Podcast
Questions and Answers
What is the primary result of an acid-base imbalance?
What is the primary result of an acid-base imbalance?
- Change in the ratio of acid to base content (correct)
- Decreased oxygen levels in blood
- Increase in blood glucose levels
- Increased heart rate
Which of the following is a characteristic of metabolic acidosis?
Which of the following is a characteristic of metabolic acidosis?
- Bicarbonate concentration is less than 22 mEq/L (correct)
- pH rises above 7.45
- Increase in carbonic acid
- Respiratory rate decreases
What indicates respiratory acidosis?
What indicates respiratory acidosis?
- pH around 7.40 and normal bicarbonate levels
- pH below 7.45 with normal carbon dioxide levels
- pH above 7.45 and carbon dioxide below 35 mmHg
- pH below 7.35 and carbon dioxide above 45 mmHg (correct)
How does metabolic alkalosis generally manifest in the body?
How does metabolic alkalosis generally manifest in the body?
What is a common cause of metabolic acidosis?
What is a common cause of metabolic acidosis?
What pH level categorizes respiratory alkalosis?
What pH level categorizes respiratory alkalosis?
Which condition can result in an increase of carbonic acid in the body?
Which condition can result in an increase of carbonic acid in the body?
Which of the following is NOT a classification of acid-base imbalances?
Which of the following is NOT a classification of acid-base imbalances?
What is Mr. James's most immediate nursing priority upon arrival in the emergency department, considering his presenting symptoms?
What is Mr. James's most immediate nursing priority upon arrival in the emergency department, considering his presenting symptoms?
Which symptom most likely indicates Mr. James is experiencing a state of shock?
Which symptom most likely indicates Mr. James is experiencing a state of shock?
Why might Mr. James be exhibiting confusion and disorientation after the fall?
Why might Mr. James be exhibiting confusion and disorientation after the fall?
What vital sign indicates potential hypovolemic shock in Mr. James?
What vital sign indicates potential hypovolemic shock in Mr. James?
What diagnostic test is most likely to be ordered for Mr. James to assess his blood loss?
What diagnostic test is most likely to be ordered for Mr. James to assess his blood loss?
When assessing Mr. James in the emergency department, which finding would be a focus of concern beyond the initial assessment?
When assessing Mr. James in the emergency department, which finding would be a focus of concern beyond the initial assessment?
In the context of Mr. James's treatment, what is the purpose of administering normal saline via large-bore IVs?
In the context of Mr. James's treatment, what is the purpose of administering normal saline via large-bore IVs?
Which characteristic of Mr. James's vital signs suggests he is in a state of tachycardia?
Which characteristic of Mr. James's vital signs suggests he is in a state of tachycardia?
What is a by-product produced from the metabolism of fats that leads to metabolic acidosis?
What is a by-product produced from the metabolism of fats that leads to metabolic acidosis?
Which condition can result from starvation and lead to metabolic acidosis?
Which condition can result from starvation and lead to metabolic acidosis?
Which scenario is associated with systemic lactic acidosis?
Which scenario is associated with systemic lactic acidosis?
What is a common consequence of excessive exercise in relation to metabolic acidosis?
What is a common consequence of excessive exercise in relation to metabolic acidosis?
Which condition can cause metabolic acidosis due to an overdose of a specific drug?
Which condition can cause metabolic acidosis due to an overdose of a specific drug?
What is the effect of diuretic drugs like spironolactone on metabolic acidosis?
What is the effect of diuretic drugs like spironolactone on metabolic acidosis?
Which factor can decrease bicarbonate levels leading to metabolic acidosis?
Which factor can decrease bicarbonate levels leading to metabolic acidosis?
What causes an increase in chloride ions that results in metabolic acidosis?
What causes an increase in chloride ions that results in metabolic acidosis?
What is a primary cause of respiratory acidosis?
What is a primary cause of respiratory acidosis?
Which lung disease is likely to lead to respiratory acidosis?
Which lung disease is likely to lead to respiratory acidosis?
What physiological change results from hyperventilation?
