Question Answer

If H+ is secreted in the distal tubule of K+; because the electrical balance

nephrons...What (+) ion is no longer will be upset if both K+ & H+ are
secreted there in exchange for Na+? secreted

Acidosis equals excess H+'s,

What is secreted to correct Acidosis? therefore, H+ is secreted to
correct Acidosis.

In Alkalosis which (+) ion would you

K+
expect the kidney to secrete?

Which ion is usually reabsorbed with

Cl-
Na+ to maintain electrical balance?

In which condition would you expect

HCO3- (bicarbonate) to be retained in Acidosis
place of Cl-?

Why would the body reabsorb Cl-

...to correct Alkalosis by releasing
instead of HCO3- (bicarbonate) in the
HCO3-'s (bicarbs).
nephron?

The kidneys control both H+ &

What do the kidney's regulate? HCO3-, in order to regulate free
H+'s.

...secretes more H+'s (& less K+);

...reabsorbs more HCO3-'s (& less
How do the kidneys ↓ H+'s
Cl-'s); ...Note: Excess HCO3-
(Hydrogens)?
(bicarbonate) binds to free H+
↓'ing it.

Alkalosis; Note: anytime breathing

What does Hyperventilation always & CO2 exchange are the
cause? cause...the origin of the imbalance
is respiratory.
How might hypoxemia such as that
O2 deficits stimulate ↑'d
with pneumonia result in respiratory
ventilation.
alkalosis?

When hopoxemia stimulates breathing CO2 leaves the body more easily
why is CO2 depleted causing alkalois? than O2 enters.

What is the cause of CNS symptoms

such as lightheadedness, faintness, ↓ Ca++; b/c it ↑'s the permeability
dizziness, and blurred visioin in of nerve membranes.
respiratory alkalosis?

Neuromuscular symptoms of
respiratory alkalosis such as tingling &
numbness of lips and fingers, muscle HYPOCALCEMIA
cramps, and carpopedal spasms are
most directly caused by?

...helps to REBREATHE CO2 that

How does breathing into a paper bag
would otherwise be eliminated by
help alleviate respiratory alkalosis?
the hyperventilation.

It retains H+'s and eliminates

How does the kidney help correct
HCO3-'s (bicarbonates)...but is a
Alkalosis?
very slow process.

When interpreting ABG's which value

pH; ... to identify Alkalosis or
should you consider 1st? pH, paCO2,
Acidosis.
or HCO3-

PaCO2;... a low value would

When interpreting ABG's which value
cause alkalosis confirming that
should you consider 2nd? pH, PaCO2,
the respiratory system is the
or HCO3-
cause.

In uncompensated Respiratory
↑ pH; ↓ pCO2; and a normal
Alkalosis; What would you expect the
HCO3-
blood gases to be?

Why would you expect the HCO3- to Because the kidneys take hours
be within normal limits in to days to respond.
uncompensated respiratory alkalosis?

In partially compensated Respiratory all values will be abnormal: ↑ pH

Alkalosis; What would you expect the (but should be returning more to
ABG's to be? normal); ↓ pCO2; and ↓ HCO3-

pH = normal; ↓ pCO2; and ↓

HCO3- ... Note: if the pH is still
high it indicates a continued
In fully compensated Respiratory
respiratory problem. A low CO2
Alkalosis; What would you expect the
shows the respiratory source &
ABG's to be?
the extremely low HCO3-
illustrates a strong kidney
compensation.

b/c the kidneys are elimiinating

more HCO3-...note: The
In the partially compensated
respiratory problem is still present
respiratory alkalosis condition ...Why is
so the CO2 remains low. The pH
the pH not as high as before?
is returning toward normal but
only b/c HCO3- is ↓'ing.

Hypoventilation always causes? Respiratory Acidosis.

Anesthesia; Pain & rib injury;

What are some causes of
infection (↓'s gas exchange);
Hypoventilation(respiratory
Premature lungs (can't ventilate
depression)?
properly)

HA, Confusion, drowsiness or

What are symptoms of Respiratory unconsciousness (lack of
Acidosis? response to verbal or painful
stimuli)

What is the cause of CNS symptoms

↑'d blood flow to the brain
in respiratory Acidosis?

What would you expect the

↑'d H+ = ↑'d Ca++
Neuromuscular symptoms of
respiratory acidosis such as ↓'d DTR's
& warm flushed skin to be most
directly caused by....?

Why is it important to monitor heart

b/c acidosis causes cellular shifts
and kidneys with respiratory acidosis;
of K+ and renal secretion of H+
(↑'d H+'s = ↑'d Ca++)?

Retaining HCO3- & secreating

H+; ...The PCO2 stays high since
the problem remains; ...The pH is
How would you expect the kidneys to
heading toward normal b/c of the
compensate for respiratory acidosis?
kidney's compensation; and...The
High HCO3- on the ABG reflects
the kidney's compensation

What ABG indicates a respiratory

PCO2
source?

What ABG indicates a non-respiratory

HCO3-'s
source (a metabolic problem)?

