this hormone, thus less water is reabsorbed & urine is dilute... this causes a drop in B/P (protective). Antidiuretic hormone (ADH)
This hormone, released from the adrenal cortex promotes sodium (and thus H2O) retention (reabsorption)... K+ is secreted in return. Aldosterone
This diuretic inhibits aldosterone by preventing the conversion of angiotensin I to angiotensin II. Lasix (Furosemide)
This hormone is produced and released from the adrenal cortex when the body is under stress: it promotes renal retention of Na & H2O. Glucocorticoids (cortisol)
This cardiac hormone is released when the atria are stretched by high blood volume or high B/P. Atrial Natriuretic Peptide (ANP)
ANP lowers blood pressure & B/P by: * causing vasoconstriction or dilation? * decreasing/increasing aldosterone? * decreasing/increasing ADH release? * decreasing/increasing GFR? * vasodilation * decreasing aldosterone * decreasing ADH release * increasing GFR
This cardiac hormone is secreted by the ventricles & decreases blood volume & pressure by: * vasoconstriction or dilation? * decreasing/increasing aldosterone? * causing diuresis with retention/excretion of Na & H2O? Brain natriuretic peptide (BNP) * vasodilation * decreasing aldosterone * causing excretion of Na & H2O
This type of transport of fluid/ electrolytes requires ATP & moves things w/o regard for charge or concentration gradient factors that might prevent entry via diffusion. Active Transport
Active transport moves fluids/ electrolytes from an area of ____ concentration to those of ____ concentration. List 5 electrolytic substances, 1 molecule, & 1 other substance transported actively. * Na, Fe, K, Ca, H * glucose * amino acids
When dehydrated, serum osmolality increases/decreases? When overhydrated, serum osmolality increases/decreases? * increases: dehyd * decreases: overhyd
The following diseases show evidence that osmolality is increased when measuring it in serum: * dehydration * diabetes insipidus * diabetic ketoacidosis * hypercalcemia * hypernatremia
The following diseases show evidence that osmolality is increased when measuring it in urine: * congestive heart failure * dehydration * hyponatremia * syndrome of inappropriate ADH: SIADH
The following diseases show evidence that osmolality is decrease when measuring it in serum: * hyponatremia * SIADH * water intoxication
The following diseases show evidence that osmolality is decreased when measuring it in urine: * diabetes insipidus * hypernatremia * hypokalemia
Which part of the brain senses fluid deficit/increase in plasma osmolality? * Decrease in volume stimulates thirst --> increased water & decreased plasma osmolality Hypothalamus
The normal function of this type of regulation is to store/release ADH. The normal release is caused by... * Pituitary regulation * Increased osmolality * Stress * Nausea * Nicotine * Morphine
The pathological action of pituitary regulation causes what in SIADH and what in Diabetes insipidus? * SIADH: increased ADH, water retention * DI: decreased ADH, dehydration, increased Na+
Glucocorticoids and Mineralocorticoids are hormones released to help regulate both water & electrolytes & are part of what type of regulation? Adrenal cortical regulation
This category of hormones enhances sodium retention & potassium excretion (aldosterone is one) Mineralocorticoids
This category of hormones is an anti-inflammatory that increases serum glucose (cortisol is one) Glucocorticoids
This type of regulation involves the kidneys & includes the primary regulators of fluid & electrolytes. Renal regulation
In renal regulation, ___ L plasma/day are filtered, yet only ___ L urine is excreted. 180, 1.5
Which 2 hormones work on the renal tubules to selectively retain & excrete water & electrolytes? ADH, aldosterone
Urine specific gravity measures ___. What is the normal level? * concentration of urine * 1.010-1.030
If urine is too dilute, what might be the level? This would indicate deficient/excess fluid intake & an inability to concentrate urine. <1.010, excess fluid intake
If urine is over-concentrated, this indicates _____, another word for excess solutes in the urine and a specific gravity of ____. dehydration, >1.030
This type of regulation involves ____, which is released from cells in the heart atria in response to excessive blood volume. Cardiac, ANP
When ANP is released, what hormones are suppressed? Further, what happens with Na+ & water, blood vessel width, & thirst? * Renin, aldosterone, ADH are suppressed * Na+ & water are excreted * Vasodilation occurs * Thirst is inhibited
Most of the water intake occurs thru the ___ tract and accounts for __-__L/day. ___mL are eliminated in feces. Not so elegant ways to eliminate greater amounts of water from the GI tract are ___ & ___. 2-3 L/day intake 100 mL feces diarrhea, vomiting
Are electrolytes lost during insensible water loss? How many mL or water is lost/ day this way (sweat, breath)? Electrolytes typically are not lost, except with excessive sweating. 600-800 mL of water account for insensible water loss.
