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N4117
Exam II pH Balance
| Question | Answer |
|---|---|
| What consists the respiratory component of pH? | The Lungs. |
| What can lung ONLY manipulate? | C02 |
| How does the lung manipulate pH to get ride of C02 from the body? | Increased ventilation by fast breathing |
| How does the lung manipulate pH to retain C02 in the body? | Decreased ventilation by slow breathing |
| At what rate does change in pH occur with respiratory component? | Very fast |
| What consists the metabolic component? | The kidney |
| How does the kidney manipulate pH? | By selectively excreting or conserving H+ and by regulating the base HCO3 |
| The kidney maipulates ONLY what? | HCO3 |
| At what rate does change in pH occur with metabolic component? | Very slow. takes 2 - 3 days. |
| How much can the kidney compensate? | Can compensate up to a CO2 of 90 mmHg |
| On what does metabolic pH disturbance have the greatest effect than respiratory disturbance? | Electrolyte mechanisms |
| What are the effects of acidosis? | Constricted pulmonary vessels, Dilated peripheral vessels, Dilated cerebral vessel Irritable myocardium |
| What are the effects of alkalosis? | Broncho constriction Pulmonary vessel dilation Irritable myocardium Peripheral vessel constriction Cerebral vessel constriction |
| Respiratory acidosis etiology? | Any condition that interferes with elimination of CO2 from the lungs |
| Give examples of resp acidosis etiology? | Hypoventilation, Damage to the respiratory center in the medulla, Depression of the respiratory center in the medulla (morphine, alcohol, barb., sedatives. |
| Further example of resp acidosis | Sleep apnea, Abdominal distention, Drug overdose, Neuromuscular disease, Pulmonary damage or airway obstruction (pneumonia, emphysema, pneumothorax, aspiration) Poor gas exchange during surgery. |
| S/S of resp. acidosis? | Tachycardia, Tachypnea, Diaphoresis, Confusion, Hypotension, Restlessness. |
| Further S/S of resp. acidosis? | Headache, Blurred vision-esp in the morning, Weakness, Cardiac dysrhythmias(ventricular), decreased cardiac contractility |
| Nursing care for acidotic patients (I) | Be aware of common causes, S&S of acidosis Predict which pts will be at risk |
| Nursing care for acidotic patients (II) | Provide opportunities for lung expansion TCDB, incentive spirometer, ambulation, Encourage fluids, chest PT, postural drainage, suctioning. |
| Nursing care for acidotic patients (III) | Supplement O2 for severe hypoxemia, Low flow O2 in COPD Pts, Watch K+ level- will go up as pH goes down, Bronchodilators, Avoid narcotics, sedation. |
| Metabolic acidosis? | Abnormal loss of HC03 or accumulation of metabolic acid |
| What is the etiology of abnormal HC03 loss? | Abnormal loss of bicarbonate Severe diarrhea Prolonged vomiting of deep GI contents Pancreatic drainage |
| Further etiology of abnormal HC03 loss? | DKA, Fever, Anesthesia, Infection, sepsis, Starvation, Renal failure, High protein, no CHO diets, Shock-lactic acidosis, Hyperchloremia. |
| Ingestion of what can also cause metabolic acidosis? | Salicylic acid,Ammonium chloride, Ferrous sulfate, Ethylene glycol (antifreeze), Methyl alcohol (wood alcohol), Drugs- propofol, nitroprusside, & lorazepam. |
| S/S of metabolic acidosis? | Changes in mental sensorium, Dizziness, Hypotension, Hyperpnea/hyperventilation-indicating respiratory compensation. Tachypnea, Cold, clammy skin Dysrhythmias, Malaise. |
| Nursing care metabilc acidosis Pts | Determine underlying mechanism and tx (i.e. insulin and fluids in DKA), Be aware of common causes, predict those at risk, diabetics, septic, renal disease, hypoxic and malnourished Pts. |
