Metabolic and Respiratory Acid-Base Balance Quiz

Adult Health 2 - Final Exam Review

• Chapter 14: Acid-Base
  • Metabolic acidosis is a buildup of acid in the body fluids affecting bicarbonate levels.
  • Causes include:
    • Increased acid production (e.g., DKA—ketones increase, lowering bicarbonate)
    • Decreased acid excretion (e.g., renal failure—high waste, increasing acids)
    • Loss of too much bicarbonate (e.g., diarrhea)
  • Metabolic alkalosis is a metabolic problem caused by excessive loss of acids (H+) or increased bicarbonate (HCO3).
  • Causes include: excessive vomiting, NG tube suctioning, or Lasix use.
  • Respiratory acidosis is caused by bradypnea (slow respiratory rate <12 bpm), leading to CO2 buildup in the lungs.
  • Blood pH decreases (<7.35) and carbon dioxide levels increase (>45)
  • To compensate, the kidneys conserve bicarbonate (HCO3) to hopefully increase the blood's pH back to normal, so HCO3 becomes >28..
  • Respiratory alkalosis is caused by tachypnea (fast respiratory rate >20 bpm), decreasing CO2 in the lungs.
  • Blood pH increases (>7.45) and carbon dioxide levels decrease (<35)
  • To compensate, the kidneys excrete bicarbonate (HCO3), to hopefully decrease the blood's pH back to normal, so HCO3 becomes <21.
  • Remember! pH - 7.35-7.45, PaCO2 35-45, HCO3 21-28.

Chapter 33: Vascular Problems

• Peripheral arterial disease (PAD): narrowing or occlusion of peripheral arteries, mainly in the lower extremities, leading to decreased oxygenated blood and tissue damage (ischemia).
• Raynaud's disease: vasospasm of peripheral arteries, usually in fingers and toes, triggered by cold or stress, causing numbness, tingling and discoloration.
• Buerger's disease: occurs with heavy tobacco use, affecting arteries and veins.

Peripheral Vascular Disease (PVD)

• PVD mainly affects blood flow to the lower extremities (feet, hands, arms, and legs).
• Varicose veins: weak vein walls and valves leading to dilated, rope-like veins in the legs; treated with compression and procedures.
• Deep vein thrombosis (DVT): clot formed in the deep veins; dangerous, as the clot can break off and travel to the lungs.
• Chronic venous insufficiency: damaged veins with overstretched walls and valves.

Atherosclerosis

• Fatty plaques are caused by atherosclerosis, creating fatty deposits in artery walls.
• The condition limits blood supply to the heart muscle and can rupture, leading to thrombosis, myocardial infarction (heart attack), hypertension, chest pain, and heart failure.

Hypertension

• Primary/Essential Hypertension: Unknown causes. Risk factors include race (African American males), increased salt/alcohol consumption, smoking/stress, low K+ and vitamin D, family health history, advanced age, high cholesterol, too much caffeine intake, obesity, and restricted activity/sleep apnea.
• Secondary Hypertension: Caused by other underlying conditions like pregnancy, Cushings syndrome, diabetes, hypo/hyperthyroidism, or tumors on the adrenal glands.

Chapters 57 and 59: Hypo/Hyperpituitarism

• Hypopituitarism: deficiency of one or more hormones from the anterior pituitary gland; deficiency in TSH (thyroid stimulating hormone) and ACTH often results in hypotension and can be life-threatening.
• Deficiency in LH and FSH (reproductive hormones) can cause infertility.
• Management involves early detection and hormone replacement.
• Hyperpituitarism: oversecretion of hormones from the anterior pituitary gland; common cause is benign tumor growth on anterior pituitary.
• Overproduction of growth hormone in adults results in acromegaly. Treatment: Parlodel. Inhibit the release of growth hormone and prolactin.

Diabetes Insipidus and SIADH

• Diabetes Insipidus: decreased ADH production/kidneys not responding to it.
  • Symptoms: High urine output, dehydration, very dry mucous membranes, hypotension, fatigue
  • Specific gravity of <1.010.
• SIADH: Excess ADH in the body.
  • Symptoms: Low urine output, fluid retention, high specific gravity, possible hyponatremia, weight gain, and hypertension. Treatment for SIADH includes fluid restrictions, diuretics (Lasix), gradual sodium replacement, and demeclocycline or hypertonic saline to remove excess fluid.

