acids n such
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| Define acid | an acid is a substance that can give up hydrogen ions (H+) when dissolved in water.
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| Define Base | a base is a substance that can give up hydroxyl ions (OH-) when dissolved in water.
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| Define Dissociation | the ability of an acid or base substance to completely come apart when dissolved in water. (Dissolve into separate “ions” in water.)
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| Define buffer | a buffer is a system that resists changes in pH. (The body has a number of buffer systems whose purpose is the resist change and keep the body in “homeostasis”).
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| Define Compensation | the body’s attempt to return the blood pH toward normal whenever an acid-base imbalance occurs.
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| List the pH range and its units of measure | pH = 1-14, the are no units of measure
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| What is the equation for calculating pH? | pH = -log [H+]
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| What is the normal pH range of the blood? | 7.35-7.40
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| How will an increase in H+ concentration affect the pH of the blood? | It will lower the pH of the blood
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| How will a decrease in H+ concentration affect the pH of the blood? | It will raise the pH of the blood.
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| Define Acidosis | a condition where there is a blood pH below the blood’s normal reference range of 7.35-7.45. (Meaning less than 7.35)
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| Define Alkalosis | a condition where there is a blood pH above the blood’s normal reference range of 7.35-7.45. (Meaning greater than 7.45)
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| What three mechanisms regulate acid-base balance? | 1.buffering systems found within the body 2. the lungs and respiratory center 3. the kidneys
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| List the four major buffering systems of the body that regulate acid-base balance | 1.the bicarbonate-carbonic acid system
2.the lactic acid-lactate system
3.the ammonium-ammonia system
4.the phosphate buffer system
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| What is the importance of the buffering systems found within the body? | The most important thing you need to know about these buffering systems is that they function to keep the pH of the blood within its narrow normal reference range of 7.35-7.45.
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| What role do the respiratory center and lungs play in acid-base balance? | The lungs play an important role in the regulation of blood pH. They do this through the retention or elimination of carbon dioxide (CO2) by changing the rate and volume of ventilation (breathing).
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| What happens to the blood during HYPOventilation? | When the lungs do not remove CO2 at the rate of its production (hypoventilation), it will accumulate in the blood causing an increase in H+ concentration, resulting in a decrease in pH.
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| What happens to the blood during HYPERventilation? | If CO2 removal is faster than its production (hyperventilation), the H+ concentration will be decreased, resulting in an increase in pH.
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| How quickly can the respiratory center and lungs respond to acid-base changes? | Healthy lungs have the capability of responding to acid-base imbalances within seconds.
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| What role do the kidneys play in regulating acid-base balance? | Regulation of blood pH by excreting acid, primarily in the form of ammonium ions, and by reclaiming (or reabsorbing) bicarbonate (HCO3-) from the glomerular filtrate (and adding it back to the blood).
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| How quickly can the kidneys respond to acid-base changes? | kidneys respond to changes in the acid-base balance of the body more slowly than the respiratory center and lungs. It can take hours, days or even weeks for the kidneys to compensate for an acid-base imbalance.
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| What is the interrelationship between the lungs and the kidneys in regulating acid-base balance? | If an acid-base disorder originates from abnormal respiratory center or lung function, it will be compensated (corrected) for by the kidneys. If the acid-base disorder originates from the kidneys, it is the lungs that do the compensating or correcting.
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| What is the Hendersen-Hasselbalch equation? | pH = pK + log [base] Note pK is defined as the pH at which there is an [acid] equal value of (+) and (-) ions in a solution.
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| Explain the purpose of the Hendersen-Haaselbaclch equation. | The relationship between the major acid-base buffering systems of the body and the Henderson-Hasselbalch equation is simply to determine the buffering capacity of those systems.
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| What are the 2 regulatory components when discussing acid-base homeostasis | regulation of blood pH through hypoventilation or hyperventilation, and regulation of blood pH through the maintenance of the HCO3- concentration.
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| what organs are involved in the regulatory processes in acid-base homeostasis | the lungs(respiratory component) and the kidneys(nonrespiratory component)
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| which gas parameter is affected with each regulatory component of acid-base homeostasis | measurement of CO2, the respiratory component. maintenance of the HCO3- concentration, nonrespiratory or metabolic component
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| define acidemia | When the pH of the blood is less than the normal reference range, the condition is termed an “acidemia”.
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| define alkalemia | When the pH of the blood is greater than the normal reference range, the condition is termed an “alkalemia”.
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| define respiratory acidosis/alkalosis | A disorder due to ventilation or respiratory dysfunction (a change in CO2) is termed a “respiratory” acidosis or alkalosis.
