Acid-Base Balance and Older Adults
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Questions and Answers

What role do central or arterial chemoreceptors play in the respiratory system's regulation of acid–base balance?

  • They detect changes in blood pressure.
  • They control oxygen transport to tissues.
  • They adjust lung ventilation based on pH changes. (correct)
  • They regulate renal filtration rates.

Which condition can lead to respiratory acidosis?

  • Hyperventilation syndrome
  • Alkalosis due to diuretics
  • Chronic obstructive pulmonary disease (COPD) (correct)
  • Diabetic ketoacidosis

Which of the following statements about metabolic compensation in respiratory acidosis is true?

  • HCO3 levels are increased above 22.
  • Metabolic compensation involves increasing PCO2.
  • The body does not compensate for respiratory acidosis.
  • HCO3 levels decrease due to excess CO2 retention. (correct)

Why are older adults more susceptible to acidosis?

<p>Decreased renal and respiratory function. (B)</p> Signup and view all the answers

What characterizes respiratory alkalosis?

<p>Decreased PCO2 and elevated pH levels. (B)</p> Signup and view all the answers

How do kidneys contribute to acid–base balance?

<p>By filtering and excreting bicarbonate. (A)</p> Signup and view all the answers

What is the main factor that leads to decreased oxygen delivery to cells in respiratory acidosis?

<p>Increased levels of H+ ion concentration reducing hemoglobin’s ability to bind oxygen. (C)</p> Signup and view all the answers

What is a common cause of acid–base imbalances in patients on medications?

<p>Use of diuretics altering electrolyte balance. (D)</p> Signup and view all the answers

What is the primary role of the kidneys in maintaining acid-base balance?

<p>Retention of bicarbonate (A)</p> Signup and view all the answers

What occurs in metabolic acidosis regarding potassium levels?

<p>Release of potassium into the blood (D)</p> Signup and view all the answers

Which physiological change occurs in response to metabolic alkalosis?

<p>Decreased HCO3- excretion (D)</p> Signup and view all the answers

What is the effect of pulmonary compensation in metabolic acidosis?

<p>Increased respiratory rate (B)</p> Signup and view all the answers

What is typically the time frame for renal compensation to establish a steady state in response to a pH imbalance?

<p>Around 3 days (D)</p> Signup and view all the answers

Which of the following describes the potential sequelae of metabolic alkalosis?

<p>Cerebral and peripheral hypoxia (B)</p> Signup and view all the answers

Which of the following is NOT a compensatory mechanism for metabolic alkalosis?

<p>Increased H+ excretion (A)</p> Signup and view all the answers

In metabolic acidosis, what is the relationship between H+ and Na+ retention in the kidneys?

<p>Na+ retention occurs in exchange for H+ excretion (A)</p> Signup and view all the answers

What is the primary goal of providing emotional and psychological support to patients and their families?

<p>To address issues like anxiety and depression linked to serious illness (A)</p> Signup and view all the answers

How does holistic care differ from traditional care approaches?

<p>It includes consideration of psychological, social, and spiritual aspects (D)</p> Signup and view all the answers

What is a key component of facilitating communication in healthcare settings?

<p>Promoting open dialogue about care preferences and prognosis (C)</p> Signup and view all the answers

Why is advance care planning important for patients and families?

<p>It allows for discussion and decisions about future care preferences (C)</p> Signup and view all the answers

What does enhancing the quality of life for patients involve?

<p>Considering the patient's physical, emotional, social, and spiritual well-being (D)</p> Signup and view all the answers

What is the normal range for pH in the human body?

<p>7.35-7.45 (B)</p> Signup and view all the answers

If a patient's pH is 7.49, what is the interpretation of that pH value?

<p>Basic (A)</p> Signup and view all the answers

What is the role of the phosphate buffer system in the body?

<p>It reduces H+ concentration through the dissociation of a weak acid. (D)</p> Signup and view all the answers

How does the carbonic acid bicarbonate buffer system respond to a decrease in pH?

<p>It shifts equilibrium to the left, resulting in increased CO2 in the blood. (A)</p> Signup and view all the answers

When interpreting respiratory status, a PaCOâ‚‚ of 62 indicates what condition?

<p>Acidosis (D)</p> Signup and view all the answers

What physiological process occurs when pH levels increase?