Addison's Disease

• Addison's disease: hyposecretion of aldosterone and cortisol.
  • Symptoms: Low sodium, low blood sugar, salt craving, tired, muscle weakness, electrolyte imbalance (high potassium, high calcium), reproductive changes in women and men, pigmentation of the skin, diarrhea, and depression.
• Treatment: Prednisone, Hydrocortisone. Education: Report stress (like illness, surgery), take medication exactly as prescribed. Do not abruptly stop medication without consulting a physician . For replacing aldosterone: Fludrocortisone aka Florinef. Education: adequate salt intake.

Addisonian Crisis

• Addisonian crisis is a life-threatening condition if Addison's disease isn't treated.
  • Symptoms: sudden pain in the stomach, back, and legs, syncope (loss of consciousness), shock, super low blood pressure, severe vomiting/diarrhea, and headaches. Treatment: IV hydrocortisone (Solu-Cortef) and IV fluids.

Cushing's

• Cushing's syndrome: hypersecretion of cortisol.
  • Symptoms include the following:
    • Skin fragile
    • Truncal obesity with thin arms
    • Rounded face (moon face)
    • Elevated blood pressure
    • Stretch marks on abdomen
    • Excessive body hair (mainly in women)
    • Dorsocervical fat pad (buffalo hump)
• Treatment for Cushing's includes prepping the patient for Hypophysectomy to remove the pituitary tumor and reducing the dosage of prednisone over time.

Diabetes Mellitus

• Glucose: Sugar that fuels body cells, enters cells with the help of insulin.
• Insulin: Hormone that helps regulate blood sugar; secreted by beta cells in the islets of Langerhans, a part of the pancreas. Prevents high blood glucose, high blood sugar is toxic.
• Type 1 diabetes: Beta cells are destroyed, so the body doesn't produce insulin. Treatment: Insulin.
  • Risk factors: genetic, autoimmune—not related to lifestyle.
• Type 2 diabetes: Insulin resistance.The body produces insulin however the body doesn’t respond to insulin as well. Treatment: Diet, exercise, oral meds, and possibly insulin.
  • Risk factors: overweight, gradual onset, rarely has ketones in urine.
• Diabetic ketoacidosis (DKA): A life-threatening complication of diabetes Mellitus Type 1 & 2; no insulin to move glucose into cells, body breaks down fats for energy which creates ketones.
  • Symptoms: hyperglycemia (glucose >300 mg/dL), ketosis, and acidosis.
• Hyperglycemic hyperosmolar syndrome (HHS): A life-threatening complication of type 2 diabetes; extremely high blood glucose over 600mg/dL. Mental status changes due to severe dehydration

Asthma

• Asthma: Chronic lung disease with airway inflammation and narrowing
  • Symptoms: audible wheeze, increased respiratory rate, use of accessory muscles to breathe, muscle retraction at the sternum and between the ribs, possible barrel chest, cyanosis in the nail beds and oral mucosa. -Treatment: Bronchodilators (beta-agonists, anticholinergic drugs—like Ipratropium) and corticosteroids (like Budenoside, prednisone).
  • Pulmonary function tests: help diagnose asthma
• Peak expiratory flow (PEF) meter readings...

COPD

• COPD: chronic obstructive pulmonary disease; involves the damaging of the alveoli sacs and development of air pockets with thick and swollen bronchioles that are deformed. -Symptoms: difficulty breathing, chronic cough (sometimes productive), possible abnormal lung sounds, and dyspnea on exertion.
  • Treatment and diagnosis use Pulmonary function tests like FVC, FEV1. Bronchodilators and steroids.

Cystic Fibrosis

• Cystic Fibrosis: genetic disorder that causes the exocrine glands to function incorrectly; results in thick, sticky mucus in airways and ducts.
  • Symptoms: blocked air pathways, frequent lung infections, dry or productive cough, abnormal lung sounds (crackles, wheezes, rhonchi), skin discoloration (blue bloaters), and increased AP diameter (barrel chest).
  • Treatment: stool softeners, pancreatic enzymes, nasal sprays, vitamins, antibiotics, anti-inflammatories, and mucolytics.

Peptic Ulcer Disease (PUD)

• PUD: stomach acid and pepsin erode the stomach lining because the defense mechanisms are disrupted or excessive stomach acid.
• Risk Factors: H. Pylori, consuming contaminated food, and NSAID use.

Colorectal Cancer

• Colorectal cancer: is one of the most common cancers
  • Risk factors: older than 50, genetic predisposition, family history, Crohns disease, ulcerative colitis, heavy alcohol and smoking, diets excessive in refined carbs and lack of fiber ,and red meat.
• Screening: fecal occult blood test yearly and colonoscopy every 10 years for patients 50 and older.
  • Teach adults to reduce refined carbs, fat, and avoid low-fiber foods.

