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Questions and Answers
In a patient experiencing a mixed acid-base disorder, what finding would suggest the presence of the condition, even if the pH is within the normal range?
In a patient experiencing a mixed acid-base disorder, what finding would suggest the presence of the condition, even if the pH is within the normal range?
- Compensatory mechanisms have fully corrected the pH.
- Absence of any renal or respiratory compensation.
- Normal PaCO2 and bicarbonate levels.
- Alterations in both PaCO2 and bicarbonate levels. (correct)
How does the body maintain acid-base balance when excess carbon dioxide ($CO_2$) is present in the blood?
How does the body maintain acid-base balance when excess carbon dioxide ($CO_2$) is present in the blood?
- By decreasing the production of bicarbonate ($HCO_3^-$).
- By converting $CO_2$ into a strong base.
- By forming carbonic acid ($H_2CO_3$), which dissociates into $H^+$ and $HCO_3^-$. (correct)
- By directly increasing the pH of the blood.
What is the primary role of arterial blood gas (ABG) analysis in assessing a patient's condition?
What is the primary role of arterial blood gas (ABG) analysis in assessing a patient's condition?
- To assess the patient's glucose metabolism exclusively.
- To measure the patient's hydration status only.
- To provide information about the body's ability to regulate pH, acid-base status, underlying cause of imbalance, and overall oxygen status. (correct)
- To determine the patient's electrolyte levels exclusively.
In a patient with a pH of 7.2, which of the following conditions is most likely present?
In a patient with a pH of 7.2, which of the following conditions is most likely present?
Which statement accurately describes the role of hydrogen ions ($H^+$) in determining pH?
Which statement accurately describes the role of hydrogen ions ($H^+$) in determining pH?
A patient's arterial blood gas (ABG) results show a pH of 7.50. Which condition does this indicate?
A patient's arterial blood gas (ABG) results show a pH of 7.50. Which condition does this indicate?
What is the fundamental difference between an acid and a base in terms of hydrogen ions ($H^+$)?
What is the fundamental difference between an acid and a base in terms of hydrogen ions ($H^+$)?
Why is maintaining acid-base balance crucial for overall health?
Why is maintaining acid-base balance crucial for overall health?
A patient with chronic obstructive pulmonary disease (COPD) is at risk for developing respiratory acidosis. Which assessment finding would indicate the patient is experiencing respiratory acidosis?
A patient with chronic obstructive pulmonary disease (COPD) is at risk for developing respiratory acidosis. Which assessment finding would indicate the patient is experiencing respiratory acidosis?
A patient is admitted with respiratory acidosis. Which of the following interventions is the highest priority for the nurse?
A patient is admitted with respiratory acidosis. Which of the following interventions is the highest priority for the nurse?
A patient is hyperventilating due to anxiety. Which of the following arterial blood gas (ABG) results would indicate respiratory alkalosis?
A patient is hyperventilating due to anxiety. Which of the following arterial blood gas (ABG) results would indicate respiratory alkalosis?
A patient with respiratory alkalosis is experiencing lightheadedness and tingling in their fingers. What should the nurse instruct the patient to do?
A patient with respiratory alkalosis is experiencing lightheadedness and tingling in their fingers. What should the nurse instruct the patient to do?
When monitoring a patient with respiratory acidosis, which electrolyte imbalance is the nurse most concerned about?
When monitoring a patient with respiratory acidosis, which electrolyte imbalance is the nurse most concerned about?
A patient is diagnosed with respiratory alkalosis secondary to a panic attack. Besides breathing techniques, what other intervention might be considered with caution?
A patient is diagnosed with respiratory alkalosis secondary to a panic attack. Besides breathing techniques, what other intervention might be considered with caution?
Why should oxygen be administered cautiously in a patient with respiratory acidosis?
Why should oxygen be administered cautiously in a patient with respiratory acidosis?
A patient presents with rapid, shallow respirations and altered mental status. An arterial blood gas (ABG) reveals a pH of 7.25 and a PaCO2 of 60 mm Hg. Which condition is most likely indicated by these results?
A patient presents with rapid, shallow respirations and altered mental status. An arterial blood gas (ABG) reveals a pH of 7.25 and a PaCO2 of 60 mm Hg. Which condition is most likely indicated by these results?
A patient is experiencing metabolic alkalosis. Which physiological response would the body initiate to compensate for this imbalance?