Electrolytes break up into particles called ___ when they dissolve in water and develop an electrical ___. ions, charge
For each positively charged ___ion, there must be a negatively charged ___ion. cation, anion
By what means of transport to electrolytes move? active transport
Which ion determines the acidity or alkalinity of body fluids? * The more H+, the more acidic a solution * The more OH-, the more basic a fluid.
In a solution, acids accept/give up H+, while bases accept/give up H+. * Acids give up H+ (they have more H+ than bases... makes sense) * Bases accept H+
List 3 cations & 5 anions found in ICF (2/3 body's water). Cations: Mostly K+, some Na+, some Mg++ Anions: Mostly PO4---, some HCO3-, protein, Cl-, SO4--
List 4 cations & 4 anions found in ECF (1/3 body's water). Cations: Mostly Na+, some K+, Ca++, Mg++ Anions: Mostly Cl-, Some HCO3-, SO4--, PO4---
The greatest concentration of sodium is found in the ICF/ECF? Sodium moves with ___. Normal level: ___-___mEq/L * ECF * water * 135-145
List 3 functions of sodium. * Regulates volume & osmolality of the ECF * Involved in nerve impulse transmission * Involved in muscle contraction * Maintains blood volume
Causes of hyponatremia related to sodium loss: * GI loss: diarrhea, vomiting, fistula, NG suction * Renal loss: SIADH, diuretics, adrenal insufficiency, Na+ wasting renal disease * Skin loss: burns, wound drainage
Causes of hyponatremia related to water gain (sodium dilution): * Congestive heart failure * excessive hypotonic IV fluids * Primary polydipsia (excessive fluid intake caused by dry mouth feeling) * SIADH
A decrease in ECF volume indicates ____ loss, while increased ECF volume indicates ___ gain. * sodium * water
Clinical manifestations of what electrolyte imbalance? * tachycardia * tremors, seizure, coma * postural hypotension * irritability, apprehension, confusion * rapid, thready pulse * JV filling * nausea * dry mucous membranes * weight loss * emin Hyponatremia: sodium loss (Decreased ECF volume)
Clinical manifestations of what electrolyte imbalance: * weight gain * nausea, vomiting * muscle spasms, seizure, coma * postural hypotension * headache, fatigue, apathy, weakness, confusion Hyponatremia: water gain (Increased ECF volume)
List possible causes of hypernatremia related to water loss. * Insensible water loss (perspiration thru heat stroke, high fever) * Diabetes insipidus * Osmotic diuresis * Diarrhea * Water deprivation
Causes of hypernatremia related to sodium gain. * IV hypertonic D5NS * IV sodium bicarbonate * IV excessive isotonic NS * Primary hyperaldosteronism * Saltwater drowning
Clinical manifestations of what electrolyte imbalance: * intense thirst * peripheral/pulmonary edema * weight gain * seizure, coma * flushed skin * restlessness, agitation, twitching Hypernatremia: sodium gain (Normal or increased ECF volume)
Clinical manifestations of what electrolyte imbalance: * Intense thirst * Dry, swollen tongue * Restlessness, agitation, twitching * Confusion * Seizure, coma * Postural hypotension * Low urinary output * Weight loss * Weakness Hypernatremia: water loss (Decreased ECF volume)
What can be done to treat water/sodium imbalances? * Treat the cause * Adjust the diet * Treat fluid loss
What percentage of potassium is intracellular? What is the normal serum potassium range? 98%; 3.5-5.0 mEq/L
In hyponatremia, cells ____, while in hypernatremia, cells ____. Severe hyponatremia, serum levels below ____mEq/L is a medical emergency & can lead to permanent brain damage. * Cells swell in hyponatremia * Cells shrink in hypernatremia * below 110 mEq/L = severe
