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34 Cards in this Set
- Front
- Back
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Basics of a Hydrogen Ion
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- Vital to life
- Expressed as pH - Circulate in the body in two forms Volatile hydrogen of carbonic acid Nonvolatile form of hydrogen and organic acids |
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Basics of Acids
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- End product of metabolism
- Acids contain hydrogen ions - Acids are hydrogen ion donors - The strength of an acid depends on the number of hydrogen ions it has - The number of hydrogen ions in body fluids determines its alkalinity, acidity or neutrality - Lungs excrete 13,000 to 30,000 meq of volatile H / day in the form of carbonic acid CO2 - The kidneys excrete 50 meq of NONvolatile acids / day |
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Explain how acids are H ion donors
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Acids give up H ions to neutralize or decrease the strength of an acid or to form a weaker base.
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Bases
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- Bases contain no H ions
- Base are H ion acceptors |
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Explain how bases are H ion acceptors
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They accept H ions from acids to neutralize or decrease a strength of a base or to form a weaker acid
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How do Buffers work
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- They are fastest acting regulatory systems
- Provide immediate protection against changes in the H ion concentration in the extracellular fluid - They are reactors that function only to keep pH within the narrow limits of stability when too much acid or base is released to the system - Buffers absorb or release H ions as needed - They serve as a transport mechanism that carries excess H ion to the lungs - Once buffers react, they are consumed. Body wont be able to withstand further stress until they are replaced |
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Primary Buffer systems in the body
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- Hemoglobin systems
- Plasma Protein systems - Carbonic acid/bicarbonate system - Kidneys |
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How does Hemoglobin System works as a Buffer
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- RBCs contain hemoglobin
- maintains Acid Base balance by CHLORIDE SHIFT - Chloride shifts in and out of the cells in response to the level of O2 in the blood - Each Chloride ion left the cell, bicarbonate ions enter and vise versa |
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How does Plasma Proteins work as Buffers?
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- Plasma proteins have the ability to attract or release H ions
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How does Acid/Bicarbonate system work as Buffer
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- The system maintains a pH of 7.4 with 20 parts of Bicarbonate to 1 part Carbonic acid
- This ratio (20:1) determines the H ion concentration of body fluid - Carbonic Acid concentration is controlled by the excretion of the CO2 from lungs. The rate and dept of the respirations change in response to CO2 - Kidneys control the bicarbonate concentration and retain or secrete bicarbonates in response to body needs |
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How does Phosphate system work as a Buffer
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- Present in cells and the body fluids
- Especially active in kidneys - It acts like bicarbonate and clears spare H ions |
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LUNGS as a Regulatory System
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In Acidosis: pH decreases --> Resp rate & depth increase to exhale acids. The carbonic acid created by the neutralizing action of bicarbonate is carried to the lungs and reduced to CO2 + water and exhaled. Thus H ions are excreted.
In Alkalosis: pH increases --> Resp decreases. The CO2 is retained and carbonic acid builds to neutralize and decrease the strength of excess bicarbonate. - The lungs can hold the H ions until deficit is resolved or can inactivate H by changing them to water to be exhaled - The process of correcting takes 30 sec. - Lungs can only deactivate H ions carried by carbonic acid. H ions created by other problems must be excreted by kidneys |
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KIDNEYS as a Regulatory System
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- In Acidosis: pH decreases and excess H secreted in to the tubules to meet with the buffers to be excreted in the urine
- In Alkalosis: pH increases and bicarbonate ions move in to tubules, combine with buffers to be excreted in the urine - Selective regulation of Bicarbonate occurs in kidneys Kidneys restore bicarbonates by the release of H and by Holding Bicarbonates Extra H excreted in the urine as Phosphoric acid The alteration of certain amino acids result in diffusion of ammonia into the kidneys. Ammonia combines with H ions and excreted in the urine |
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POTASSIUM as a Regulatory System
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- In Acidosis: Body moves H into the cells to protect itself from the acid, therefore Potassium ions shift from the cells to the plasma causing Hyperkalemia