A patient is experiencing metabolic alkalosis. Which physiological response would the body initiate to compensate for this imbalance?
A patient presents with the following arterial blood gas (ABG) values: pH = 7.48, HCO3 = 30 mEq/L, and PaCO2 = 48 mmHg. Which of the following conditions is most likely?
A patient presents with the following arterial blood gas (ABG) values: pH = 7.48, HCO3 = 30 mEq/L, and PaCO2 = 48 mmHg. Which of the following conditions is most likely?
Which of the following clinical manifestations would be most indicative of a patient experiencing metabolic alkalosis?
Which of the following clinical manifestations would be most indicative of a patient experiencing metabolic alkalosis?
A patient with prolonged vomiting is at risk for developing metabolic alkalosis. Which of the following mechanisms contributes to this acid-base imbalance?
A patient with prolonged vomiting is at risk for developing metabolic alkalosis. Which of the following mechanisms contributes to this acid-base imbalance?
A patient's arterial blood gas results show a normal pH, elevated PaCO2, and elevated HCO3. Which condition does this indicate?
A patient's arterial blood gas results show a normal pH, elevated PaCO2, and elevated HCO3. Which condition does this indicate?
A patient is diagnosed with metabolic alkalosis. Which of the following electrolyte imbalances is most likely to occur concurrently?
A patient is diagnosed with metabolic alkalosis. Which of the following electrolyte imbalances is most likely to occur concurrently?
According to the ROME mnemonic, how are the pH and CO2 related in respiratory conditions?
According to the ROME mnemonic, how are the pH and CO2 related in respiratory conditions?
A patient undergoing nasogastric suctioning is at risk for developing metabolic alkalosis. What is the primary mechanism by which this occurs?
A patient undergoing nasogastric suctioning is at risk for developing metabolic alkalosis. What is the primary mechanism by which this occurs?
A patient experiencing respiratory alkalosis reports tingling in their fingers and toes. Which underlying physiological process is most likely contributing to this symptom?
A patient experiencing respiratory alkalosis reports tingling in their fingers and toes. Which underlying physiological process is most likely contributing to this symptom?
A patient is using pursed-lip breathing. What acid-base imbalance is the patient most likely experiencing and what is the intended effect of this breathing technique?
A patient is using pursed-lip breathing. What acid-base imbalance is the patient most likely experiencing and what is the intended effect of this breathing technique?
A patient is instructed to breathe into a paper bag for 6-12 breaths. What acid-base imbalance is the patient most likely suffering from and what is the principle behind this intervention?
A patient is instructed to breathe into a paper bag for 6-12 breaths. What acid-base imbalance is the patient most likely suffering from and what is the principle behind this intervention?
What is the primary physiological effect of a bicarbonate (HCO3-) deficit in the body?
What is the primary physiological effect of a bicarbonate (HCO3-) deficit in the body?
In metabolic acidosis, the respiratory system attempts to compensate for the acid-base imbalance. What is the primary mechanism that the respiratory system employs to achieve this compensation?
In metabolic acidosis, the respiratory system attempts to compensate for the acid-base imbalance. What is the primary mechanism that the respiratory system employs to achieve this compensation?
What is a key characteristic of Kussmaul breathing, and under which acid-base imbalance condition is it typically observed?
What is a key characteristic of Kussmaul breathing, and under which acid-base imbalance condition is it typically observed?
A patient with metabolic acidosis is experiencing arrhythmias and hypotension. Which of the following interventions is most important to address these cardiovascular cues?
A patient with metabolic acidosis is experiencing arrhythmias and hypotension. Which of the following interventions is most important to address these cardiovascular cues?
In the management of a patient with lactic acidosis, why is the administration of oxygen a crucial intervention?
In the management of a patient with lactic acidosis, why is the administration of oxygen a crucial intervention?
In partial compensation for an acid-base imbalance, what key indicator remains outside the normal range?
In partial compensation for an acid-base imbalance, what key indicator remains outside the normal range?
Which of the following mechanisms does the body employ to compensate for a metabolic disorder?
Which of the following mechanisms does the body employ to compensate for a metabolic disorder?
What characterizes complete compensation in an acid-base imbalance?
What characterizes complete compensation in an acid-base imbalance?
In respiratory acidosis, what changes in arterial blood gases would you typically observe?
In respiratory acidosis, what changes in arterial blood gases would you typically observe?