What physiological change results from hyperventilation?
What may cause metabolic alkalosis due to loss of hydrochloric acid?
What may cause metabolic alkalosis due to loss of hydrochloric acid?
What serum level changes characterize respiratory acidosis?
What serum level changes characterize respiratory acidosis?
Why can excessive use of sodium bicarbonate lead to metabolic alkalosis?
Why can excessive use of sodium bicarbonate lead to metabolic alkalosis?
Which compensation mechanism is employed by the lungs during metabolic acidosis?
Which compensation mechanism is employed by the lungs during metabolic acidosis?
In respiratory alkalosis, which action is taken by the kidneys?
In respiratory alkalosis, which action is taken by the kidneys?
What is the typical ratio of bicarbonate to carbonic acid in a compensated acid-base status?
What is the typical ratio of bicarbonate to carbonic acid in a compensated acid-base status?
What primary disorder is characterized by a deficiency in bicarbonate?
What primary disorder is characterized by a deficiency in bicarbonate?
What happens when the respiratory system compensates for metabolic alkalosis?
What happens when the respiratory system compensates for metabolic alkalosis?
Which system primarily regulates acid-base balance related to carbonic acid?
Which system primarily regulates acid-base balance related to carbonic acid?
In metabolic alkalosis, what happens to respiration rates?
In metabolic alkalosis, what happens to respiration rates?
When the pH returns to normal due to compensation, it is said to be what?
When the pH returns to normal due to compensation, it is said to be what?
What is the effect of metabolic acidosis on the body's ventilation rate?
What is the effect of metabolic acidosis on the body's ventilation rate?
Which of the following changes occurs in respiratory acidosis regarding bicarbonate levels?
Which of the following changes occurs in respiratory acidosis regarding bicarbonate levels?
What typically triggers the compensation mechanisms in acid-base disorders?
What typically triggers the compensation mechanisms in acid-base disorders?
What physiological process primarily causes hyperventilation due to anxiety?
What physiological process primarily causes hyperventilation due to anxiety?
Which of the following is a risk factor for acid-base imbalances?
Which of the following is a risk factor for acid-base imbalances?
Which of the following correctly describes respiratory alkalosis?
Which of the following correctly describes respiratory alkalosis?
Which condition can cause an increase in body metabolism leading to hyperventilation?
Which condition can cause an increase in body metabolism leading to hyperventilation?
What is the most common consequence of cardiac arrest related to acid–base imbalance?
What is the most common consequence of cardiac arrest related to acid–base imbalance?
Which factor is crucial in differentiating between metabolic and respiratory acid-base disorders?
Which factor is crucial in differentiating between metabolic and respiratory acid-base disorders?
Which of the following can increase the respiratory rate due to elevated body temperature?
Which of the following can increase the respiratory rate due to elevated body temperature?
What effect does the intentional overdose of salicylate drugs have on respiration?
What effect does the intentional overdose of salicylate drugs have on respiration?
Which of the following conditions typically results in chronic respiratory acidosis?
Which of the following conditions typically results in chronic respiratory acidosis?
In metabolic alkalosis, which factor can contribute to the increase in serum bicarbonate?
In metabolic alkalosis, which factor can contribute to the increase in serum bicarbonate?
What is one consequence of severe hypercapnia?
What is one consequence of severe hypercapnia?
Which of the following would most likely NOT lead to hyperventilation?
Which of the following would most likely NOT lead to hyperventilation?
Which of these factors does NOT commonly cause a decrease in arterial pH?
Which of these factors does NOT commonly cause a decrease in arterial pH?
Acute respiratory conditions may lead to what type of acid-base imbalance?
Acute respiratory conditions may lead to what type of acid-base imbalance?
Flashcards
Acid-Base Imbalances
Acid-Base Imbalances
Conditions where the balance between acids and bases in the body is disrupted, often due to disease or inadequate compensatory mechanisms.
Metabolic Acidosis
Metabolic Acidosis
A condition where the body's pH falls below 7.35 due to increased acid or decreased bicarbonate.
