A&pii-Test4-5

Front 1

resp alkalosis is caused by what

Back 1

d/t excessive loss of CO2 from body d/t increased ventilation causing a decrease of H2CO3 and H+

Front 2

what can cause resp alkalosis

Back 2

*anything that causes hyperventilation
*severe anxiety
*mech hyperventilation
*high altitude r/t hypoxia
*OD of salicilates-stimualte resp centers
*CHF leads to hypoxia which in turn stimulate hyperventilation

Front 3

metabolic acidosis is caused by

Back 3

excess loss of HCO3 ions

Front 4

direct loss of HCO3 ions causing acidiosis is caused by

Back 4

GI tract-severe diarrhea

Front 5

what is the most frequent casr of metabolis acidosis

Back 5

DIRECT loss GI tract (diarrhea)

Front 6

severe diarrhea causes pancreas acinar glands to do what

Back 6

increase production of H2Co3 via carbonic anhydrase rxn

-HCo3 ions secreted in GI tract and H+ ions secreted into plasma=metabolic acidosis

Front 7

what is the indirect cause of metabolic acidosis

Back 7

DKA

Front 8

during DKA HCO3 ions are used to what? this is followed by what?

Back 8

buffer ketoacids in plasma-immediate effect for compensation

-kussmaul breathing

Front 9

resp acidosis is due to what

Back 9

excess retention of CO2 associated with decreased ventilation (buildup of H2CO3 and H+)

Front 10

what would cause resp acidosis

Back 10

*emphysema
*some anesthetic drugs
*certain narcs-barbs
*trauma/damage to resp system
*head/brain injuries affecting medulla/pons

Front 11

T or F

Metabolic alkalosis is very common

Back 11

FALSE

not common

Front 12

how could metabolic alkalois be caused as a direct effect

Back 12

by adding alkaline substances (drugs) to the plasma

Front 13

if you add alkaline substances to plamsma what occurs

Back 13

metabolic alkalosis

-increases the HCO3/Co2 ratio of the plasma

Front 14

how could metablic alkalosis be caused as a indirect effect

Back 14

d/t loss of gastric acid by vomiting

Front 15

if loss of gastric acid occurs what happens to HCO3/CO2 ratio

Back 15

it increases

Front 16

with prolonged use of a NG tube what occurs

Back 16

removes acid from the stomach

Front 17

does the body over compensate for acid-base imbalances

Back 17

NO

Front 18

in metabolic acidosis what occurs to increase ventilation with resp compensation

Back 18

a large increase in H+ plasma stimulates peripheral chemoreceptors (carotid)

Front 19

in metaboic acidosis with resp compensation what occurs to bring HCO3/CO2 ratio closer to normal (7.35-7.45 range)

Back 19

hyperventilation occurs for elimination of CO2

Front 20

in metabolic acidosis with resp compensation is compensation complete

Back 20

NO

-kidneys must complete compensation back to normal

Front 21

in metabolic alkalosis with resp compensation what occurs to bring HCO3/CO2 ratio back closer to normal

Back 21

HYPOventilation for retention of CO2

Front 22

what value will CO2 NOT exceed during resp compensation for metabolic alkalosis and why

Back 22

*60 mmHg

*b/c a greater Co2 would increase stimulus for breathing at a time when hypoventilation is to be occuring

Front 23

with resp compensation for metabolic alkalosis is compensation complete

Back 23

NO

Front 24

resp acidosis is caused by what

Back 24

HYPOventilation

Front 25

with renal compensation with resp acidosis what is occuring

Back 25

formation and reabsorption of 'new' HCO3 into plasma and secretion of H+ into renal tubular fluid

Front 26

renal compensation with resp acidosis does what to plasma HCO3/Co2 ratio

Back 26

increases it

Front 27

resp alkalosis is caused by what

Back 27

HYPERventilation

Front 28

with renal compensation with resp aklalosis what is occuring

Back 28

the kidneys do NOT absorb all the HCO3 ions b/c fewer H+ secreted into urine therefore there is loss of HCO3 into the urine

