Acid-Based Balance (Hydrogen Ions, Acids, and Bases)

Hydrogen Ions

Hydrogen ions are vital for life, expressed as pH. They circulate in the body in two forms:

1. Volatile hydrogen of carbonic acid
2. Nonvolatile hydrogen and organic acids.

Acids

• Acids are produced as end products of metabolism and contain hydrogen ions. They give up hydrogen ions to neutralize or decrease the strength of an acid or to form a weaker base.
• The number of hydrogen ions in body fluid determines its acidity, alkalinity, or neutrality.
• The strength of an acid is determined by the number of hydrogen ions in contains.
• The kidneys excrete 50 mEq of nonvolatile acids per day.
• The lungs excrete 13,000-30,000 mEq of volatile hydrogen per day in the form of carbonic acid as CO2.

Bases

• Bases contain no hydrogen ions.
• Bases are hydrogen ion acceptor means they accept hydrogen ions from acids to neutralize or decrease the strength of a base or to form a weaker acid.

Herbal Medicines

New model question of NCLEX test now including the nurse knowledge of common used herbal medicine. Commonly used herbs are following here:

Aloe: anti-inflammatory and antimicrobial effect
Angelica: antispasmodic and vasodilator
Bilberry: improves microcirculation in the eyes
Black cohosh: produces estrogen-like effect
Cat’s claw: antioxidant, immune system, lowers the blood pressure
Chamomile: antispasmodic and anti-inflammatory, mild sedative
Dehydroepiandrosteron: convert to androgens and estrogen, is used for erectile dysfunction.
Echinacea: stimulates immune system
Evening primrose: to metabolize fatty acid
Feverfew: anti-inflammatory, used for headaches, arthritis, and fever
Garlic: antioxidant, lowers cholesterol levels
Ginger: anti-emetic

Ginkgo biloba: antioxidant, improves memory
Ginseng: increase physical endurance and stamina
Glucosamine: amino acid to synthesize cartilage
Goldenseal: anti-inflammatory and antimicrobial, anticoagulant and to increase blood pressure
Kava: anti-anxiety and skeletal muscle relaxant, sedative effects
Melatonin: hormone that regulates sleep, used for insomnia
Milk thistle: antioxidant, used for liver and gallbladder disease
St. John’s wort: antibacterial, antiviral, and antidepressant
Saw palmetto: anti-estrogen activity, used for UTI infections and BPH
Valerian: to treat nervous disorder (anxiety, restlessness, insomnia)
Zinc: antiviral, immune system

NCLEX - CGFNS : Cultural Diversity (4)

NATIVE AMERICANS

• They use languages include English, Navajo, and other tribal languages.
• They speak in a low tone of voice
• Silence indicates respect for the speaker and eye contact is viewed as disrespect
• Body language is important
• Touch another person’s hand during greetings is important
• Some tribes may prohibit touching of a dead body
• Message is used for the newborn infant to promote bonding
• Members are family oriented and basic family unit is the extended family and in some tribes, grandparents are viewed as family leaders
• Elders are honored
• Religion and healing practices are integrated
• Father does all the work outside the home and mother does responsibility for domestic duties
• It is important to teach children to respect traditions
• Community social organization are important.
• Health is assumes as a state of harmony between the person, the family, and the environment and illness is caused by supernatural forces disequilibrium between person and environment
• Traditional health and illness beliefs may continue to be observed
• They have health risks : injury, alcohol abuse, heart disease, diabetes mellitus, tuberculosis, arthritis, gallbladder disease, lactose intolerance, and glaucoma.

So it is important as a nurse when giving care to Native American to:

• Clarify communication
• Be attentive to own use of body language
• Understand that client may be attentive even when eye contact is absent
• Encourage client to personalize space
• Assess for availability of running water, infection control and hygiene practice at home
• Provide modes of healing include herbs, restoration balance between person and the universe, and traditional healers

NCLEX - CGFNS : Cultural Diversity (3)

EUROPEAN AMERICAN (WHITE) ORIGIN

• They use national language and English.
• Eye contact is viewed as indicating trustworthiness and silence is used to show respect or disrespect depends on situation.
• For them time is important and members tend to be on time
• Handshakes is used for formal greeting and may be aloof and tend to avoid close contact
• The man is dominant figure.
• Religion includes Judeo Christian beliefs.
• The nuclear family is the basic unit, even the extended family is also important for them.
• They will see that community social organization is important.
• They will see that the health is viewed as an absence of disease or illness and will rely on modern Western health care delivery system.
• For this population: cancer, diabetes mellitus, heart disease, and injury are health risks for them.
• As a nurse to deliver nursing care to this group should monitor and assess client’s body language and respect client’s personal space.