Low O2;...therefore, you nust be

When respiratory depression is
careful with supplemental O2 b/c
chronic,...What is the major stimulus to
you may actually depress the
breathe?
drive to breathe.

pH becomes or returns to near

normal range; the ABG allows you
What would you predict the pH to be in
to recognize the stress to
chronic respiratory acidosis?
acid-base balance that is not
reflected in the near normal pH;..

CNS, NM & Cardiac symptoms are

usually absent with a near normal pH
Respiratory distress
in chronic respiratory acidosis. ...What
signs & symptoms remain?

Who is least likely to suffer a fluid vol., An elderly pt. with a type I
electrolyte, or acid-base imbalance? decubitus;
An infant suffering from gastroenteritis
for 3 days; An elderly pt. with a type I
decubitus; or Adults with impaired
cardiac function or Clients who are
confused

Hypervolemia; Isotonic solns,

An elderly pt was hydrated with LR in
such as NS & LR, initially remain
the ED for the last hour. During the
in the vascular compartment,
most recent evaluation of the pt by the
expanding vascular vol. Isotonic
RN, a finding of rapid bounding pulse
imbalances occur when water and
and SOB were noted. Reporting this
electrolytes are lost or gained in
episode to the MD, the RN suspects
equal proportions, and serum
that the pt now shows signs of:
osmolality remains constant.

A client taking lasix for CHF is seeing

the MD for a K+ value of 3.0. An order
for oral K+ taken daily is written. In
addition, K+ rich foods should be
eaten. All of the following are K+ rich
except: Baked potato, White bread,
Apricot, or Orange juice
White bread; White bread is
known to help meet fiber needs
for the body. Potassium is found in
many fruits, vegetables, meat,
and fish.

Edema that forms in clients with kidney Increased capillary hydrostatic

disease is due to: pressure.

A pt suffering a narcotic OD is seen in

the ED. The client is confused, with
Respiratory acidosis; b/c Narcotic
warm, flushed skin, headache, and
OD causes more carbonic acid
weakness. VS are T 102.6, HR 128, R
levels to rise b/c of hypoventilation
24, and BP 130/86. ABG's are as
and carbon dioxode retention.
follows: pH 7.33, PaCO2 53, PaO2 72,
HCO3 24. This client is at risk for:

Measurements related to fluid balance

Daily weights, vital signs, and fluid
of clients that a nurse can initiate
intake and output
without a physician's order include:

The results of an arterial blood gas are Metabolic alkalosis; ABG's

as follows: pH: 7.5, PaCO2: 50, PaO2:
88, HCO3: 28; Base excess: +5.
Evaluate the acid-base imbalance.
What are the Anions in the body?
Colloid Osmotic or Oncotic Pressure
Proteins in the blood plasma exert
pressure on the vascular walls to
control or prevent the release of fluid
from the vascular space. Evaluating
Edema...
Filtration changes in a capillary bed
Arterial pressure is higher..nutrients
flow out Venous pressure is
lower..wastes come in. What moves
fluid out of the capillaries into the
interstitial fluid?
What are the clinical signs of
Hypochloremia?
Isotonic Fluid Volume Imbalances:
Fluid Volume Deficit/Hypovolemia
Losses can occur from?
What are Solutes?
In evaluating dietary choices of a client C. ½ cup raisins
evaluate acid-base bal. & O2. pH
measures relative acidity or
alkalinity. PaCO2: measures
carbon dioxide. PaO2 is the P
exerted by O2, HCO3: measures
metabolic component of acid-base
bal. Base excess= value of
HCO3-'s.
Chloride (Cl-); Bicarbonate
(HCO3-); Phosphate(PO4-);
Sulfate (SO3-)
1+ barely detectible; 2+ 2-4mm;
3+ 5-7mm; 4+ more than 7mm
Hydrostatic (blood) pressure and
Osmotic (interstitial) pressure:
Hypochloremia-related to loss
from GI tractcauses muscle
twitching, tetany and tremors
GI tract, wound drainage, kidneys,
decreased fluid intake, bleeding or
third spacing.
aka electrolytes; crystalloid(like
salt) or colloid(like protein);
sodium is a solute
on a potassium-restricted diet, which
dietary selection indicates the need for
further teaching? A. 2 slices whole
wheat bread; B. 2 boiled eggs; C. ½
cup raisins; D. 1 cup oatmeal

serum level below 1.5mEq/L;

Seizures; Tetany;
What are the clinical findings of
Anorexia/arrhythmias; Rapid
Hypomagnesemia: serum level below
Heart Rate; Vomiting; Emotional
1.5mEq/L
Liability; Deep tendon reflexes
increased

What are Isotonic IV fluids and what is

0.9%NS, Lactated Ringers; Stay
their Job when administered? Isotonic
in vascular compartment and
means that the IV fluid has Osmolality
expand vascular volume.
the same as body fluids

Fluid moves from vasc. space into

ECF; get an isotonic FVD. Fluid
may move to bowel, peritoneal or
pleural space or ICF as edema. Pt
What is Third Space Syndrome?
may not have visible fl loss & fluid
may shift back into vasc
compartment causing FVE. Pt’s wt
will probably be unchanged.

In administering a hypertonic fluid to a

Interstitial space to intravascular
client, the nurse recognizes that this
space
will cause fluid to move from:

What is Intravascular Fluid and where Found in the vascular

is it found? compartment.