Front 29

renal compensation with resp alkalosis does what to HCO3/CO2 ratio

Back 29

decreases it

Front 30

during acidois H+ do what from ECF

Back 30

enter tissue cells and are buffered by intracellular protein and phosphate buffers

Front 31

during acidosis K ions do what from cells

Back 31

exit cells and enter plasma to maintain electrical neutrality across cell membrane (K for H)

Front 32

during acidosis the increase in K in the plasma causes what to occur

Back 32

secretion of aldosterone from the aona glomerulosa of the adrenal cortex

Front 33

aldosterone stimulates what to occur

Back 33

the secretion of K ions into the renal tubular filtrate in exchange for Na

Front 34

during acidosis what is lost in the urine

Back 34

K

Front 35

individuals with chronic acidosis can have what electrolyte abnormality

Back 35

hypokalemia

Front 36

to correct the electrolye abnormality the chronic acidosis pts have give what

Back 36

HCO3

-K ions enter tissue cells in exchange for H+ ions that enter ECF

Front 37

during alkalosis what occurs with H+ ions

Back 37

move out of tissue cells into the ECF to decrease ECF pH

Front 38

during alkalosis what occurs with K ions

Back 38

move INTO cells to maintain electrical neutrality resulting in low K plasma (hypokalemia)

Front 39

hypokalemia can lead to what

Back 39

metabolic alkalosis

Front 40

hyperkalemia can lead to what

Back 40

metabolic acidosis

Front 41

with hyperkalemia what occurs with K and H ions

Back 41

excess H ions diffuse from the ECF into cells with the movement of H+ ions from the cells into ECF to balance movement of K ions

Front 42

normal pH range for ABG

Back 42

7.35-7.45

Front 43

normal PaCO2 range for ABG

Back 43

35-45

Front 44

normal HCO3 range for ABG

Back 44

22-26 mEq/L

Front 45

normal BE range for ABG

Back 45

+/- 2 mEq/L

Front 46

what is base excess or base deficit

Back 46

is the number of mEq of acid needed to titrate 1 L of blood to pH 7.4 at 37 degree C with the PaCO2 at 40 mmHg

Front 47

normal base excess is what

Back 47

0

Front 48

what is used preferentially in final interpretation of ABG BE or HCO3 and why

Back 48

BE

-HCO3 levels can increase or decrease without any compensation occuring

Front 49

when is there complete compensation

Back 49

when pH lies within normal range

Front 50

which system cannot competely compensate

Back 50

resp system

Front 51

what is the sequence for reading an ABG

Back 51

1-pH (acidosis or alkalosis)
2-PaCO2 (acidosis or alkalosis)
3-BE (consider acidosis or alkalosis)
-positive BE= alkalosis
-negative BE= acidosis

Front 52

a positive BE is acidosis or alkalosis

Back 52

alkalosis

Front 53

a negative BE is acidosis or alkalosis

Back 53

acidoisis

Front 54

what is the value of pulmonary function tests

Back 54

*assist in dx of disorders-do not necessarily provide a definitive dx
*assist in evaul of severity of a pulm disorder
*assis in the evaul of the course of therapy
*assist in pre-op screening to predict likelihood of pulmonary complications

Front 55

with pulmonary function test what is used to acquire data

Back 55

spirometer or plethysmograph

Front 56

for pulmonary function test what position are the tests done in

Back 56

seated or upright position

Front 57

when tests are performed for pulmonary function test after pt accomodates to instrument how many times are test done and what value is taken

Back 57

3 and the highest value is taken

Front 58

are pulm fxn test extremely sensitive

Back 58

NO

Front 59

what value is taken as normal with pulm fxn test

Back 59

a value of +/- 20% of the predicted value

Front 60

specific pulmonary fxn tests include:

Back 60

*vital capacity (VC)