Cells become dehydrated in hypo/hypernatremia? Normally, sense of thirst helps correct this disorder, but thirst mechanism may not be in tact or water may not be available. hypernatremia (excess sodium in ECF)
Potassium must be replaced in the diet because __% is excreted by the kidneys. 80%
Is hyper/hypokalemia more dangerous? Why? hyperkalemia is more dangerous b/c it can lead to cardiac arrest
Normal functions of potassium? * Maintains ICF osmolality * Transmits nerve impulses * Regulates cardiac impulse transmission (rhythm) * Regulates muscle contraction of smooth/skeletal muscle * Regulates acid-base balance * Promotes cell growth * Leaves cells during tissue breakd
Potassium is the major extra/intracellular cation? intracellular
Sources of Potassium: * Dark yellow & orange fruits * Avocados * Dark green leafy veggies * Sweet potatoes * Meat: beef, chicken, liver, pork, veal, turkey * Nuts, peanut butter * Cocoa, soda * Instant tea, coffee
Causes of what electrolyte imbalance: * Abnormal fluid loss (vomiting, diarrhea, fistulas, NG suctioning, ileostomy) * Metabolic alkalosis hypokalemia
SxS of what electrolyte imbalance: * fatigue * leg cramps * decreased deep tendon reflexes * polyuria * ventric arrhythmias * enhanced digitalis effect * myasthenia * N, V, ileus * paresthesia * weak, irreg pulse * hyperglycemia * bradycardia Hypokalemia
List treatments for hypokalemia: * prevention of metabolic acidosis * treat diarrhea, vomiting * adequate dietary intake * give K+ supplements * monitor med side effects
List several causes of hyperkalemia. * Usually renal failure * Hypoaldosteronism * potassium-conserving diuretics * massive cell damage * rapid K+-containing IV infusions * catabolism * metabolic acidosis, burns, infections (moves K+ out of cells) * adrenal insufficiency
What hormone helps move K+ into cells? insulin
Clinical manifestations of what electrolyte imbalance: * irritability * anxiety * abd cramping, diarrhea * myasthenia (legs) * paresthesias * irreg pulse * cardiac standstill * ventric fibrillation hyperkalemia
List some treatments for hyperkalemia. * calcium gluconate IV * regular insulin & glucose admin IV * sodium bicarbonate * dialysis * sodium polystyrene sulfonate (Kayexalate: trades Na+ for K+, elim in feces)
Hypo and hyperkalemia refer to deficiencies in extra/intracellular potassium? extracellular
Chloride is the major intra/extracellular anion? Normal level: ___-___mEq/L extracellular; 95-108
Functions of chloride? * major component in formation of HCl in gastric juices * regulates acid-base balance * chloride shift in RBCs
Clinical manifestations of what electrolyte imbalance? * stupor * rapid, deep breathing * muscle weakness Hyperchloremia
Clinical manifestations of what electrolyte imbalance? * increased muscle excitability * tetany * decreased respirations Hypochloremia
Chloride deficiencies/excesses are also associated with similar deficiencies/excesses of which electrolyte? Na+
Functions of Calcium * forming bones/teeth * nerve impulse transmission * muscle contrxn * cardiac pacemaker * blood clotting * activates fat-digesting enzymes * normal cell fxn/membrane stability * hormone secretion (PTH, Vit D is necessary for Ca++ absorption)
Disorders of calcium in ECF account for only ___% of total body calcium, but this amount is vital. 1%
50% of ECF calcium circulates in a free, ionized, unbound form, range is ___-___mg/dL. The other 50% is bound to proteins (albumin) or other ions (PO4, carbonate). The total serum calcium level including both bound & unbound calcium is ___-___mg/dL 4.0-5.0mg/dL Total: 8.5-10.5 mg/dL