Irritable Bowel Syndrome (IBS)

• IBS: chronic or recurring diarrhea, constipation, abdominal pain, and bloating.
  • Unknown cause, but diet, stress, possibly genetics play a role.
  • Diet: 30-40 grams of fiber per day and 8-10 glasses of water
  • Treatment: Anti-diarrheals or laxatives based on the condition.

Peritonitis

• Peritonitis: acute inflammation and infection of the visceral peritoneum and lining of the abdominal cavity.
  • Causes include leakage/rupture of abdominal organs (like the appendix).
  • Inflammation/infection leads to fluid buildup in the abdomen, making it turbid and with increased amounts of protein, white blood cells, cellular debris, and blood.
  • Treatment: IV antibiotics, hypertonic fluids, NGT suctioning, and NPO (nothing by mouth) status to allow the abdomen to heal.

Appendicitis

• Appendicitis: inflammation of the appendix
  • Obstruction of the appendix due to a fecalith (hard stool), parasites, foreign bodies, or swollen lymph nodes can be implicated.
• Symptoms: generalized, abdominal pain that moves to the right lower quadrant, poor appetite, fever, elevated temperature, nausea/vomiting, desire to be in fetal position. Increased WBC
• Treatment: surgery to remove the appendix.

Ulcerative Colitis

• Ulcerative colitis: inflammation of the colon and rectum; tends to start in the rectum and throughout the large intestine in a uniform pattern over time.
  • Symptoms include: abdominal pain, diarrhea, nausea/vomiting, elevated temperature, weight loss, possible blood in stools, cramps, and possible tender abdomen.
• Treatment: low fiber diet at the start, avoid spicy and high-fat foods.

Crohn's Disease

• Crohn’s Disease: chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. Symptoms include inflammation and ulcers throughout the GI tract wall and not usually uniform.
  • Symptoms: diarrhea, abdominal pain, possible blood in stool, possible fissures in the anal area, possible weight loss and malnutrition.
• Treatment: diet, and medications.

Diverticulitis

• Diverticulitis: inflammation of one or more pouches in the intestines called diverticula which are caused by pressure in the intestinal wall from low-fiber diet.
  • Symptoms: change in bowel pattern (constipation/diarrhea), abdominal bloating, increased pain and frequency of bowel movements.
• Treatment: high-fiber diet, fluids, possibly antibiotics, or bowel surgery.

Urinary Tract Infections (UTIs)

• UTIs: infection in any part of the urinary tract causing burning, pain, urgency, increased need to urinate.
  • Risk factors: women due to shorter urethra and proximity to the rectum.

Kidney Stones

• Kidney stones: hard deposits of minerals and salts.
• Common symptoms: dull, aching pain in the flank or costovertebral area, wave-like pain when the stone moves, possible blood, nausea, vomiting, fever, cloudy odorous urine.
• Treatment: hydration, pain management, possibly medications, or surgery.

Benign Prostatic Hyperplasia (BPH)

• Benign Prostatic Hyperplasia (BPH): enlargement of the prostate gland causing urinary outflow blockage, retention, and stasis in men 40+.
• Symptoms: trouble starting or stopping urination, weak stream, frequent urination, urinary retention, possible complications like hydronephrosis.
• Treatment options include medications and surgery.

Uterine Fibroids

• Uterine fibroids: benign tumors in uterine tissue; causes symptoms of vaginal bleeding; c/o pressure, constipation, urinary frequency, and painful intercourse, and infertility.
• Treatments can include Nonsurgical or surgeries dependent on the patient’s condition.

Uterine Cancer

• Uterine cancer: symptoms include postmenopausal bleeding, and other diagnostic assessments.
  • Treatment: surgery, radiation, or chemotherapy.

Ovarian Cancer

• Ovarian cancer: an aggressive type of cancer rarely diagnosed early and can have vague abdominal discomfort
  • Diagnosis: CA-125, ultrasound, IV pyelography (radiographic exam), barium enema, upper GI radiography (rule out other tumors)
• Treatment for ovarian cancer depends on the extent of the disease.

Cervical Cancer

• Cervical cancer: a progression from totally normal cells to pre-malignant and finally malignant cervical cells.
  • Risk factors: HPV, genetics (BRCA mutations)..
  • Diagnosed via HPV vaccine (9-26), genetic testing, or pap smears..

Breast Cancer

• Breast cancer: invasive or non-invasive (remains in ducts); diagnosed from self-exam, or doctor exam
  • Symptoms: possible painless lump, skin flattening, change in size or contour, pitted surface, pain, unusual nipple discharge,
• Screening: annual mammography (45-54) or every 2 years or older.

