Self Check Review

1
Self Check Review

• Acid-Base Disturbances

2
Review Concepts Related to Acid-Base Disturbances
3
These ABGs (pH-7.51, pCO2-28, HCO3-26) show

• Partially compensated respiratory acidosis
• Uncompensated respiratory acidosis
• Partially compensated metabolic acidosis
• Normal acid-base balance
• Uncompensated respiratory alkalosis
• A combined metabolic and respiratory alkalosis

4
These ABGs (7.51, pCO2 28, HCO3 26) show

• Partially compensated respiratory acidosis
• Uncompensated respiratory acidosis
• Partially compensated metabolic acidosis
• Normal acid-base balance
• UNCOMPENSATED RESPIRATORY ALKALOSIS
• A combined metabolic and respiratory alkalosis

5
These blood gases (pH-7.25, pCO2-51, HCO3-30)
could be caused by (select all that apply)

• Diarrhea
• Anxiety
• COPD
• An ASA overdose
• Sepsis
• Cocaine overdose
• DKA
• Thoracic Surgery

6
These blood gases (pH-7.25, pCO2-51, HCO3-30)
(Partially compensated respiratory acidosis)
could be caused by

• Diarrhea (causes metabolic acidosis)
• Anxiety (causes respiratory alkalosis)
• COPD (CAUSES RESPIRATORY ACIDOSIS)
• An ASA overdose (causes metabolic acidosis or a
  respiratory alkalosis)
• Sepsis (causes respiratory alkalosis)
• Cocaine overdose (causes respiratory alkalosis)
• DKA (causes metabolic acidosis)
• THORACIC SURGERY (CAN CAUSE HYPOVENTILATION
  RESP. ACIDOSIS)

7
These ABGs (pH 7.29, pCO2-49, HCO3 26) could be
treated with(select all that apply)

• Breathing into a paper bag
• Incentive spirometry
• Insulin
• TPN
• Lomotil
• Albuterol
• Recommending the patient quit smoking

8
These ABGs (pH 7.29, pCO2-49, HCO3 26)
(uncompensated respiratory acidosis) could be
treated with

• Breathing into a paper bag (used for a low pCO2)
• INCENTIVE SPIROMETRY
• Insulin (used in DKA a metabolic acidosis
  problem)
• TPN (used for starving cells a metabolic acidosis
  problem)
• Lomotil (used for diarrhea a metabolic acidosis
  problem)
• ALBUTEROL
• QUIT SMOKING REOMMENDATION

9
The following problems could lead to these ABGs
(pH-7.19, pCO2-33, HCO3-14)(Select all that
apply)

• Intestinal fistula
• Emphysema
• Anxiety attack
• Diabetic ketoacidosis
• Prolonged vomiting
• Shock
• Pneumonia
• NG suctioning
• Salicylate intoxication
• A starving patient

10
The following problems could lead to these ABGs
(pH-7.19, pCO2-33, HCO3-14)(partially
compensated metabolic acidosis)

• INTESTINAL FISTULA
• Emphysema (causes respiratory acidosis)
• Anxiety attack (causes respiratory alkalosis)
• DIABETIC KETOACIDOSIS
• Prolonged vomiting (causes metabolic alkalosis)
• SHOCK
• Pneumonia (causes respiratory acidosis)
• NG suctioning (causes metabolic alkalosis)
• SALICYLATE INTOXICATION
• A STARVING PATIENT

11
Which of the following indicates uncompensated
metabolic alkalosis? (select all that apply)

• pH 7.32, PCO2 40, HCO3 19
• pH 7.55, PCO2 20, HCO3 26
• pH 7.55, PCO2 37, HCO3 30
• pH 7.49, PCO2 35, HCO3 29
• pH 7.30, PCO2 50, HCO3 29
• pH 7.43, PCO2 53, HCO3 30
• pH 7.44, PCO2 38, HCO3 26
• pH 7.43, PCO2 32, HCO3 20

12
Which of the following indicates uncompensated
metabolic alkalosis?

• pH 7.32, PCO2 40, HCO3 19 (uncomp met acid)
• pH 7.55, PCO2 20, HCO3 26 (uncomp resp alk)
• pH 7.55, PCO2 37, HCO3 30
• pH 7.49, PCO2 35, HCO3 29
• pH 7.30, PCO2 50, HCO3 29 (part comp resp acid)
• pH 7.43, PCO2 53, HCO3 30 (comp met alk)
• pH 7.44, PCO2 38, HCO3 26 (normal)
• pH 7.43, PCO2 32, HCO3 20 (comp resp alk)

13
Which of the following problems could cause these
ABGs (pH 7.63, PCO2-24, HCO323)? (Select all
that apply)

• Fear
• Emphysema
• Vomiting
• Narcotic overdose
• Anxiety
• Atelectasis
• Renal failure

14
Which of the following problems could cause these
ABGs (pH 7.63, PCO2-24, HCO323) (Uncompensated
respiratory alkalosis?