Metabolic Alkalosis
Metabolic Alkalosis
A condition where the body's pH rises above 7.45 due to decreased acid or increased bicarbonate.
Respiratory Acidosis
Respiratory Acidosis
A condition where the body's pH falls below 7.35 due to increased carbon dioxide, which forms carbonic acid.
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Respiratory Alkalosis
Respiratory Alkalosis
A condition where the body's pH rises above 7.45 due to decreased carbon dioxide, and thus decreased carbonic acid.
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Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA)
A type of metabolic acidosis caused by uncontrolled diabetes, where the body metabolizes fats for energy, producing excess acids.
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CO2 pressure (PCO2)
CO2 pressure (PCO2)
The pressure exerted by dissolved carbon dioxide in the blood; a key indicator of respiratory function.
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Bicarbonate (HCO3-)
Bicarbonate (HCO3-)
A crucial base in the body, an important part of buffering the blood against pH changes.
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Respiratory System's Role
Respiratory System's Role
The respiratory system, through its control over carbon dioxide levels, plays a crucial role in regulating blood pH.
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Metabolic Acidosis Cause: Starvation
Metabolic Acidosis Cause: Starvation
Extreme caloric restriction, like in eating disorders or acute alcoholism, forces the body to burn fats instead of glucose, creating acidic ketone bodies.
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Renal System's Role
Renal System's Role
The kidneys, through their control of bicarbonate levels, are essential in managing blood pH.
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Primary Acid-Base Disorders
Primary Acid-Base Disorders
These are classified as either metabolic or respiratory, depending on the primary cause of the pH change.
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Metabolic Acidosis Cause: Kidney Failure
Metabolic Acidosis Cause: Kidney Failure
Damaged kidneys can't remove enough acid from the blood, leading to a buildup of hydrogen ions.
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Metabolic Acidosis Cause: Shock
Metabolic Acidosis Cause: Shock
Poor blood flow and oxygen deprivation leads to cells producing energy without oxygen, creating lactic acid.
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Causes of Metabolic Acidosis
Causes of Metabolic Acidosis
Common causes include diabetic ketoacidosis, lactic acidosis, renal failure, and severe diarrhea.
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Metabolic Acidosis Cause: Excessive Exercise
Metabolic Acidosis Cause: Excessive Exercise
During strenuous exercise, cells can't produce enough energy aerobically, leading to a buildup of acid in muscles.
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Metabolic Acidosis Cause: Aspirin Poisoning
Metabolic Acidosis Cause: Aspirin Poisoning
Aspirin is acidic. Overdosing causes a buildup of acid in the body.
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Metabolic Acidosis Cause: Metformin Side Effect
Metabolic Acidosis Cause: Metformin Side Effect
Certain diabetes medication can cause lactic acidosis, especially in people with kidney problems.
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Causes of Metabolic Alkalosis
Causes of Metabolic Alkalosis
Common causes include excessive vomiting, hypokalemia, and excessive bicarbonate administration.
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Metabolic Acidosis Cause: HIV Drugs
Metabolic Acidosis Cause: HIV Drugs
Some HIV medications damage cells, causing a significant production of lactic acid.
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Causes of Respiratory Acidosis
Causes of Respiratory Acidosis
Common causes include acute respiratory conditions like pneumonia, opiate overdose, and chronic respiratory conditions like COPD.
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Metabolic Acidosis Cause: Diuretics (Spironolactone)
Metabolic Acidosis Cause: Diuretics (Spironolactone)
These drugs cause the body to excrete less acid, leading to a build-up in the blood.
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Metabolic Acidosis Cause: Severe Diarrhea
Metabolic Acidosis Cause: Severe Diarrhea
Losing bicarbonate-rich fluids through diarrhea can disrupt the body's acid-base balance.
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Causes of Respiratory Alkalosis
Causes of Respiratory Alkalosis
Common causes include anxiety-induced hyperventilation, fever, and early salicylate intoxication.
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Metabolic Alkalosis Cause: Vomiting
Metabolic Alkalosis Cause: Vomiting
Vomiting removes stomach acid, leading to a loss of hydrogen ions.