What is the direct consequence of hypoventilation on blood gas levels?
What is the direct consequence of hypoventilation on blood gas levels?
If a patient has a condition causing respiratory depression, which acid-base imbalance is most likely to develop?
If a patient has a condition causing respiratory depression, which acid-base imbalance is most likely to develop?
How do the kidneys typically respond to respiratory acidosis in terms of acid-base balance?
How do the kidneys typically respond to respiratory acidosis in terms of acid-base balance?
Which of the following scenarios can directly lead to respiratory acidosis?
Which of the following scenarios can directly lead to respiratory acidosis?
Flashcards
Acid
Acid
Produces hydrogen ions (H+) and lowers pH.
Base
Base
Accepts hydrogen ions (H+) and raises pH.
Mixed Acid-Base Disorders
Mixed Acid-Base Disorders
Two or more primary acid-base disorders occurring simultaneously.
Job of Acids and Bases
Job of Acids and Bases
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Importance of Acid-Base Balance
Importance of Acid-Base Balance
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Hydrogen Ions
Hydrogen Ions
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Acidosis
Acidosis
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Alkalosis
Alkalosis
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Acid-Base Balance Regulation
Acid-Base Balance Regulation
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Compensation (Acid-Base)
Compensation (Acid-Base)
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Partial Compensation
Partial Compensation
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Complete Compensation
Complete Compensation
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Acid-Base Disorders
Acid-Base Disorders
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H+
H+
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Respiratory Acidosis
Respiratory Acidosis
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PaCO2
PaCO2
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Respiratory Alkalosis Cues
Respiratory Alkalosis Cues
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Pursed-Lip Breathing
Pursed-Lip Breathing
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Paper Bag Breathing
Paper Bag Breathing
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Metabolic Acidosis
Metabolic Acidosis
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Respiratory Compensation (Metabolic Acidosis)
Respiratory Compensation (Metabolic Acidosis)
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Kussmaul Breathing
Kussmaul Breathing
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Neurologic Metabolic Acidosis Cues
Neurologic Metabolic Acidosis Cues
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Cardiovascular cues of Metabolic Acidosis
Cardiovascular cues of Metabolic Acidosis
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Metabolic Alkalosis
Metabolic Alkalosis
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HCO3- Excess
HCO3- Excess
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pH Increase
pH Increase
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Nasogastric Suction
Nasogastric Suction
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Respiratory Cue
Respiratory Cue
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Neurologic cues
Neurologic cues
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Acid-Base Pneumonic
Acid-Base Pneumonic
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Compensation
Compensation
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Chronic Respiratory Problems
Chronic Respiratory Problems
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Hyperventilation
Hyperventilation
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Respiratory Alkalosis
Respiratory Alkalosis
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Cues of Respiratory Acidosis
Cues of Respiratory Acidosis
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Actions for Respiratory Acidosis
Actions for Respiratory Acidosis
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Actions for Respiratory Alkalosis
Actions for Respiratory Alkalosis
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Take Actions for Respiratory Alkalosis
Take Actions for Respiratory Alkalosis
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Study Notes