| Etiology of respiratory alkalosis? | Pain, Hyperventilation, Anxiety, Pregnancy, Extreme exercise, CNS disorders: meningitis, encephalitis, cranial surgery, Fever, Gram - bacteremia, Drug overdose - Resp. stimulators such as Tiophellium, Catecholamines, Progesteron. Hyperthyroidism. |
| Further Etiology of respiratory alkalosis? | ARDS, Asthma, Pulmonary embolus, High altitude, Hypoxemia. |
| S/S of Resp. Alkalosis? | Dizziness, Paresthesia, especially of the fingers, Tachypnea, Deep rapid respirations, Nervousness, Light-headedness, Inability to concentrate, Tetany Numbness and tingling in the fingers and around the mouth, Seizures---late sign |
| Nursing care of Pt with Resp. Alkalosis? | Be aware of cause and S&S. Eliminate underlying cause: provide 02 to those with hypoxemia, encourage breath-holding for hyperventilation, reassurance and emotional support for anxiety and hysteria. |
| Etiology of metabolic Alkalosis? | Any condition that causes a loss of acids or retention of bicarbonate. |
| Etiology of metabolic Alkalosis example? | Loss of HCL from stomach: vomiting, suction Loss of CL causing a reabsorption of bicarbonate, i.e. increased aldosterone as in stress and trauma, Use of diuretics-hypokalemia, Excessive ingestion of milk of magnesia or soda. |
| S/S of metabolic alkalosis? | Muscle weakness, Hyporeflexia, Dysrhythmias, Confusion, Apathy, Stupor, Slow, shallow respirations, Dizziness, Tingling of extremities, Tetany, Irritability, hypertonicity of the muscles, Disorientation, confusion, & seizures---late sign |
| Nursing care of Pts with metabolic alkalosis? | Determine and treat the cause, Fluid replacement and KCL replacement, Predicting those at risk, such as those who self-medicate with antacids, GI suction, steroids, diuretics. Watch for signs of hypocalcemia. |
| Interprete this: pH 7.32, PaCO2 35, HCO3- 20 | Uncompensated Metabolic acidosis |
| Interprete this: pH 7.32, PaCO2 48, HCO3- 20 | Partially compensated Metabolic acidosis |
| Interprete this: pH 7.46, PaCO2 33, HCO3- 20 | Partially compensated Respiratory alkalosis |
| Interprete this: pH 7.48, PaCO2 30, HCO3- 22 | Uncompensated Respiratory alkalosis |
| Interprete this: 7.30,PaCO2 50,HCO3- 23 | Uncompensated Respiratory acidosis |
| Interprete this: pH 7.45, PaCO2 33, HCO3- 20 | Fully compensated respiratory alkalosis |
| Interpret this: pH 7.42, PaCO2 46, HCO3- 27 | Fully compensated metabolic alkalosis |
| Interprete this: pH 7.35, PaCO2 45, HCO3- 22 | Normal Levels |
| Nursing acction after blood is drawn from art line | Provide line care |
| Nursing acction after blood is drawn from venules | Needle safety, 5min of manual pressure at the site of puncture, then reassess. |
| Nursing action with theblood drawn? | Send out labs - may have to wait for results |
| Point of care testing is? | Blood tested at the bedside. |
| What exceptions to the rules are there for abnormal ABGs | If Pt is tolerating it well, if Pt is a COPD Pt, |
| When in doubt of ABGs, what do you do? | Always check ABGs, and Compare the ABGs to the patient response before reacting |
| CO2 is always what? | Acid (Acidotic) |
| HC03 is always what? | Base (alkalotic) |
| What are two ways to become acidotic? | Gain acid or lose base |
| What are two ways to be alkalotic? | Gain base or lose acid |
| Normal pH is? | 7.35 - 7.45 (H+ ion concentration) |
| Normal PcO2 is | 35 - 45 (Respiratory) |
| Normal HCO3 is? | 22 - 26 (Metabolic) |
| Nnormal PaO2 is? | 80 - 100 |
| Normal base is? | ±2 |
| Base deficit -2 mEq/L means what? | Metabolic acidosis |
| Base excess of +2 mEq/L means what? | Metabolic alkalosis |
Created by:
nze
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