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| define metabolic acidosis/alkalosis | A disorder due to kidney dysfunction (a change in HCO3-) is termed a “nonrespiratory or metabolic” acidosis or alkalosis
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| How is an acid-base disorder determined an “acidosis” or “alkalosis”? | Determined by the pH
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| How is an acid-base disorder determined “respiratory” or “metabolic”? | Whether the condition (initially) is considered “respiratory” or “metabolic” will be determined by the CO2 or HCO3- changes
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| How does the body attempt compensation of an acid-base imbalance if it is the kidneys (metabolic) that are malfunctioning? What is the usual outcome of the compensation? | if(metabolic dysfunction), the lungs will attempt to compensate for the imbalance.
The lungs can compensate immediately,the response is short term and often incomplete.
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| How does the body attempt compensation of an acid-base imbalance if it is the lungs (respiratory) that are malfunctioning? What is the usual outcome of the compensation? | imbalance is due to (respiratory dysfunction), the kidneys will attempt to compensate for the imbalance
the kidneys are slower to respond (2 days to 4 days),the response is long term and potentially complete.
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| define partial compensation | “Partially compensated” implies the pH is approaching normal
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| define full compensation | “Fully compensated” implies that the pH has returned to normal
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| explain metabolic acidosis | Metabolic acidosis means there is a decrease in HCO3- concentration, resulting in a decreased pH.The body compensates for metabolic acidosis through hyperventilation, which is an increase in the rate or depth of breathing.
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| explain metabolic alkalosis | due to a gain in HCO3- causing an increase in the pH. The body responds to metabolic alkalosis by depressing the respiratory center.
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| explain respiratory acidosis | results from hypoventilation, causing a decreased elimination of CO2 by the lungs.The body compensates for respiratory acidosis by the kidneys excreting more H+ and increasing the reabsorption of HCO3-.
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| explain respiratory alkalosis | due to hyperventilation causing an excess elimination of CO2 by the lungs. The kidneys compensate by excreting HCO3-, and retaining H+.
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| What is the major reason a physician orders blood gases on a patient? | When a physician wants to know how well a patient is able to exchange O2 for CO2,how well the patient is breathing.
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| normal reference range for pH | 7.35 - 7.45
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| normal ref. range for PO2 (p=partial pressure)(mol/L) | 80 - 110
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| normal ref. range for PCO2(mm Hg) | 35 - 45
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| normal ref. range for HCO3- (mol/L) | 22 - 26
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| normal ref. range for Total CO2 (mol/L) | 23 - 27
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| normal ref. range for SO2 (%) | > 95
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| BE (base excess) | ? unknown....
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| Define partial pressure (“p”) | Partial pressure (p) is defined as the pressure each individual gas (being discussed) exerts in the atmosphere.
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| How would you calculate Partial pressure ("p") | partial pressure (p) for each gas in the atmosphere is equal to the barometric pressure(BP) at a particular altitude times the appropriate percentage for each gas.
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| calculating Partial pressure cont..... | 2 One atmosphere exerts 760 mm Hg pressure and is made up of O2 (21%), CO2 (0.03%), nitrogen (N2, 78%), and other inert gases (1%).
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 1. available atmospheric O2 (if there wasn’t O2 available, we would all die!)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 2. adequate ventilation (the respiratory center and lungs need to be healthy)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 3.gas exchange between the lungs and blood (exchange of O2 for CO2)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 4. ability of hemoglobin (hgb) molecule to carry O2 (we should remember from Hematology I that it is the hgb molecule that transports O2 throughout the body)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 5.adequate hemoglobin (hgb) (it stands to reason, that if we do not have enough hgb in the body to carry O2, the tissues will not have an adequate supply)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 6.adequate cardiac output (it is the heart that pumps the blood to all parts of the body)
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| list 1 of the 7 conditions necessary for adequate tissue oxygenation to occur | 7.ability of hemoglobin (hgb) to release O2 to the tissues (once the O2 has reached the tissues, the hgb molecule must have the capability to release it and pick up CO2)
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| How is O2 transported through the blood? | Most of the O2 in blood is transported to the tissues by hemoglobin (hgb). Each molecule can combine with 4 molecules of O2, but it depends on, O2 avail.conc and types of hgb present, and amount of non oxygen substances present in body.