<p>The equilibrium of carbonic acid is shifted to the right. (C)</p> Signup and view all the answers

What is the appropriate term for a situation where the un-matching value is outside of the normal range but reflects the opposite of the pH value?

<p>Partial compensation (D)</p> Signup and view all the answers

Which mechanism is considered the last resort for maintaining acid-base balance in the body?

<p>Kidneys adjusting the excretion and reabsorption of ions. (C)</p> Signup and view all the answers

In the case where a patient presents with a pH of 7.49, a PaCO₂ of 62, and an HCO₃ of 46, how would you classify the primary disturbance?

<p>Metabolic Alkalosis (C)</p> Signup and view all the answers

What is an essential goal of palliative care for patients experiencing distressing symptoms?

<p>Alleviating physical symptoms (A)</p> Signup and view all the answers

What happens to bicarbonate in the kidneys during alkalosis?

<p>Bicarbonate is excreted and H+ is retained. (D)</p> Signup and view all the answers

In the context of stress management for family members in palliative care, which of the following approaches would be most effective?

<p>Initiating an open and honest conversation (A)</p> Signup and view all the answers

What is the immediate action of the body when faced with an acid-base imbalance?

<p>The body uses chemical buffers for first-line response. (B)</p> Signup and view all the answers

Which laboratory value is primarily involved in metabolic compensation?

<p>HCO₃ (B)</p> Signup and view all the answers

During acidosis, how do the lungs help restore balance?

<p>They increase respiratory rate to eliminate CO2. (B)</p> Signup and view all the answers

What is the primary function of proteins in the buffering system?

<p>To bind and release H+ ions preventing pH changes. (D)</p> Signup and view all the answers

In what way does the phosphate buffer system function to manage H+ concentration?

<p>By using hydrogen phosphate to buffer changes in H+ levels. (C)</p> Signup and view all the answers

How do kidneys contribute to acid-base balance through sodium and chloride ions?

<p>They must excrete a cation whenever bicarbonate is discarded. (D)</p> Signup and view all the answers

What is a primary cause of metabolic acidosis?

<p>Lactic acidosis (C)</p> Signup and view all the answers

Which of the following is a source of bases?

<p>Antacids (A)</p> Signup and view all the answers

Which condition is most likely to result in respiratory acidosis?

<p>Pulmonary edema (A)</p> Signup and view all the answers

What effect does excessive exhalation of CO2 have on blood pH?

<p>Increases pH (D)</p> Signup and view all the answers

What is a common sign of respiratory alkalosis?

<p>Increased respiratory rate (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of metabolic alkalosis?

<p>Decreased HCO3 (A)</p> Signup and view all the answers

What could cause excessive production of metabolic acids?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

Which physiological response indicates compensatory mechanisms during acidosis?

<p>Increased excretion of H+ via kidneys (B)</p> Signup and view all the answers

Which symptom is commonly associated with metabolic acidosis?

<p>Kussmaul respiration (C)</p> Signup and view all the answers

What is a potential cause of metabolic alkalosis through the gastrointestinal tract?

<p>Excessive loss of hydrochloric acid (B)</p> Signup and view all the answers

Hyperkalemia is commonly associated with which type of acid-base imbalance?

<p>Diabetic ketoacidosis (A)</p> Signup and view all the answers

Which of the following statements is correct regarding the effect of diuretics on acid-base balance?

<p>They can lead to metabolic alkalosis if K+ wasting occurs. (B)</p> Signup and view all the answers

What physiological change occurs during respiratory acidosis?

<p>Increased HCO3 retention (B)</p> Signup and view all the answers

What characterizes metabolic alkalosis in terms of blood gas levels?

<p>Increased pH and increased HCO (B)</p> Signup and view all the answers

Flashcards

Respiratory Acidosis

A condition where the lungs fail to remove enough carbon dioxide from the blood, leading to a lower blood pH.

Respiratory Alkalosis

A condition where the lungs remove too much carbon dioxide from the blood, resulting in a higher blood pH.

Acid-Base Balance

The body's process of maintaining a stable level of acidity (pH) in the blood.

Pulmonary Regulation (Acid-Base)

The lungs' role in controlling the body's acid-base balance by adjusting carbon dioxide levels in the blood.

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Metabolic Compensation (Acid-Base)

Renal system adjusting bicarbonate levels to compensate for imbalances caused by respiratory issues.

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Older Adult Acidosis Risk Factors

Older adults have a greater risk of acidosis due to decreased kidney function, respiratory issues, chronic conditions, and potential infections.