HISPANIC AMERICAN

• Their languages include Spanish and Portuguese, tend to be verbally expressive.



• Direct confrontation is disrespectful and expression of negative feeling is impolite.
• When expressing emotion or pain, they will use dramatic body language such as gesture and facial expression.
• Close proximity with family, friends, and acquaintance is important for them.
• They will be very tactile and using embraces and handshakes and politeness and modesty are essential.
• The nuclear family is the basic unit for them, also the extended family is highly regarded.
• Men are the decision makers and women are the caretakers and homemakers.
• Their religions include Catholicism, Evangelicalism, Jehovah’s Witness, and Mormons. Social organization are important.
• They see the health may be a reward from God or a result of good luck, also it results from a state of balance between “hot and cold” forces and “wet and dry” forces.
• On the other hand, illness may be viewed as a result of God’s punishment for sin and they will adhere to folk medicine tradition.
• This group will have health risk of lactose intolerance, diabetes mellitus, parasites, hypertension, and heart disease.
• As a nurse delivers care to this groups should allow time for client to discuss treatment options with family member, protect privacy, and flexible regarding time of arrival for appointment.
• Give them alternative modes of healing include herbs, consultation with lay healers, prayer, and religious medals.

NCLEX - CGFNS : Cultural Diversity (2)

ASIAN AMERICAN

• They may use languages include Chinese, Japanese, Korean, Vietnamese, and English
• They act "silence" as a value thing
• Eye contact may be considered inappropriate or disrespectful and criticism or disagreement is also not expressed verbally
• Head nodding doesn't mean agreement and the word "no" may be interpreted as disrespect for others
• Preference is for a formal personal space except with family and close friends
• During conversation, they usually do not touch each others.
• Touching is unacceptable with opposite sex
• Do not touch someone on the head, because the head is considered to be sacred, and touching it is considered disrespectful
• Many Asian American Members are devoted to tradition and extended family network are common
• Men have the power and authority, and women are expected to be obedient.
• Their family unit is structured and hierarchical
• They view education as important
• Religions among them include Taoism (Buddhism), Islam, and Christianity.
• Health is a state of physical and spiritual harmony with nature and a balance between yin and yang (positive and negative energy forces), and illness is viewed as an imbalance between yin and yang



• Yin foods are cold and yang foods are hot so one eats cold foods when has a hot illness, and one eats hot foods when has a cold illness
• Health risks are Hypertension, Cancer, Heart disease, Lactose Intolerance and Thalassemia

So as a nurse when giving care to the Asian American client should consider :

• Limit eye contact and avoid gesturing with hand
• Avoid physical excessive touching, and only touch head when necessary and informing them before doing so.
• Female client prefers a female health care provider / nurse
• Flexibe and avoid rigidity in giving them nursing care and ancourage family involvement.
• Consider alternative treatment including herbs, acupuncture, restoration of balance with foods, massage, and offering of prayers and incense

NCLEX - CGFNS : Cultural Diversity (1)

Nurses will care for clients who come from ethnic, cultural, or religious backgrounds that are different from their own. Acknowledgment and acceptance of cultural diversity with nonjudgmental attitude are essential for nurse to provide culturally sensitive care.

Some questions of NCLEX-RN exam or CGFNS test are about cultural diversity, how nurse give a care to client with different ethnic, cultural and religion.

AFRICAN AMERICAN

• They are competent in standard English based on pronunciation, grammar, and vocabulary.
• Head nodding does not mean agreement.
• Direct contact is interpreted as rudeness or aggressive.
• Personal question that is asked on initial contact may be viewed as intrusive.
• They are comfortable with close personal space when interacting with family and friends.
• Relationship is more important than being on time.
• Extended family are important and the elderly are respected.
• Religious beliefs are sources of strength.
• They believe that illness can be prevented by nutrition, rest and cleanliness.
• Most of them have the health risk : Hypertension, sickle cell anemia, hearth disease, cancer, diabetes mellitus, and lactose intolerance.

According to that cultural diversity, as a nurse, you should build a relationship based on trust with them, be flexible and avoid rigidity in scheduling nursing care, clarify the meaning of client's verbal and nonverbal behavior, and encourage family involvement. Nursing care for them may go to the alternative modes of healing such as herbs, prayer, and laying on of hands.