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| Explain oxyhemoglobin (O2Hb) | O2 reversibly bound to hgb
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| Explain deoxyhemoglobin (HHb; reduced hgb) | hgb not bound to O2, but is capable of binding O2 when it is available
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| Explain carboxyhemoglobin (COHb) | hgb bound to carbon monoxide (CO); the bond between CO and hgb is reversible, but is 200x stronger than the bond between O2 and hgb
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| Explain methemoglobin (MetHb) | hgb unable to bind O2 because the iron molecule found within the hgb molecule has a 3+ charge associated with it, and not the normal 2+ charge.
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| Explain sulfhemoglobin (SulfHb) | hgb that is irreversibly bound with drugs. This type of hgb is unable to bind O2 at all. SulfHb circulates in the body until the lifespan of the affected RBCs is exhausted, and they are removed from the circulation.
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| What is the purpose in measuring Total CO2 | Total CO2 is all of the CO2 contained within the body. even within the “dead” spaces of the lungs. It is a value that aids the physician in knowin how well a patient is ventilating
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| what is the purpose of measuring SO2 (oxygen saturation) | the ratio of O2 that is bound to hgb, compared with the total amount of hgb available to bind with O2. Normally, 98-99% of the available hgb is saturated with O2
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| What is the purpose in measuring BE (base excess) | Base Excess (BE) is used by some physicians to evaluate the metabolic component of a patient’s acid-base disorder.
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| Purpose of hemoglobin Oxygen dissociation curve | The hemoglobin-oxygen dissociation curve is the graphic explanation of how the hemoglobin molecule either releases or retains the oxygen it is carrying so that the tissues of the body become oxygenated or not.
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| summarize how H+, pH, pO2, pCO2 2,3-DPG, and temperature are all interrelated when determining hemoglobin-oxygen dissociation curve shifts. | pH ( H+), PCO2, temperature, 2,3-DPG all leads to a shift in the dissociation curve to the left, and hgb affinity for O2, therefore O2 is made available to the tissues.
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| What is 2,3-DPG | 2,3-DGP is a phosphate substance found within RBCs
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| Purpose of 2,3-DPG | functions in controlling whether the RBCs will release or retain the O2 molecules they are carrying.
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| The relationship between 2,3-DPG and hgb affinity for O2 is this: | (lower) 2,3-DPG levels will allow the RBCs(RBCs have lower affinity for O2)to give up O2 to the tissues.(increased) 2,3-DPG levels will not allow the RBCs (RBCs have higher affinity for O2) to give up O2 to the tissues.
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| What is a co-oximeter | a noninvasive measurement of SO2 levels
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| What is the principle of the co-oximeter operation | The principle used in Co-Oximeters is “pulse oximetry”, where the patient’s finger (usually) is attached to the analyzer by a clip, and a measurement of SO2 taken. It is the O2 found within the capillary beds of the finger that is analyzed.
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| What is the specimen of choice for collecting blood gases? | arterial blood
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| WHat are the normal venipuncture sites for collecting ABG samples | radial, brachial and femoral arteries
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| what is the Allen Test | use the radial artery as the arterial site of choice. If the radial artery is used, a test for the circulation status of the ulnar artery is recommended.
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| Can venous blood be used for blood gas analysis? Explain. | Venous blood is not routinely used for O2 assessment. If venous blood is used, venous blood reference ranges should also be reported to the physician, and this documented on the patient’s chart.
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| When is capillary blood normally collected for blood gas analysis? | Capillary blood is used when blood gas results are needed on newborns and infants. Heel punctures are usually performed to obtain these types of specimens.
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| Why is it important to collect ABGs under anaerobic conditions | Exposing the specimen to room air will affect the PO2 and PCO2 measurements. When a blood gas specimen is exposed to room air, PCO2 decreases, and PO2 increases.
Also, any bubbles found within the specimen, must be expelled. Bubbles will introduce O2.
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| What is the anticoagulant of choice for collecting blood gas specimens? | Heparin is the anticoagulant of choice. (Lithium heparin is preferred over sodium heparin because often times the physician will order blood gases and electrolytes.
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| Why can’t clotted specimens be used for blood gas analysis? | A clotted specimen cannot be used for blood gas measurement. (Clotted specimens would clog up the analyzer…)
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| Why is transport time critical to blood gas analysis? | should be minimal. The blood gas specimen must be promptly analyzed to avoid changes in SO2 resulting from the use of O2 by metabolizing cells (i.e. WBCs contained within the specimen)
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| What types of quality control can be used to assess the proper functioning of blood gas analyzers? | Most blood gas analyzers will have three levels of blood gas controls (low, normal, high) that can be run on the analyzer to determine that it is functioning properly. Normally, all three levels are run within a 24-hour period
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