• Fear
• Emphysema (causes respiratory acidosis)
• Vomiting (causes metabolic alkalosis)
• Narcotic overdose (causes respiratory acidosis)
• Anxiety
• Atelectasis (causes respiratory acidosis)
• Renal failure (causes metabolic acidosis)

15
Treatment for these ABGs (pH-7.55, PCO2 43, HCO3
29) could include(Select all that apply)

• An ampule of NaHCO3 given after careful
  consideration
• Hyperventilation
• An anti-emetic to control vomiting
• Holding the administration of antacids
• IPPB treatments
• Lomotil to control diarrhea
• Insulin to decrease the breakdown of fats

16
Treatment for these ABGs (pH-7.55, PCO2 43, HCO3
29) (uncompensated metabolic alkalosis) could
include

• An ampule of NaHCO3 given after careful
  consideration (may be cautiously used in
  acidosis)
• Hyperventilation (used in respiratory acidosis)
• An anti-emetic to control vomiting (STOPS ACID
  LOSS)
• Holding the administration of antacids (STOPS
  ADDING BASE)
• IPPB treatments (used in respiratory acidosis)
• Lomotil to control diarrhea (used in metabolic
  acidosis)
• Insulin to decrease the breakdown of fats (used
  in metabolic acidosis)

17
These ABGs (pH-7.13, PCO2-36, HCO3-14) are
interpreted as

• Partially compensated respiratory acidosis
• Uncompensated metabolic acidosis
• Combined respiratory and metabolic acidosis
• Uncompensated metabolic alkalosis

18
These ABGs (pH-7.13, PCO2-36, HCO3-14) are
interpreted as

• Partially compensated respiratory acidosis
• UNCOMPENSATED METABOLIC ACIDOSIS
• Combined respiratory and metabolic acidosis
  (there is no respiratory acidosis, pCO2 is WNL)
• Uncompensated metabolic alkalosis

19
The body could compensate for these ABGs
(pH-7.30, pCO2-40, HCO3-17) by (select all
that apply)

• Breathing in a shallow manner
• Producing urine with a high pH
• Increasing the respiratory rate
• Retaining more H ions
• Increasing respiratory depth
• Excreting more bicarb

20
The body could compensate for these ABGs
(pH-7.30, pCO2-40, HCO3-17) (Uncompensated
metabolic acidosis) by

• Breathing in a shallow manner (this would worsen
  the acidosis)
• Producing urine with a high pH (to increase the
  pH of the urine more HCO3 would be excreted.
  This would be counter productive as there is not
  enough base in the system)
• INCREASING THE RESPIRATORY RATE ELIMINATES ACID
• Retaining more H ions (this would make it worse)
• INCREASING RESPIRATORY DEPTH ELIMINATED ACID
• Excreting more bicarb (this would make it worse)

21
A patient with these ABGs (ph 7.24, pCO2-42,
HCO3-18) would likely have(select all that apply)

• A feeling of fullness in the head
• Dizziness
• Slow, shallow respirations
• Tingling of the fingers and toes
• Warm, flushed skin
• Carpal-pedal spasm
• Increased DTRs

22
A patient with these ABGs (ph 7.24, pCO2-42,
HCO3-18) Uncompensated metabolic acidosis) would
likely have

• A FEELING OF FULLNESS IN THE HEAD
• Dizziness (alkalosis)
• Slow, shallow respirations (causes resp acidosis)
• Tingling of the fingers and toes (alkalosis)
• WARM FLUSHED SKIN
• Carpal-pedal spasm (alkalosis)
• Increased DTRs (alkalosis)

23
True or False

• A patient with alkalosis can develop hypokalemia
  as a complication.

24
TRUE

• If a person is alkalotic (has a low number of H
  ions in the blood), H ions will leave the cells.
  To keep the number of positives balanced in the
  cell, K will move in. This results in
  hypokalemia.

25
A patient with a pH of 7.55, pCO2 of 21 and a
HCO3 of 23 is likely to exhibit(select all that
apply)

• A headache
• Warm flushed skin
• Light-headedness
• Decreased DTRs
• Decreased respiratory rate
• Tingling around the lips
• Decreased blood pressure

26
A patient with a pH of 7.55, pCO2 of 21 and a
HCO3 of 23 Uncompensated respiratory alkalosis)
is likely to exhibit

• A headache (acidosis)
• Warm flushed skin (acidosis)
• LIGHT-HEADEDNESS
• Decreased DTRs (acidosis)
• Decreased respiratory rate (lead to CO2
  retention)
• TINGLING AROUND THE LIPS
• Decreased blood pressure (blood vessels constrict
  when alkalotic, plus BP is often elevated if
  anxious)