___% calcium is in bones/teeth. 99%
What is a normal APTT level? What should the level be if on heparin? 14-20... If on heparin, level should be twice the normal level (30-40)
List some sources of Calcium: * milk products * dark green leafy veggies * canned salmon * beans * nuts * cauliflower * egg yolk
Clinical manifestations of what electrolyte imbalance: * lethargy * depressed reflexes * anorexia, N, V * stupor, coma * paresthesia * bone pain, fractures * psychosis * polyuria, dehydration * muscle tremors * ventric arrhythmias Hypercalcemia (> 5 mEq/L)
The following are causes of what electrolyte imbalance? * multiple myeloma * prolonged immobilization * hyperparathyroidism * Vit D OD * thiazide diuretics * increased intest absorp * high bone turnover * ESRD (end-stage renal dz) * drugs * acid Hypercalcemia
Clinical manifestations of what electrolyte imbalance: * fatigue * depression, anxiety, confusion * numbness, tingling around mouth, arms/legs * hyperreflexia, muscle cramps * Trousseau's sign * laryngeal spasm* * Chvostek's sign * tetany, seizure Hypocalcemia
What is Chvostek's sign? Contraction of facial muscles produced by tapping the facial nerve in front of the ear. Indicates hypocalcemia
What is Trousseau's sign? A carpal spasm that occurs by inflating a B/P cuff on upper arm to 20 mmHg higher than systole for 2-5 mins: indicates hypocalcemia (wrist is curled up
The following are causes of what electrolyte imbalance? * chronic renal failure, * primary hypoparathyroidism * Vit D deficiency * Mg loss * high phosphorus * #1: acute pancreatitis * alcoholism * hypothermia * alkalosis * low PTH * rhabdomyol hypocalcemia: < 4 mEq/L
Phosphorus is chiefly an extra/intracellular anion? Normal level is ___-___ mg/dL. intracellular; ECF level: 2.8-4.5
Phosphorus and ____ have an inverse relationship in the body. Calcium
The majority of phosporus is found with calcium in the ___ & ___. Phosphorus also relies on ___ for absorption. bones, teeth; vit D
Functions of phosphorus: * forms bones, teeth * digests carbs, proteins, fats * produces ATP, DNA * muscle, nerve, RBC fxn * acid-base balance * regulates Ca++ levels
The following are causes of what electrolyte imbalance? * diabetic ketoacidosis * dietary insufficiency * impaired kidney fxn * misdistribution of this electrolyte Hypophosphatemia
Treatment for hypophosphatemia: * oral supplements * foods high in phosphorus * may need IV of Na or K phosphate
SxS of hypophosphatemia: (do not usually occur unless level is below __ mg/dL) * muscle weakness/pain * paresthesia * confusion 1mg/dL
The following are causes of what electrolyte imbalance? * renal insufficiency * increased intake of this mineral or vit D * chemotherapy Hyperphosphatemia
SxS of hyperphosphatemia: * tetany * paresthesia around mouth * muscle spasms
Treatment for hyperphosphatemia: * treat cause * restrict phosphate-containing foods * give Basajel, Amphogel, Aluminet (phosphate-binding agents)
The following are functions of what electrolyte? * Relaxes muscle contrxns * Active transport: operates Na+-K+ pump * Cell signaling/nerve impulse transmission * Cell migration/wound healing * regulates cardiac fxn * intracellular metabolism Magnesium
List the 1% level found in ECF: ___-___mEq/L 1.5-2.5 mEq/L
More than half of Mg++ is found in ___ & ___ and 40-50% is in the extra/intracellular fluid compartment? bone, muscle; intracellular
You would supplement magnesium if the level is about ___ even if it isnt quite to the bottom range of deficiency... b/c it is dangerous. 1.7-1.8