- In Alkalosis: H ions get released from the cell to increase the acidity, therefore Potassium moves in to the cells causing Hypokalemia |
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Causes of RESPIRATORY ACIDOSIS
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Astma
Emphysema Atelectasis Brain Trauma Bronchitis Hypoventilation Pulmonary Edema Meds: Sedatives, Narcotics, anesthetics |
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Symptoms of RESPIRATORY ACIDOSIS
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- Resp dept and rate increase
- Headache - Restlessness - Drowsiness, confusion - Diaphoresis - Cyanosis - Hyperkalemia - Rapid irregular pulse - Dysrhythmias leading to ventricular fibrltn. |
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Interventions for RESPIRATORY ACIDOSIS
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- Monitor the signs for resp distress
- Encourage client to turn, cough and deep breathe - Monitor Electrolytes - Semi-Fowlers position - Hydrate Client - Adm O2 - Reduce restlessness by improving the ventilation instead of using sedatives (that can make the condition worse) - Suction if necessary - Adm antibiotics for infection - Prepare to adm respiratory treatments |
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Causes of RESPIRATORY ALKALOSIS
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- Fever
- Hyperventilation - Hypoxia - Hysteria - Over mechanical ventilation - Pain |
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Symptoms of RESPIRATORY ALKALOSIS
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- Tachypnea
- Headache - Hypokalemia, Hypocalcemia - Tetany, convulsions - Mental Status changes - Light headedness, vertigo - Parasthesias: tingling of the fingers and toes |
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Interventions for RESPIRATORY ALKALOSIS
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- Encourage appropriate breathing:
Carbondioxyde breathing Voluntarily holding breath Use of rebreathing masks - Caution with ventilator client - Monitor electrolytes - Prepare to adm Calcium Gluconate for tetany - Adm meds as prescribed |
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Causes of METABOLIC ACIDOSIS
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- Diabetes Mellitus or Diabetic Ketoacidosis
- Increased ingestion of Asprin - High fat diet - Insufficient metabolism of carbohydrates - Renal Insufficiency or failure - Malnutrition - Severe Diarrhea |
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Symptoms of METABOLIC ACIDOSIS
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- Hyperkalemia
- Hyperpnea (KUSSMAUL'S RESP) - Fruity breath (caused by improper fat metb) - Headache - Nausea, vomiting, diarrhea - Mental dullness, drowsiness, stupor, coma - Twitching, convulsion |
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Interventions for METABOLIC ACIDOSIS
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- Assess LOC
- Monitor I/O, assist with electrolyte replacement - IV infusion to increase buffer base - Monitor serum potassium levels closely - Seizure precautions - Interventions for Diabetes or Diabetic ketoacidosis Adm insulin to move the glucose in the cell thereby decreasing the ketosis When glucose is properly metabolized body will stop converting fats to glucose Monitor for circulatory collapse due to polyuria - Interventions for Renal Failure Dialysis---> removes protein and waste products---> lessens acidosis state A diet in LOW PROTEIN, HIGH CALORIE |
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Causes of METABOLIC ALKALOSIS
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- Excessive ingestion of Sodium bicarbonate
- Excessive suctioning or vomiting - Diuretics: Loss of H & Chloride ---> compensatory increase of bicarbonate in blood - HYPERaldesteronism: Increased tubular reabsorption of Na--->loss of H ions - Massive transfusion of whole blood |
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Symptoms of METABOLIC ALKALOSIS
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- Decreased RESP rate and depth
- Tachycardia - Hypocalcemia - Hypokalemia - Twitching on extremities - Nausea, vomiting, diarrhea - Restlessness |
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Interventions for METABOLIC ALKALOSIS
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- Monitor electrolytes
- Safety precautions - Meds for kidney excretion of bicarbonate - Prep to replace potassium chloride |
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pH Value
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7.35 - 7.45
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Pco2 Value
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35 - 45 mm Hg
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Hco3 Value
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22 - 27 meq/L
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Po2
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80 - 100 mm Hg
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Compensated Resp Acidosis-Alkalosis
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Ph normal
Hco3 abnormal |
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Uncompensated Resp Acidosis-Alkalosis
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Hco3 normal
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Partial Compensated Metabolic Acidosis-Alkalosis
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Ph normal
Pco2 abnormal |
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Uncompensated Metabolic Acidosis-Alkalosis
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Pco2 normal
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