*forced vital capacity (FRC)

*forced expiratory volume timed FEVt

*forced mid-expiratory flow (FEF 25-75%)

Front 61

what is expiratory vital capacity

Back 61

max amt of air exhaled after max inhalation

Front 62

with expiratory vital capacity how much time is the pt allowed

Back 62

as much time as needed to complete the test

Front 63

with vital capacity PFT and an obstructive disorder what would the results be

Back 63

can be normal, below normal or quite abnormal

-decreased VC d/t air trapping

Front 64

with vital capacity PFT and a restrictive disorder what would the results be

Back 64

decreased VC b/c lungs cannot be expanded to fullest normal extent during inhalation

Front 65

how is forced vital capacity PFT performed

Back 65

pt takes max inspiration then exhales forcibly and as rapidly as possible

Front 66

in normal individual VC=

Back 66

FRC

Front 67

an FRC may be less than VC when/if

Back 67

the VC is determined over a SLOW expiration b.c of resistance to air flow under forced expiration conditions
(appropriate way to do test is rapid)

Front 68

with forced vital capacity PFT what would the result be with an obstructive disorder

Back 68

decreased FVC

Front 69

why are the results altered in forced vital capacity PFT with obstructive disorder

Back 69

in chronic obstruction there is loss of small (<2 mm) bronchiolar support d/t loss of elastic tissues
-plus + IPP required during forced expiration causes early collapse of these bronchioles

Front 70

with forced vital capacity PFT what would the results be with a restrictive disorder

Back 70

decreased FVC

Front 71

why are the results altered in forced vital capacity PFT with restrictive disorders

Back 71

d/t a decreased VC and a decreased TLC (inability to inhale maximally as compared to normal)

Front 72

what is forced expiratory volume timed

Back 72

volume of air exhaled over a given time interval during the FVC maneuver

Front 73

what is FEV1

Back 73

the volume of air exhaled during the 1st second from the onset of exhalation

Front 74

with forced expiratory volume timed PFT what is equivalent to a measure of air flow b/c it measures a volume over time

Back 74

FEV1

Front 75

what is one of the most common measurements made

Back 75

FEV1

Front 76

what would FEV1 be with obstructive disorders

Back 76

decreased

Front 77

what would FEV1 be with restructive disorders

Back 77

decreased

Front 78

can FEV1 distinguish between obstructive and restrictive disorders

Back 78

NO

Front 79

what tests can give a more diagnostic tool for comparing b/t obstructive and restrictive disorders

Back 79

FEV1/FVC

Front 80

the normal individual can EXHALE how much FVC in ONE second

Back 80

80%

Front 81

with obstructive disorders the FEV1/FVC is what and why

Back 81

< 80%

-d/t airway resistance affecting FEV1

Front 82

with restrictive disorders the FEV1/FVC is what and why

Back 82

> 80%

-FEV1 reduced d/t reduced Vt and FVC is reduced d/t VC so the ratio may be unaffected or increased

Front 83

forced mid-expiratory flow (FEF 25-75%) is also called what

Back 83

maximal expiratory flow rate (MMFR or MMEFR)

Front 84

what is forced mid-expiratory flow (FEF 25-75%)

Back 84

max inhalation followed by a forced max expiration

Front 85

with forced mid-expiratory flow PFT how is max flow measured

Back 85

as liters of expired air b/t the 25% and 75% volumes of expired air on the spirogram

Front 86

when is inertia involved in the PFT forced mid-expiratory flow

Back 86

the first 25%

Front 87

with mid-expiratory flow rate PFT obstruction in the mid to smaller airways shows what on the graph

Back 87

a decreased slope

Front 88

the mid-expiratory flow rate PFT is fairly sensitive to what type of disorders

Back 88

early obstruction

-it is more reliable and more consistent than FEV1/FVC

Front 89

with mid-expiratory flow rate PFT and restriction disorders what is the slope like on the graph

Back 89

close to normal