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Blood Gas Levels

Measurements of gases like oxygen, carbon dioxide, and pH in the blood, vital for assessing acid-base balance.

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pH

Measure of acidity or alkalinity in the blood, determining the balance of acid-base in the body.

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Metabolic Compensation (HCO3-)

The kidneys' response to pH imbalances by regulating bicarbonate (HCO3-) reabsorption or excretion. It takes days to fully compensate.

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Metabolic Acidosis Cause

A condition where both pH and bicarbonate (HCO3-) levels decrease in the blood, often due to excess acids or bicarbonate loss.

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Metabolic Acidosis Compensation

The body attempts fast compensation by increasing the respiratory rate (hyperventilation) and the kidneys reabsorb HCO3- and excrete H+ to restore acid-base balance over several days.

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Metabolic Alkalosis Cause

A condition with increased blood pH and bicarbonate (HCO3-) level, often resulting from excessive loss of acids or bicarbonate excess.

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Metabolic Alkalosis Compensation

Compensation involves decreased breathing rate (hypoventilation) and the kidneys increasing excretion of HCO3- to return the pH to normal.

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Metabolic Acidosis Hyperkalemia

In metabolic acidosis, cells release K+ to balance with H+, potentially causing high blood potassium (hyperkalemia) and related ECG changes.

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Metabolic Alkalosis Effects

The high pH in metabolic alkalosis can stimulate the nervous system, cause vasoconstriction affecting blood flow, and disrupt K+ balance, leading to confusion and arrhythmias.

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Acid-Base Balance Buffering

The collective process of adjusting the body's pH through kidney functions to reabsorb or excrete bicarbonate, regulate H+, along with the respiratory system.

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Palliative Care

A specialized type of care that focuses on improving the quality of life for people living with a serious illness. It addresses physical, emotional, social, and spiritual needs.

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Advance Care Planning

The process of discussing and documenting future care decisions, covering topics like end-of-life wishes. It involves patients, families, and healthcare providers.

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Holistic Care

A comprehensive approach to healthcare that considers the whole person, addressing physical, emotional, social, and spiritual needs.

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Emotional Distress

A state of significant emotional suffering often experienced by patients and their families facing serious illness.

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Dignity and Respect

Treating patients with kindness and understanding, allowing them to live their remaining days as fully and meaningfully as possible.

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Phosphate Buffer System

A buffer system that uses dihydrogen phosphate (a weak acid) to resist changes in pH.

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Dihydrogen Phosphate

A weak acid essential for the phosphate buffer system, primarily obtained from diet and excreted through urine.

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Carbonic Acid-Bicarbonate Buffer System

This buffer system uses carbonic acid (a weak acid) and bicarbonate to maintain blood pH.

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Acidosis

A condition where the body's pH falls below the normal range.

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Alkalosis

A condition where the body's pH rises above the normal range.

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Chemical Buffer

A substance that resists changes in pH by absorbing or releasing H+ ions.

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Lungs in Acid-Base Balance

The lungs regulate blood pH by controlling CO2 levels.

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Kidneys in Acid-Base Balance

The kidneys fine-tune blood pH by adjusting the excretion and reabsorption of acids and bases in urine.

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CO2 Regulation

The lungs control CO2 levels in the blood, which in turn affects blood pH.

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Metabolic Alkalosis

A condition where the body has too much bicarbonate (HCO₃) in the blood, making the blood more alkaline (base) and increasing the pH.

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Metabolic Acidosis

The blood becomes more acidic due to the kidneys not removing enough acids or not making enough bicarbonate (HCO₃).

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Partial Compensation

The body's attempt to correct an acid-base imbalance, but the pH is still outside the normal range.

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Full Compensation

The body successfully adjusts the blood pH back to a normal range, even with an imbalance in CO₂ or HCO₃.

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No Compensation

The body is not able to make any adjustments to the blood pH.

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Causes of Metabolic Acidosis

Increased acid production (ketoacidosis, lactic acidosis, aspirin overdose), impaired acid removal (renal disease, circulatory failure), and excessive base loss (diarrhea).

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Causes of Metabolic Alkalosis

Excessive loss of acids through the GI tract or kidneys (vomiting, gastric suctioning, diuretics) and excessive intake of bicarbonate.