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Metabolic Alkalosis Cause: Diuretics (Loop)
Metabolic Alkalosis Cause: Diuretics (Loop)
Loop diuretics can cause the body to lose excessive chloride ions, contributing to metabolic alkalosis.
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Mixed Acid-Base Disorders
Mixed Acid-Base Disorders
These involve a combination of respiratory and metabolic imbalances, often with complex causes.
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Cardiac Arrest and Mixed Disorders
Cardiac Arrest and Mixed Disorders
This condition presents with severe metabolic acidosis, respiratory acidosis, and hypoxemia, a prime example of mixed disorders.
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Metabolic Alkalosis Cause: Baking Soda Abuse
Metabolic Alkalosis Cause: Baking Soda Abuse
Excessive use of sodium bicarbonate elevates bicarbonate levels in the blood, leading to alkalosis.
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Hyperventilation
Hyperventilation
An increase in the rate and depth of breathing, often leading to respiratory alkalosis.
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Respiratory Acidosis Cause: Narcotic Overdose
Respiratory Acidosis Cause: Narcotic Overdose
Narcotic overdose slows breathing, causing carbon dioxide buildup.
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Causes of Hyperventilation
Causes of Hyperventilation
Common causes include anxiety, pain, stress, thyrotoxicosis, fever, and salicylate overdose.
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Compensation Mechanism
Compensation Mechanism
The body's natural response to correct an acid-base imbalance. The lungs, kidneys, or both work together to restore the proper pH.
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Respiratory Compensation
Respiratory Compensation
The lungs adjust their breathing rate and depth to help correct metabolic acid-base imbalances.
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Renal Compensation
Renal Compensation
The kidneys adjust their bicarbonate reabsorption and hydrogen ion excretion to help correct respiratory acid-base imbalances.
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Carbonic Acid Bicarbonate Buffer System
Carbonic Acid Bicarbonate Buffer System
The primary buffer system in the lungs. It converts carbon dioxide (CO2) into carbonic acid (H2CO3) and bicarbonate (HCO3-), helping to maintain the blood's pH.
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Metabolic Acidosis Compensation
Metabolic Acidosis Compensation
The respiratory system increases ventilation (breathing faster) to expel more CO2, reducing carbonic acid (H2CO3) levels.
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Metabolic Alkalosis Compensation
Metabolic Alkalosis Compensation
The respiratory system decreases ventilation (breathing slower) to retain more CO2, increasing carbonic acid (H2CO3) levels.
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Respiratory Acidosis Compensation
Respiratory Acidosis Compensation
The kidneys increase bicarbonate reabsorption and hydrogen ion excretion to restore the proper balance.
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Respiratory Alkalosis Compensation
Respiratory Alkalosis Compensation
The kidneys increase bicarbonate excretion and hydrogen ion retention to restore the balance.
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Fully Compensated
Fully Compensated
A state where an acid-base imbalance has been completely corrected, and the pH has returned to the normal range.
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Partially Compensated
Partially Compensated
A state where an acid-base imbalance has been partially corrected, but the pH is still outside the normal range.
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What's the priority system to assess?
What's the priority system to assess?
Initially focus on the cardiovascular system due to the patient's signs of shock, including cool, clammy skin, thready pulse, and low blood pressure.
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Thready pulse: priority?
Thready pulse: priority?
A weak, rapid pulse is a sign of poor blood circulation, indicating shock. The priority is to address this by stabilizing the patient's hemodynamics and preventing further complications.
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Why confusion?
Why confusion?
The patient's confusion and disorientation likely stem from inadequate blood flow to the brain, which can be caused by shock, blood loss, or potential head injury.
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Priority interventions
Priority interventions
The immediate priorities are identifying and treating the underlying cause of shock, ensuring adequate oxygenation and fluid resuscitation, monitoring vital signs closely, and assessing for any potential head injuries.