Blood Transfusions

• Blood transfusions: procedure where blood is given to a patient.
  • Pre-transfusion: important to collect a sample, type and crossmatch it to prevent transfusion reactions...clerical error is a common cause of transfusion reactions.
  • Process: patient is typed & crossmatched to a donor; prescribed units are ordered by blood bank ; transfusion reaction is assessed.

Seizures

• Seizures: abnormal electrical activity in the brain, due to an imbalance in excitatory (glutamate) and inhibitory (GABA) neurotransmitters.. -Pre-seizure precautions: oxygen, suction, IV access to give anti-seizure meds, padded sides, bed in low position, and remove dangerous items from around patient.

Radiation Therapy

• Radiation therapy: used to treat cancer by destroying cancer cells with high-energy rays
  • Side effects: hair loss, nausea, vomiting, taste changes, urinary tract infections (UTIs), pulmonary fibrosis, and skin reactions.

Chemotherapy

• Chemotherapy: systemic treatment that uses chemicals to destroy cancer cells; side effects include anemia, decreased white blood cells, decreased platelets, nausea, vomiting, mucositis and possible bone marrow suppression.

Care of Patients with Thrombocytopenia

Care of these patients involves cautious movement and activity, use of an electric razor, and gentle handling in all activities, and avoidance of IM injections and venipuncture.

Advance Directives

• Advance directive (living will): legally binding document that specifies a person's wishes for medical care if they are unable to make decisions for themselves. CPR/DNR: By law, health care providers in the US must initiate CPR for someone who isn't breathing or is pulseless unless a DNR or similar document exists.

Hospice Care

• Hospice care: type of care for terminally ill patients; focuses on comfort and reducing pain, emotional and spiritual support.
• Palliative care: any type of care for patients with life-threatening illnesses; focuses on symptom management and quality of life.

Signs/Symptoms of Approaching Death

• Signs of approaching death include: coolness of extremities, increased sleeping, decreased appetite and thirst, incontinence, congestion, gurgling, changes in breathing patterns, disorientation, and restlessness.

Managing Dyspnea Near Death

• Morphine and oxygen are common measures used for managing dyspnea (difficulty breathing) near death. Encourage proper positioning to prevent gurgling and provide comfort.

Grief Intervention

• Grief intervention for family members near death involves active listening and acknowledgement instead of attempts to minimize or deny the situation.

Chapters 52, 55, 61, 62, 67: Peritonitis

• Peritonitis: inflammation/infection of the peritoneum.
  • Symptoms: abdominal pain, fever, elevated temperature, nausea/vomiting, possible increased WBCs and wound drainage, abdominal rigidity, and tenderness.
• Treatment: IV antibiotics, fluid management, and surgery as needed.

Fat Embolism Syndrome

• Fat embolism syndrome (FES): complication of fractures/trauma with fat globules released; can affect
  • Symptoms: hypoxia, dyspnea, tachypnea, decreased level of consciousness, lethargy, confusion...
• Treatment and supportive care

Bone Fractures

• Closed reduction: done manually.
• Cast: to hold fractured bones in place to allow healing using fiberglass or plaster.
• Open reduction: surgical approach to reposition bones Complications: monitoring for infection, compartment syndrome (early signs are crucial: pain, pallor, paresthesia, paralysis, decreased/absent peripheral pulses), and appropriate care to prevent delayed complications.

Cancer Treatment

• Goal of cancer treatment is to cure or eliminate cancer cells and/or the tumor.
• Palliative treatment: focus on alleviating pain and symptoms.

Radiation Therapy

• Radiation therapy: treatment using high-energy waves to destroy cancerous cells..
  • Side effects include hair loss, nausea, vomiting, taste changes, UTIs, pulmonary fibrosis, and skin reactions.

Chemotherapy

• Chemotherapy: systemic treatment of cancer cells that are used throughout the body..
• Side effects: anemia, decreased white blood cells, decreased platelets, alopecia (hair loss), and mucositis (mouth sores).
• Important considerations: low bacteria diet, monitoring for infection, and patient safety when giving meds for this procedure.

Other Topics

• Chapters 19, 22: Covers general features of cancer cells such as abnormal, lack of a useful function, loss of adherence to parent cells, increase in nuclear size.

• Miscellaneous: Includes information on risk factors for cancer, common sites of metastasis, prevention methods, and different types of treatment.

Test your knowledge on the causes and indicators of metabolic and respiratory acid-base disorders. This quiz covers key concepts such as metabolic acidosis, alkalosis conditions, and lab value changes. Perfect for students studying physiology or related health sciences.