musculoskeletal exam

normal pH level

7\.35-7.45

a pH lower than 7.35 is indicative of

acidosis

a pH higher then 7.45 is indicative of

alkalosis

a perfect pH level is

7\.4

when the body is holding on to CO2, it is ___.

acidotic

normal PaCO2 value is

35-45

normal HCO3 (bicarb) value

22-28

hydrogen ions, like potassium and chloride, in higher amounts make the body

acidic blood

decreased hydrogen ions like K+ and chloride make the blood

alkalotic

what is the **FIRST line of defense** the body uses when trying to maintain an adequate pH (homeostasis/acid-base balance)?

chemical & protein buffers

when does the body use respiratory buffers?

long term holding of oxygen (COPD pt for example)

what is the third line of defense for maintaining acid-base balance?

kidney buffers bc they can do it long term

If a patient is ___, they are in respiratory acidosis.

hypo-ventilating because of the INCREASED CARBON DIOXIDE

carbon dioxide is acidic or alkalotic?

acidic

If a patient is ___, they are in respiratory alkalosis.

hyper-ventilating because of they are BLOWING OFF TOO MUCH CO2

A nice way to remember metabolic acidosis is ___.

losing base out the butt

Losing base out the butt refers to losing fluids out of the ass such as ___.

diarrhea

When a patient is **vomiting**, the body is going into what type of acid base balance?

metabolic alkalosis bc it is coming out VERY ACID so the patient is left alkalotic

when the body **loses too much** acid (like CO2, vomit) it will be in a state of ___.

body will be in alkalosis

when the body **gains too much** acid (retention of CO2, hypoventilation) it will be in a state of ___.

body will be in acidosis

what acid base occurs with ostomy drainage?

metabolic acidosis bc the base is leaving the butt

what acid base is common in pregnant women?

respiratory alkalosis due to tachypnea (they are carrying a whole child for christ sake, of course they’re going to be tired)

why is metabolic acidosis common with **fistulas?**

bc the patient is losing base out of the butt

what lab value do HCP use to treat metabolic acid base imbalance?

anion gap

Respiratory acidosis can occur in patients while in surgery due to what meidcation?

anesthesia

why does anesthesia cause resp. acidosis?

bc anesthesia can cause resp. depression (blowing off too much CO2)

how long are you supposed to hold pressure after an **ABG?**

5-10 mins

when we inhale we take in our __, when we exhale we breathe out our __.

O2, CO2

breathing in too much O2 causes what in our body?

respiratory alkalosis bc we are taking in too much oxygen, which means the body has less CO2

less CO2 in the body (tachypnea, expelling co2) =

less acid in the blood, alkalosis

more CO2 in the body (bradypnea, inhaling co2) =

more acid in the blood, acidosis

respiratory acidosis can be caused by **DEPRESS**ION**:**

Drugs

Edema

Pneumonia

Respiratory center of the brain damage

Emboli

Spasms

Sac elasticity of alveoli

___ is the leading cause of respiratory acidosis.

respiratory depression bc the pt is blowing off too much CO2

why does pleural edema/effusion and pneumonia cause **resp. acidosis?**

the fluid build up in the lungs does not allow for CO2 to be exhaled properly, causing retention of CO2

what **assessment finding** is the biggest indicator that a patient is in resp. acidosis?

diminished lungs (the pt will not be able to properly blow off CO2=retention)

ANY disease process where a patient cannot __ their lungs, they are at risk for __.

properly expand their lungs; respiratory acidosis bc they are holding onto CO2

what **diseases** might cause **respiratory acidosis?**

asthma, pneumothorax, obesity, emphysema, COPD, chronic bronchitis, sleep apnea

____ are examples of things that compromise the respiratory center of the brain, which in turn cause the patient’s breathing to be compromised and **NOT BE ABLE TO FULLY EXPAND LUNGS** or even breathe on their own.

Stroke, aneurysm, overhydration

what kind of __surgeries__ **might limit a pt being able to fully breathe and expand lungs**, causing metabolic acidosis?

open heart surgery, broken ribs, abdominal

what assessment findings are indicative of respiratory acidosis?

bradypnea, drowsy/confused, hypotension, increased K+ levels, pale/cyanotic, HA due to no O2 to brain, EKG changes

Expelling too much CO2 puts the body in ___.

respiratory alkalosis, such as tachypnea (blowing off too much CO2)

The kidneys will try to compensate a state of respiratory alkalosis by ___.

increasing urination (excreting bicarb)

respiratory alkalosis causes TACHYPNEA:

Temperature (fever)

Aspirin toxicity

Controlled mechanical ventilation

Hyperventilation

Y hYsteria

Pain, Pregnancy

Neurological changes

Embolism

Asthma

A patient comes into the ER complaining of acute pain on his left side. The patient states “I am going to die, I just know it!” The patient is hyperventilating. His vitals signs showed the following: RR 26, HR 120, BP 138/96.

A. What might this patient be experiencing?

B. What kind of acid balance is this patient experiencing?

A. anxiety due to a “sense of doom”

B. respiratory alkalosis due to pulmonary embolism

When a patient has **acute pain** due to trauma (especially), he/she will most likely be hyperventilating or hypoventilating?

hyperventilating

___ causes **respiratory alkalosis** because the body will have increased temp & increased RR--meaning the body will be working too hard.

aspirin toxicity

respiratory alkalosis signs and symptoms include:

increased RR, increased HR, confused and tired, nausea

A patient in respiratory alkalosis will have the following labs:

low calcium levels - less than 8

low potassium levels - less than 3.5

Since a patient with respiratory alkalosis will have low CA+ & low K+, they may exhibit the following symptoms:

positive chvostek’s sign, tetany, tingling in fingers, EKG changes

how is respiratory alkalosis treated if its due to anxiety/asthma?

deep breathing

rebreathing into paper bag

administer oxygen

anxiety reduction

monitor labs

intubation may apply

Metabolic acidosis is caused by ___ with a __.

increase in CO2; decrease in bicarb HCO3

Increased acid + decrease in bicarb production causes metabolic acidosis. What are examples?

DKA, renal failure increases CO2

diarrhea decreases bicarb HCO3

Metabolic refers to what system?

GI because we are **losing base** out of the butt

What patients are at risk for metabolic acidosis?

patients with diarrhea, ileostomy/ostomy pouches, fistulas