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Causes of Respiratory Acidosis

Any condition that impairs gas exchange or lung ventilation, primarily due to hypoventilation.

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Causes of Respiratory Alkalosis

Excessive exhalation of carbon dioxide (CO2) due to hyperventilation.

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Signs & Symptoms of Metabolic Acidosis

Weakness, fatigue, headache, dysrhythmias, Kussmaul respirations, muscle aches, and nausea.

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Signs & Symptoms of Metabolic Alkalosis

Dizziness, decreased respiratory rate, numbness in fingers and toes, CVS dysrhythmias, and CNS anxiety.

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Signs & Symptoms of Respiratory Acidosis

Anxiety, confusion, headache, restlessness, blurry vision, tremors, weakness, vasodilation, and decreased respiratory rate.

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Signs & Symptoms of Respiratory Alkalosis

Dizziness, dry mouth, numbness and tingling in fingers and toes, increased neural activity (seizures), and decreased respiratory rate.

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Compensation for Metabolic Acidosis

Increased excretion of H+ via the kidneys, reabsorption of bicarbonate, and hyperventilation.

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Compensation for Metabolic Alkalosis

Decreased excretion of H+ via the kidneys, increased excretion of bicarbonate, and decreased ventilation.

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Compensation for Respiratory Acidosis

Increased excretion of H+ via the kidneys and reabsorption of bicarbonate.

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Compensation for Respiratory Alkalosis

Decreased excretion of H+ via the kidneys and decreased reabsorption of bicarbonate.

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Study Notes

Acid-Base Balance

  • The respiratory and renal systems maintain homeostasis, regulating the body's acid-base balance.
  • Buffering mechanisms maintain balance.
  • Common causes of imbalances include conditions like diabetes, chronic kidney disease, and COPD.
  • Normal blood gas levels are crucial.
  • Holistic nursing care is applied to clients needing chronic care management.
  • pH (acidity/alkalinity): 7.35-7.45
  • PaCO2 (carbon dioxide, acidic): 35-45
  • HCO3 (bicarbonate, base): 22-26

Older Adults and Acidosis

  • Older adults are more susceptible to acidosis due to factors like diuretic use, ASA, antacids, and decreased renal and respiratory function.
  • Chronic health conditions (diabetes, COPD, etc.) also increase susceptibility.

Respiratory System Regulation

  • Lungs control PCO2 levels to maintain acid-base balance by altering ventilation rate.
  • This process is fast, occurring within minutes or hours.
  • Respiratory acidosis occurs with ventilation impairment (high PCO2, low pH). In acidosis, hemoglobin releases less oxygen to tissues.
  • Respiratory alkalosis results from hyperventilation (low PCO2, high pH). In alkalosis, hemoglobin holds onto oxygen more tightly.

Renal System Regulation

  • Kidneys adjust HCO3- (bicarbonate) retention and H+ excretion to regulate acid-base balance.
  • Compensation is slower, taking days.
  • Metabolic acidosis (low pH, low HCO3-) occurs with excessive acid production or loss of bicarbonate.
  • Metabolic alkalosis (high pH, high HCO3-) is from excessive loss of acids or excessive base intake.

Buffer Systems

  • Chemical buffers (proteins, phosphate) and physiological buffers (lungs, kidneys) maintain a stable pH.
  • Phosphate buffer system involves HPO42- and H2PO4–, regulating blood pH.
  • Bicarbonate buffer functions in interstitial fluid and blood. This system is most important in adjusting to changes in CO2.

Acid-Base Imbalances

  • ACIDOSIS:

    • Inside cell: buffers are proteins and phosphate
    • Outside cell: buffers are proteins and bicarbonate

  • ALKALOSIS

    • Inside cell: buffers are proteins and phosphate
    • Outside cell: buffers are proteins and bicarbonate

  • Respiratory and metabolic acidosis and alkalosis have distinct causes, symptoms, and compensation mechanisms.

Blood Gas Analysis

  • pH, PaCO2, and HCO3 values are used to assess acid-base balance.
  • Analyzing blood gas levels helps determine whether the imbalance is respiratory or metabolic, or if the body is compensating.
  • Normal ranges are crucial in interpretation.

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Description

This quiz focuses on the acid-base balance in the body, emphasizing the roles of the respiratory and renal systems. It also discusses the susceptibility of older adults to acidosis and the implications of chronic health conditions. Test your knowledge on blood gas levels and buffering mechanisms.

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