The following are causes of what electrolyte imbalance? * renal insufficiency * meds like Lithium, laxatives, antacids with Mg+ * volume depletion * rhabdomyolysis * hypothyroidism * hypomotility disorders * hyperparathyroidism * bowel obstruction hypermagnesemia
Clinical manifestations of what electrolyte imbalance: * lethargy * drowsiness * impaired reflexes * N,V * Somnolence * Bradycardia * Cardiac arrest * Hypotension * EKG changes * Resp arrest hypermagnesemia
Treatment/interventions for hypermagnesemia? * Monitor EKG * Prevent/identify/eliminate cause * IV CaCl, Ca gluconate * fluids * neuro assessment * discontinue contributing meds
The following are causes of what electrolyte imbalance? * diet: malnutrition * drinking ETOH * diuretics * drugs * diarrhea, malabsorption * diabetes mellitus hypomagnesemia
Clinical manifestations of what electrolyte imbalance: * hyperactive deep tendon reflexes * tremors * seizures * cardiac arrhythmias * confusion hypomagnesemia
Treatment for hypomagnesemia? * oral supplements * increased in diet * if severe: parenteral IV or IM Mg++
The following are causes of what imbalance? * anorexia * malnutrition * starvation * fad dieting * poorly balanced veg diets * hemorrhage * nephrotic syndrome * may shift out of intravascular space with inflammation Hypoproteinemia
What proteins are a significan determinant of blood volume? Plasma proteins, such as albumin
This protein imbalance is rare, but may occur with dehydration. hyperproteinemia
Clinical manifestations of what imbalance: * edema * slow healing * anorexia * fatigue * anemia * muscle wasting * ascites Hypoproteinemia
Treatment for hypoproteinemia * high protein diet * supplements * enternal nutrition or TPN
Bicarbonate is a main anion of the E/ICF? Normal level is ___-___mEq/L 22-26
Is bicarbonate a major acidic or alkaline electrolyte? alkaline
Ratio for homeostasis of acid-base regulation is ___ part(s) carbonic acid to ___ part(s) bicarbonate. 1, 20
What blood test determines whether a solution is acidic, neutral, or alkaline? ABG: taken at wrist
List what gases are measured by ABG. * pH (7.35-7.45 normal) * PaCO2 * HCO3 * PaCO2 * SaO2
List normal range for PaCO2. 35-45 mm Hg
Normal range for HCO3. 22-26 mEq/L
Normal range for PaO2: 80-100 mm Hg
Normal range for SaO2: 95-100%
2 types of acid-base imbalances: metabolic, respiratory
Metabolic imbalances involve deficiency/excess of what ion? bicarbonate
Respiratory imbalances involve deficiency/excess of what ion? carbonic acid
3 systems in the body that regulate acid-base balance: * blood buffers * kidneys * lungs
These buffers circulate in pairs, neutralizing acids/bases by donating or accepting H+... act immediately Blood buffers
The buffers speed up or slow down respirations, can incrase or decrease amount of CO2 in blood: respond in minutes to hours Lungs
These buffers excrete varying amts of acid/base; respond in hours-days * Reabsorbs or secretes H+ and HCO3 Kidneys
This is caused by any condition that impairs normal ventilation, perfusion or diffusion. (too much carbonic acid in blood, CO2 retention) Respiratory acidosis
This is caused by losses of excessive amounts of CO2.. causing a decrease in carbonic acid in the blood. Respirations that increase in rate, depth, or both may also cause this. Respiratory alkalosis
List pH level, PaCO2 level, and what happens to bicarbonate in respiratory acidosis. ph: < 7.35 PaCO2: > 45 mmHg bicarbonate stays normal, before it increases b/c it takes a bit for kidneys to retain it to compensate