- Acid produces H+ and lowers pH
- Base accepts H+ and raises pH
Mixed Acid-Base Disorders
- Two or more primary acid-base disorders occurring simultaneously
- Common in hospitalized individuals
- The degree of compensation is determined in these cases
- Renal and respiratory compensation rarely normalizes pH
- Alterations in PaCO2, bicarbonate levels, and normal pH can occur
Job of Acids and Bases
- Maintains pH levels, stable H+ concentrations
- Provides a neutral environment and compensates for imbalances
Importance of Balance
- Necessary for homeostasis
- Essential for cellular metabolism
Hydrogen Ions
- Maintain homeostasis of H+ concentration in body fluids
- H+ indicates acid, while “H+ indicates alkaline
pH and Hydrogen Ion Concentration
- Hydrogen ion concentration is expressed as pH
- H+ results in pH and “H+ results in 'pH
Acids, Bases and H2CO3
- H2CO3 (carbonic acid) forms when CO2 dissolves in H2O
- Dissociates to release H+ and HCO3-
Acidosis vs Alkalosis
- Conditions related to acid-base status imbalance
Acidosis
- Indicates excessive acidity in body fluids
- pH is below 7.35
Alkalosis
- Occurs when pH is above 7.45
Arterial Blood Gas Values (ABG)
- Provide information about body's ability to regulate pH
- Indicate a patient's acid-base status, the cause of imbalance, and overall oxygen status
Detection of Imbalances
- Kidneys retain or excrete H+ and HCO3-
- Lungs retain or expel CO2
Compensation
- One system helps when the primary system cannot regain acid-base balance
Lung and Kidney Response
- Lungs may respond to a metabolic disorder
- Kidneys may respond to a respiratory disorder
Partial and Complete Compensation
- Partial compensation occurs when pH remains abnormal
- Complete compensation occurs when pH returns to normal
Acid-Base Disorders
- Conditions occurring when body's pH varies from normal
Hydrogen Ion (H+)
- Influences pH level in the body
Respiratory Acidosis
- Decreased ventilation leads to increased PaCO2 and decreased pH
Hypoventilation
- A decrease in ventilation results in increased carbon dioxide levels
PaCO2 (Partial Pressure of Carbon Dioxide)
- Increases in arterial blood during respiratory acidosis
H2CO3
- Carbonic acid that forms from the reaction of CO2 dissolved in H2O
Renal Compensation in Respiratory Acidosis
- Kidneys increase absorption of HCO3- and excretion of H+
Respiratory Depression
- A decrease in the rate and depth of breathing
Obstruction
- Can lead to respiratory acidosis by preventing normal airflow
Chronic Respiratory Problems
- Long-term conditions that may contribute to respiratory acidosis
Recognizing Respiratory Acidosis
- Signs include: rapid and shallow respirations (shallow and depressed), dizziness, disorientation, headache, coma, arrhythmias, hypotension, seizures, and muscle twitching
Actions for Respiratory Acidosis
- Maintain patent airway
- Administer oxygen cautiously
- Monitor vital signs (respiratory rate and depth) and ABG levels
- Monitor serum potassium level
- Administer sedatives cautiously
- Reinforce patient teachings
Respiratory Alkalosis
- Increased ventilation leads to decreased PaCO2 and increased pH
Hyperventilation
- An increase in ventilation results in decreased carbon dioxide levels
Actions for Respiratory Alkalosis
- Instruct patient to breathe slowly and less deeply
- Monitor vital signs and ABG levels
- Monitor serum potassium level
- Administer sedatives cautiously
- Reinforce patient teachings
- Have the patient take 6-12 natural breaths with a paper bag over the mouth and nose, then remove the bag for easy natural breaths
Recognize Cues of Respiratory Alkalosis:
- Periods of apnea and hyperventilation (respiratory)
- Lightheadedness, confusion, lethargy (neurological)
- Tachycardia and arrhythmias (cardiovascular)
- Tingling of extremities, hyperreflexia, tetany, and seizures (neuromuscular)
- Epigastric pain, nausea, and vomiting (gastrointestinal)
Pursed-Lip Breathing Techniques
- Helps control breathing in respiratory alkalosis
Natural Breaths with Paper Bag
- Taking 6-12 natural breaths with a paper bag over the mouth and nose
Metabolic Acidosis
- Gain of acid and/or inability to excrete acid
HCO3- Deficit
- A decrease in bicarbonate levels contributes to metabolic acidosis
pH Due to Excess H+
- Decreases in pH levels are caused by an increase in hydrogen ions
Respiratory Compensation in Metabolic Acidosis
- Body eliminates CO2 to raise pH
- Ventilation efforts retain CO2
Kussmaul Breathing