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Expected diagnostic tests
Expected diagnostic tests
The physician will likely order blood tests (CBC, electrolytes, blood gases), imaging studies (chest x-ray, CT scan of the head), and potentially a urine analysis to assess the patient's overall condition and identify the source of bleeding.
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What does a thready pulse indicate?
What does a thready pulse indicate?
A thready pulse, characterized by a weak and rapid pulse, signifies significantly reduced blood volume and pressure, indicating shock or a circulatory issue.
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What is a makeshift tourniquet?
What is a makeshift tourniquet?
A makeshift tourniquet is a temporary measure for controlling severe bleeding, often improvised using materials found at hand.
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What is a nonrebreather mask?
What is a nonrebreather mask?
A nonrebreather mask is a type of oxygen delivery device that delivers a high concentration of oxygen to a patient, typically used in emergencies.
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Acid-Base Imbalances
- Acid-base imbalances are categorized as acidosis or alkalosis, arising from a disruption in the 20:1 ratio of acid to base.
- Imbalances can result from underlying diseases or insufficient compensatory mechanisms.
- Imbalances are classified as respiratory or metabolic.
- Metabolic imbalances affect the base, while respiratory ones involve carbonic acid concentration changes.
Metabolic Acidosis
- Characterized by decreased pH (below 7.35) and bicarbonate concentration (below 22 mEq/L).
- Caused by:
- Increased hydrogen ions:
- Uncontrolled diabetes (diabetic ketoacidosis)
- Eating disorders/alcoholism (starvation)
- Chronic kidney failure
- Heart failure/sepsis/blood loss/shock/cardiac arrest (lactic acidosis)
- Excessive exercise (muscle metabolic acidosis)
- Salicylate toxicity
- Antidiabetic drugs (lactic acidosis)
- HIV/AIDS medication (lactic acidosis)
- Decreased bicarbonate:
- Severe diarrhea/intestinal fistulas/laxative abuse
- Drugs that block bicarbonate reabsorption/kidney damage
- Increased chloride:
- Bile acid sequestrants
- Excessive sodium chloride IV fluids
- Increased hydrogen ions:
Metabolic Alkalosis
- Characterized by increased pH (above 7.45) and bicarbonate concentration (greater than 26 mEq/L).
- Caused by:
- Decreased hydrogen ions:
- Excessive vomiting
- Decreased chloride:
- Excessive loop diuretic use
- Increased bicarbonate:
- Excessive sodium bicarbonate use
- Decreased hydrogen ions:
Respiratory Acidosis
- Caused by carbon dioxide retention, increasing carbonic acid.
- Characterized by decreased pH (below 7.35) and increased carbon dioxide partial pressure (above 45 mmHg).
- Associated with hypoventilation.
- Example causes:
- Opiate overdose
- Lung diseases (COPD, asthma, pneumonia, pulmonary edema)
- Foreign body aspiration
Respiratory Alkalosis
- Caused by carbon dioxide loss (hyperventilation).
- Characterized by increased pH (above 7.45) and decreased carbon dioxide partial pressure (below 35 mmHg).
- Associated with hyperventilation.
- Example causes:
- Anxiety/pain/stress
- Thyrotoxicosis (excessive thyroid)
- Fever, infection, high altitude
- Salicylate overdose
Compensation
- The respiratory and renal systems compensate for each other to restore the 20:1 acid-to-base ratio.
- Lungs compensate for metabolic imbalances by adjusting ventilation.
- Kidneys compensate for respiratory imbalances by altering bicarbonate and hydrogen ion levels.
- Compensation can be partial or full, depending on the extent of pH return to normal.
Acid-Base Imbalance Clinical Example (Mr. James)
- Mr. James, a rock climber, suffered a traumatic injury causing significant blood loss.
- Initial focus is on managing Mr. James's hypovolemia due to blood loss and assessing oxygenation.
- Priority nursing interventions should involve restoring circulating volume via IV fluids, and checking signs of shock.
- Confusion/disorientation may result from hypovolemia, hypoxemia, and/or pain-related stress response.
- Potential diagnostic tests may include blood tests, urinary output and possible chest x-ray.
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