Disturbances of Acid-Base Balance
If an acid-base disturbance shifts the pH outside of the physiologic range, various control measures are activated to resist the change in pH. Compensatory mechanisms try to preserve the normal 20:1 ratio of bicarbonate to carbonic acid to keep the pH at normal range. The body works to maintain normal ratios through a compensation mechanism using renal and respiratory methods (Crowley, 2010).
Metabolic Alkalosis
Metabolic alkalosis is seen by an increase in the concentration of plasma bicarbonate relative to the concentration of carbonic acid, which shifts the pH to the alkaline side of the physiologic range (case study- pH 7.5). The main causes of metabolic alkalosis are loss of gastric juice or neutralization of gastric juice by antacids, chloride depletion, and excess adrenal corticosteroid hormones.
Excessive amounts of gastric juice may be lost by prolonged vomiting (case study-several times daily x 8 days (?)). The loss of gastric juice causes loss of hydrogen ions. Alkalosis results from the way that hydrochloric acid is formed in the stomach. Within the gastric epithelial cells, carbon dioxide and water combine under the influence of the enzyme carbonic anhydrase to form carbonic acid, which dissociates into hydrogen and bicarbonate. The hydrogen ion is secreted along with the chloride ion to form hydrochloric acid, and the remaining bicarbonate ion is absorbed into the blood plasma.
Normally most of the acid secreted by the stomach is neutralized in the duodenum by alkaline pancreatic juice that is rich in bicarbonate ions. The amount of bicarbonate decomposed in the duodenum when gastric juice is neutralized is normally equivalent to the amount of bicarbonate absorbed when acid is ...
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...(case study – severely dehydrated) and administering potassium chloride and sodium chloride solution. The potassium restores the serum and intracellular potassium levels, allowing the kidneys to more effectively conserve hydrogen ions. Chloride promotes renal excretion of bicarbonate. Sodium chloride solutions restore fluid volume deficits that can contribute to metabolic alkalosis. In severe alkalosis, an acidifying solution such as dilute hydrochloric acid or ammonium chloride may be administered. Additionally, drugs may be used to treat the underlying cause of the alkalosis (Lemone & Burke, 2004).
Works Cited
Crowley, L. (2010). Introduction to human disease: pathology and physiology correlations. Sudbury, MA: Jones & Bartlett
Lemone, P., & Burke, K. (2004). Medical surgical nursing: critical thinking in client care. Upper Saddle River, NJ: Prentice Hall.
Enns, C., Gregory, D., (2007). Lamentation and loss: expressions of caring by contemporary surgical nurses. Journal of Advanced Nursing 58(4), 339-347
bottom edges are not tightly shut, and acid moves form the stomach up into the
Under hypoxic conditions, the abnormal hemoglobin start to change shape. They become sickled, stiff, and have greater difficulty moving though the blood vessels. As a result they begin to stick together and eventually block the tissues from receiving nutrients and oxygen. This causes the tissue to become infarcted and leads to pain. In a hypoxic states the cells are forced to make energy also known as adenosine triphosphate (ATP) without oxygen. This is called anaerobic glycolysis and results in the production of lactic acid as a byproduct (citation). The presence of lactic acid lowers the pH of the environment, the cells must recycle lactic acid back into the cells, and ATP production is significantly slowed. The cells
Critical thinking and knowledge are the foundation of nursing practice, and the most essential elements in providing quality nursing care. Nu...
Huether, S.E. & McCance, K.L. (2008). Understanding pathophysiology (4th ed.). St. Philadelphia, PA: Mosby Elsevier
Ignatavicius, D. D., & Workman, M. L. (2013). Care of Intraoperative Patients. Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier.
Homeostasis mostly works through negative feedback, this is where the effectors response lessens the effects of the original stimulu...
Gastroparesis is defined as a chronic symptomatic syndrome of delayed gastric emptying without any indications of mechanical obstruction.1 The etiologies for gastroparesis are diverse, but a majority of cases are from idiopathic causes or secondary to diabetes mellitus.2 In a study done of 146 patients with gastroparesis, 36% were suffering from idiopathic gastroparesis, 29% from diabetic gastroparesis and the remaining 35% had a variety of etiologies which included: postgastric surgery, Parkinson’s disease, collagen vascular disorders, intestinal pseudoobstruction and miscellaneous causes.3
Critical incidents are snapshots of something that happens to a patient, their family or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Rich & Parker 2001). Reflection and analysis of critical incidents is widely regarded as a valuable learning tool for nurses. The practice requires us to explore our actions and feelings and examine evidence-based literature, thus bridging the gap between theory and practice (Bailey 1995). It also affords us the opportunity of changing our way of thinking or practicing, for when we reflect on an incident we can learn valuable lessons from what did and did not work. In this way we develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). Critical incidents ???
Preusser, B. (2008). 4th Ed. Winningham and Preusser’s critical thinking in nursing: Medical-surgical, pediatric, maternity, and psychiatric case studies. New York: Elsevier/Mosby Inc.
Lunney, M. (2010). Use of critical thinking in the diagnostic process. International Journal Of Nursing Terminologies & Classifications,21(2), 82-88. doi:10.1111/j.1744-618X.2010.01150.x
Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are lost (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypoglycemia, and Acute Pancreatitis.
Critical thinking involves evaluating information and deducing consequences in order to solve problems and improve outcomes. The critical thinking steps are as follows: Identify the problem, investigate the problem, formulate viable solutions, and select the best solution (Adler & Carlton, 2012). Critical thinking skills are essential in radiation therapy. Patients arrive daily with unique challenges that do not fit the mold of normality. Creativity is necessary to ensure every patient receives the quality of care required by the radiation therapy practice standards and code of ethics (Washington & Leaver, 2010). This essay will examine different scenarios that present in the practice of radiation therapy.
I want to start off by talking to you about the stomach in some pretty good detail. Inside the stomach, we have something called the parietal cells. These cells release intrinsic factor and hydrochloric acid. Intrinsic factor is a type of protein, which helps the intestines, a tube that helps digest the food once it leaves the stomach, absorb vitamin B12. Vitamin B12 is part of our diet when we eat meat and drink milk. It is very important because if we don’t have enough in our bodies (or too much) we can get some diseases. So, the intrinsic factor is there to help our bodies take in the vitamin. Then, we have a hormone in our stoma...
It has three functions which are to act as a food reserve, to break down food further whilst mixing it with digestive juices and to start protein digestion (Aspinall and Cappello, 2009). There are gastric pits within the gastric mucosa that produce hydrochloric acid, mucus and pepsin. The process of breaking down and mixing the food with digestive juices takes approximately two hours using the muscles to contract and mix the contents of the stomach. Once this is complete, chyme is produced which moves into the duodenum (Dallas, 2012).