- Deep, labored breathing associated with metabolic acidosis, particularly DKA
Respiratory Cues of Metabolic Acidosis
- Kussmaul breathing and fruity breath are associated with DKA (Diabetic Ketoacidosis)
Neurologic Cues of Metabolic Acidosis
- Dull headache, lethargy, confusion, and coma can occur
Cardiovascular Cues of Metabolic Acidosis
- Arrhythmias and hypotension can occur
Neuromuscular Cues of Metabolic Acidosis
- Tingling and numbness in the extremities can occur
Gastrointestinal Cues of Metabolic Acidosis
- Abdominal pain, anorexia, nausea, and vomiting can occur
Actions for Metabolic Acidosis
- Monitor neurological status
- Administer O2
- Monitor ABG
- Monitor K
- Assess respiratory functions
Metabolic Alkalosis
- Loss of strong acid leads to bicarbonate excess
HCO3- Excess
- Increase in bicarbonate levels contributes to metabolic alkalosis
pH Due to Decrease in H+
- Increase in pH levels is caused by a decrease in hydrogen ions
Nasogastric Suction
- Can cause metabolic alkalosis due to loss of gastric acid
Respiratory Cues of Metabolic Alkalosis
- Slow, shallow breathing can occur
Neurologic Cues of Metabolic Alkalosis
- Irritability, disorientation, belligerence can occur
Cardiovascular Cues of Metabolic Alkalosis
- Dysrhythmias can occur
Neuromuscular Cues of Metabolic Alkalosis
- Tingling, muscle cramps, and tetany can occur
Gastrointestinal Cues of Metabolic Alkalosis
- Anorexia, nausea, and vomiting can occur
Acid-Base Pneumonic (ROME)
- Respiratory - Opposite, Metabolic - Equal
Compensation
- pH changes indicate compensation mechanisms
Partially Compensated Respiratory Acidosis
- Low pH (<7.35)
- High PaCO2 (>45)
- High HCO3 (>28)
Partially Compensated Metabolic Alkalosis
- Elevated pH
- High HCO3 (>28)
- High PaCO2 (> 45)
Compensated Respiratory Acidosis
- Normal pH
- High CO2 (Acidic)
- High HCO3(Alkalotic, >28)
Uncompensated Respiratory Acidosis
- Acidic pH (<7.35)
- High PaCO2 (>45)
- Normal HCO3 (22-28)
Compensated Respiratory Alkalosis
- Normal pH (7.35-7.45)
- Low CO2 (<35 (alkalotic))
- Low HCO3 (<22)
Uncompensated Respiratory Alkalosis
- High pH (>7.45)
- Low PaCO2 (<35)
- Normal HCO3 (22-28)
Compensated Metabolic Acidosis
- Normal pH (7.35-7.45)
- Low PaCO2 (< 35)
- Low HCO3 (< 22)
Uncompensated Metabolic Acidosis
- Low pH (<7.35)
- Normal PaCO2 (between 35-45)
- Low HCO3 (<22)
Compensated Metabolic Alkalosis
- Normal pH
- High PaCO2 (> 45)
- High HCO3 (> 28)
Uncompensated Metabolic Alkalosis
- High pH (>7.45)
- Normal PaCO2 (35-45)
- High HCO3 (>28)
HCO3 Normal Range
- Normal range is typically 22 - 28 mEq/L
Lung and Kidney Response
- Lungs may respond to a metabolic disorder
- Kidneys may respond to a respiratory disorder
Respiratory Acidosis Etiology
- Respiratory depression, obstruction, or chronic respiratory problems
Respiratory Alkalosis Etiology
- Any factor that contributes to hyperventilation
Renal Compensation for Respiratory Alkalosis
- Involves absorption of H+ and excretion of HCO3- in urine
Metabolic Acidosis Etiology
- DKA, renal failure, diarrhea, salicylate poisoning, and starvation
Respiratory Acidosis Compensation
- Involves eliminating excess CO2
Respiratory Alkalosis Compensation
- Body retains CO2
Metabolic Acidosis Compensation:
- Conserving HCO3- and eliminating excess H+
Metabolic Alkalosis Compensation
- Conserve H+, increase CO2 retention, and increase H⁺ production
Acid-Base Disorders Criteria
- Uncompensated: pH and one other value is abnormal
- Partially Compensated: All 3 values will be abnormal
- Compensated: pH is normal while other two values are abnormal
Actions in Metabolic Acidosis
- Monitor neurologic status, vital signs, and respiratory rate and depth
- Position patient to facilitate breathing and administer O2 to correct lactic acidosis
- Monitor ABG levels
- Monitor HCO3- and K+ levels
- Administer IV fluids containing as ordered
- Administer insulin and NS to correct hyperglycemia
- Administer NaHCO3 (SODIUM BICARB) cautiously
- Institute cardiac monitoring for patients with K+
- Reinforced patient teachings
Actions for Metabolic Alkalosis
- Monitor vital signs and assess neurological status
- Monitor ABG values
- Administer IVF and electrolyte supplements as ordered and monitor patients at risk
- Reinforced patient teachings
Metabolic Alkalosis Etiology
- Nasogastric suction, diuretic therapy, and prolonged vomiting can cause metabolic alkalosis
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