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NR 2392 multidimensional care 2 exam with updated solutions 2025
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Acid Base Balance is characterized by Hydrogen atoms too many means more acidic too little means less acidic pH is how hydrogen concentration is measured lower pH means higher acidity, higher pH means lower acidity
What are the main 3 ways the body controls pH? -Hydrogen atoms ("buffy buffer"/chemical buffer/metabolic buffer) -Respiratory system (carbonic acid) -Renal system (bicarbonate) Gastric Juice pH 1.0 - 3. Urine pH 5.0-6. Arterial blood pH 7.35-7. Venous blood pH 7.31-4. CSF pH
Pancreatic fluid pH 7.8-8. When acid base is balanced it is characterized by? fluid containing equal number of positive charges, ions with negative charges Changes in acid base balance can affect -shape of hormones and enzymes -distribution of other electrolytes -excitable membranes -effectiveness of hormones and drugs ABG (Arterial Blood Gas) measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery what are 3 parts to an ABG -pH 7.35-7. -Co2 35-45 (this is an acid) (higher the number more acidic) -Hco 22-26 (bicarb) Respiratory issue= renal system compensates Metabolic issue= lungs compensate if pH and Co same side= respiratory issue if pH and HCo3 same
-From kidney absorption and breakdown of carbonic acid -Level is typically 20 times greater than that of carbonic acid -70-80% is excreted in the stool When chemical/metabolic buffers can not prevent blood pH changes what is the second line of defense? respiratory system how does the respiratory system buffer? hyperventilation/hypoventilation What is the 3rd line of defense against pH changes? kidneys What can cause metabolic acidosis? -diabetic ketoacidsosi -renal failure -diarrhea -Ileostomy -Hyperthyroidism -Pancreatitis -Liver failure -Dehydration -Seizure activity -Ethanol intoxication -Aspirin toxicity Laboratory assessment of Metabolic Acidosis -pH<7. -Bicarbonate <21 mEq/L -PaO2 normal -PaCO2 normal or slightly decreased -Serum potassium high* Clinical manifestations of metabolic acidosis -Kussmaul's breathing >20bpm -weak -confused -hypotension -cardiac changes (due to hyperkalemia)** -nausea -vomiting Nursing interventions metabolic acidosis -hydration -antidiarrheal medications -monitor electrolytes (potassium) -Renal failure (intake output, monitor diet, may need dialysis) -Neuro status (seizure precautions
-DKA (patient will need insulin drip) -Bicarbonate (only with low serum level) -Watch for respiratory distress (patient may need to be ventilated) alkalosis is defined as a decrease in free hydrogen ion level of the blood and an arterial blood pH above 7. Clinical manifestations of metabolic alkalosis
Respiratory changes: -increased rate and depth of ventilation (RA) -decreased respiratory effort associated with skeletal muscle weakness (MA) Neuromuscular Changes: hyperflexia, muscle cramping, twitching, skeletal muscle weakness. Cardiovascular changes: increased HR, normal or low blood pressure, increased digitalis toxicity. CNS changes: increased activity, anxiety, positive chvostek's and trosseau's sign, paresthesias. Nursing interventions for metabolic alkalosis -treat the cause -watch for respiratory distress -if vomitting administer anti emetics (Zofran, phenergan) -Stop NG suctioning -Stop or alter dose of diuretic -May administer Diamox (watch for hypokalemia) Respiratory Alkalosis defined by -ABG result with high pH coupled with low CO2 level -O and bicarbonate usually normal
