Nursing 113-exam 2

Nursing 113-exam 2 Acid-Base Balance ØRefers to the homeostasis of the hydrogen ion (H-) concentration in the plasma high amount of hydrogen ions is considered an acid low amount of hydrogen ions is considered an alkaline or base Buffer Systems: Hydrogen ion concentration is determined by the ratio of carbonic acid to bicarbonate For homeostasis, we need the ratio to be 1 part carbonic acid to 20 parts bicarbonate 10= basic Normal pH is between 7.35-7.45 pH <7.35 is acid pH >7.45 alkaline/base By hyperventilation we remove carbon dioxide from the blood which lowers the carbonic acid levels and raises pH which makes the body more alkaline If there is too much alkaline in the blood, the body hypoventilation and we retain carbon dioxide which results in lower pH and makes the body more acidic Kidneys can can return the pH back to normal Blood buffers are immediate and continuous Respiratory works in minutes Kidneys works in hours/days However all of them can increase/decrease pH Respiratory Acidosis Symptoms Tachycardia, elevated BP, confusion, decreased LOC respiratory alkalosis causes: by hyperventilation; anxiety, adult respiratory distress syndrome, CHF, head trauma, severe blood loss respiratory alkalosis treatment: sedation and reassurance; breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide Respiratory Alkalosis symptoms Lightheadedness, inability to concentrate, numbness and tingling, tachycardia, ventricular and atrial arrhythmias. Metabolic Acidosis retaining too many acids or losing too many bases Metabolic Acidosis Effect: hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level Metabolic Acidosis Treatment is the administration of sodium bicarbonate Metabolic Acidosis symptoms: Headache, decreased LOC, lethargy Kussmaul respirations (deep/rapid) Abd pain, anorexia, diarrhea, N/V Metabolic alkalosis •significant amount of acid is lost from the body or an increase in the bicarbonate level occurs; •The most common cause is vomiting gastric content, normally high in acid; •Renal acid loss Metabolic Alkalosis Symptoms slow, shallow RR with periods of apnea anorexia, N/V, atrial tachycardia hypertonicity of muscles, tetany, tremors •PaCO2 normal range: 35-45 HCO3- range 22-26 HCO3-, is a measure of renal metabolic component of acid-base balance HCO3- increases, the pH increases HCO3- decreases, the pH decreases Acute renal failure is a reversible syndrome that results in decreased GFR and oliguria low urine output Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia elevation of serum BUN & Creatinine Creatinine waste product of muscle metabolism; Normal serum level - 0.7 to 1.4 mg/dL BUN Normal level - 10 to 20 mg/dL; Breakdown of protein complications of AKI; Acute kidney injury ´Metabolic acidosis ´Fluid & Electrolyte imbalances Acute kidney injury treatment aimed at replacing the renal function ´Minimize potential lethal complications ´Reduce potentially increased kidney injury Phases of AKI