List pH level, PaCO2 level, & what happens to bicarbonate in respiratory alkalosis. pH: > 7.45 PaCO2: < 35 mm Hg bicarbonate stays normal until kidneys compensate by excreting it
The following are causes of what acid-base imbalance? * aspiration * cardiac arrest * severe pneumonia * emphysema * pulmonary edema * pneumothorax * obesity * stroke * head injury * COPD * asthma * resp infection Respiratory acidosis
The following are causes of what acid-base imbalance? * hyperventilation * anxiety * fear * head injury * ASA (aspirin) overdose * pneumonia * CNS disorders * hypoxia * high fever * pulmonary emboli Respiratory alkalosis
Clinical SxS of what acid-base imbalance? * lethargy * disorientation * dizziness * tremors * weakness * tachycardia * HTN * dyspnea * decrease LOC * occipital H/A (headache) Resp acidosis
Clinical SxS of what acid-base imbalance? * anxious appearance * irritability * paresthesias of hands/toes * fainting * dizziness * tachypnea * cardiac arrhythmias * tetany * muscle weakness * chest tightness/palpitations Resp alkalosis
The following is treatment for what acid-base imbalance? * treat source of anxiety * breathe into paper bag * admin sedatives resp alkalosis
The following is treatment for what acid-base imbalance? * improve ventilation * use bronchodilators * administer O2 * administer fluids * medicate: anit-infectives? resp acidosis
This acid-base imbalance can result from a gain of H+ or a loss of HCO3 metabolic acidosis
List the pH value, PaCO2 value, HCO3 value and lung compensation associated with metabolic acidosis. pH: <7.35 PaCO2: normal HCO3: < 22 mEq/L Lungs compensate by excreting CO2
This acid-base imbalance results when a significant amount of acid is lost from the body or an increase in bicarbonate (base) occurs: metabolic alkalosis
List the pH value, PaCO2 value, HCO3 value and lung compensation associated with metabolic alkalosis. pH: >7.45 HCO3: >24 mEq/L PaCO2: normal Lungs compensate by retaining CO2
The following are causes of what acid-base imbalance? * Starvation * dehydration * ketoacidosis * renal failure * shock * diarrhea * aspirin * acid ingestion * fistulas * severe infection * excessive GI loss metabolic acidosis
The following are causes of what acid-base imbalance? * excessive vomiting * prolonged NG suctioning * electrolyte disturbance (hypokalemia) * Cushing's dz * drugs (steroids, diuretics, antacids) * hyperaldosteronism: too much Na+ & H2O buildup in b Metabolic alkalosis
Clinical SxS of what acid-base imbalance? * headache * lethargy * irritability * decreased LOC * tachycardia * slow, shallow resp * N,V * paresthesia in extremeties * tetany metabolic alkalosis
Clinical SxS of what acid-base imbalance? * headache * N,V * Kussmaul's breathing (shallow, rapid) * drowsiness * increased breathing * diarrhea * lethargy * decreased LOC * cardiac arrhythmias metabolic acidosis
The following is treatment for what acid-base imbalance? * Reverse underlying cause * Administer Na HCO3- * Insulin to move K+ into cells Metabolic acidosis
The following is treatment for what acid-base imbalance? * Reverse cause (thiazide diuretics, NG suctioning discontinued) * admin antiemetic * restore normal fluid volume Metabolic alkalosis
How to know whether the body is compensating for an acid-base disorder: pH is normal
Degree of compensation? * pH is normal but neither CO2 nor HCO3 is normal complete compensation
Degree of compensation? * CO2 & HCO3 are moving in the same direction, but pH is not normal yet. partial compensation
Degre of compensation? * One component is normal CO2 or HCO3), the pH is abnormal and 3rd component is abnormal. uncompensated
Created by: 2049796