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Summary NUR 323 Final Exam Study Guide

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This is a comprehensive and detailed exam study guide on finals for Nur 323. *Essential Study Material!!

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  • September 19, 2024
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Fluid and Electrolyte Disturbances

Acid-Base Balance
 Body normally maintains steady balance between acids produced during metabolism and
bases that neutralize or promote excretion of the acids
 Increased CO2 or H+  hyperventilation
o Leads to acidity
 Decreased CO2 and H+  hypoventilation
o Leads to alkaline solution
 The lower the pH, the higher the H+ concentration
 pH of solution (ranges from 1-14)
o pH 7  neutral
o pH <7  acidic
o pH >7  alkalosis
 Normal blood pH is 7.35-7.45 (slightly alkaline)
o <7.35 is acidosis
o >7.45 is alkalosis
 Buffer system primary regulator

Acid-Base Regulation
 Buffer System
o Fastest-acting and primary regulator in the body
o Buffers act chemically to change strong acids to weaker acids; bind acids to
neutralize their affect
o Cells can act as buffer system by shifting H+ in and out of cells
 Respiratory System
o Responds in minutes, maximum effectiveness in hours
o Helps maintain pH by excreting CO2 and water (by-products of metabolism)
 When released into circulation, CO2 enters RBC and combines with water
to form H2CO3 (CO2 + H2O)
 Carbonic acid dissociates into H+ and HCO3-
 H+ is buffered by hemoglobin and HCO3- diffuses into plasma
 In capillaries this process is reversed, CO2 is formed and excreted
by the lungs
 The amount of CO2 in the blood directly relates to carbonic acid
concentration and subsequent H+ concentration
 Increased respirations more CO2 expelled and less in blood
less carbonic acid less H+
 Decreased respirations more CO2 in blood more carbonic
acid more H+
 Rate of CO2 excretion is regulated by medulla in brainstem
 Increased CO2 or H+  hyperventilation (blow off CO2)
 Decreased CO2 or H+ hypoventilation (retain CO2)
 Renal System



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, o 2-3 days for maximal response but can maintain balances indefinitely in chronic
imbalances
o Normal conditions kidney reabsorbs and conserves all bicarbonate they filter
o Kidneys can generate additional bicarbonate or eliminate excess H+ as a
compensation for acidosis
 Normal urine acidic pH 6
 Compensatory mechanism urine can decrease to pH 4 or increase to pH
8

Alteration in Acid-Base Balance
 Occurs when ratio of 1:20 between acid and base content is altered
o NORMAL ACID-BASE BALANCE IS 1:20
o Primary disease or process may alter one side of ratio
o Compensatory process attempts to maintain the other side of ratio
 When compensatory mechanism fails, acid-base imbalance results
 Because of pathophysiology or not enough time for mechanism to
function
o Ex: CO2 retention in pulmonary disease
 Increased renal bicarbonate reabsorption
 Increased H+ excretion
 Respiratory Acidosis (excess carbonic acid)
o Occurs with hypoventilation
 CO2 builds up and subsequent carbonic acid
o To compensate, kidneys conserve bicarbonate and secrete H+ in urine
 Respiratory Alkalosis (Carbonic Acid Deficit)
o Occurs with hyperventilation
 Hypoxemia from pulmonary disorders, anxiety, CNS disorders,
mechanical ventilation
o Compensated respiratory alkalosis is rare, must treat cause
o May get buffering by shifting bicarbonate (HCO3-) into cells in exchange for Cl-
 Metabolic Acidosis (Bicarbonate Deficit)
o Occurs when acid (other than carbonic acid) accumulates in body or when
bicarbonate is lost from body fluids
 Ketoacids with ketoacidosis
 Lactic acid with shock
 Severe diarrhea results in loss of bicarbonate
 Renal disease, kidney loses ability to reabsorb bicarbonate
o Compensatory mechanism increase CO2 excretion
 Hyperventilation; Kussmaul breathing
 Metabolic Alkalosis (Bicarbonate Excess)
o Occurs in loss of acid or gain of bicarbonate
 Prolonged committing or gastric suction
 Ingestion of baking soda
o Compensatory mechanism
 Decreased respiratory rate to increase plasma CO2 hypoventilation


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,  Renal excretion of bicarbonate
 Metabolic acidosis correct with hyperventilation
 Metabolic alkalosis correct by hypoventilation
 Carbonic acid respiratory
 Bicarbonate metabolic

Examples of Acid-Base Balance
1. pH is 7.54
a. alkalosis (pH is >7.45)
b. respiratory rate will decrease
c. retain CO2 (an acid) and correct the alkalosis
2. pH is 7.28
a. acidosis (pH is <7.35)
b. respiratory rate will increase
c. to rid body of CO2 (acid) and correct acidosis

ABGs: Analyzing Blood Gases

Diagnostic Studies
 Arterial Blood Gas (ABG)
o Measures PaO2, PaCO2, acidity (pH), and bicarbonate (HCO3) in arterial blood
o SaO2 is either calculated or measured
o Specimen obtained from arterial puncture; usually radial or femoral
o Risk for bleeding; risk for infection; painful

Normal ABG Levels
 pH: 7.35-7.45
 PaCO2: 35-45 mmHg
 Bicarbonate (HCO3): 22-26 mEq/L
 PaO2: 80-100 mmHg
 SaO2: 95%
 Base excess: +/- 2.0 mEq/L

Analyzing Arterial Blood Gases
 Determine if its acid or base
 Analyze PaCO2 to determine if respiratory acidosis or alkalosis
 Analyze bicarbonate to determine if patient has metabolic acidosis or alkalosis
 Determine if CO2 or HCO3- changes match the pH alteration
 Decide if body is trying to compensate


Acidic Normal Alkaline
pH <7.35 7.35-7.45 >7.45
Resp. PaCO2 >45 35-45 <35
Met. HCO3 <22 22-26 >26



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, Fluid and Electrolytes
Key Terms:
 Homeostasis
o Equilibrium in the body
 Intracellular fluid
o Fluid inside the cells; 2/3
 Extracellular fluid
o Fluid outside the cells; 1/3
 Cations
o Positively charged ions
 Anions
o Negatively charged ions
 Active transport
o Molecules move against concentration gradient using energy
o Move from low to high concentration
 ex: Na+/K+ pump
 Na+ moves out, K+ moves in
 Diffusion
o Movement from high to low concentration through semipermeable membrane
o Requires no energy
 Facilitated diffusion
o Use of carrier protein to pass larger molecules though membrane (high to low
concentration)
 No energy, passive
 Osmosis
o Movement of water from region of low solute concentration to high solute
concentration
o Higher the concentration the stronger the pull (osmotic pressure)
o Requires no energy
o Osmolarity fluids outside the body
 Sodium-Potassium Pump
o Active transport
o Sodium moves out
o Potassium moves in
o Energy used ATP produced in cells mitochondria
 Colloids
o Version of crystalloids but with larger particles that cannot cross membrane
 Crystalloids
o Water and small particles
 Hypotonic
o Solutions in which solutes are less concentrated than the cells
o Swells

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