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95 Cards in this Set
- Front
- Back
What is the normal pH range?
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7.35-7.45
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What range of pH is compatible for life?
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6.8-7.8
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The two major buffer systems in the body are:
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lungs and kidneys
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The function on acids and bases:
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regulate the body's hydrogen ion (H+)
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Acids
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produce (promote) H+ (holding on)
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Bases
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eliminate (neutralize) H+
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Respiratory buffer response
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CO2 dissolved in H2O turns into carbonic acid (H2CO3). Lungs control CO2 and H2CO3
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Respiratory acidosis causes:
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RR increase and causes elimination of CO2
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Respiratory alkalosis causes:
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RR decreases and causes CO2 to be retained
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What is the normal range for CO2?
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35-45 mmHg
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Renal buffer response
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kidneys excrete or retain bicarbonate
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Metabolic alkalosis causes
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kidneys retain H+ and excrete HCO3 through the urine
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Metabolic acidosis causes
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kidneys excrete H+ and retain HCO3
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Normal range for HCO3
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19-26
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What is the pH and PaCO2 of a patient in respiratory acidosis?
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pH < 7.35
PaCO2 > 45mmHg |
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What causes respiratory acidosis?
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an accumulation of CO2 caused by pneumonia, lung collapse, pneumothorax, aspiration, flail chest, spinal cord injury, chest trauma, sleep apnea, OD on sedatives
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What are s&s of respiratory acidosis?
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dyspnea, shallow resp., HA, confusion, tachycardia, anxiety, tachypnea, decreased BP, dysrhythmias, hyperkalemia, drowsiness, dizziness, disorientation, hypoxia, muscle weakness, hyperreflexia
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Treatment of respiratory acidosis consist of:
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increasing ventilation (elevate HOB), treating the root cause, medications such as bronchodilators (bronchospasm), antibiotics (respiratory infection) and anticoagulants (pulmonary emboli), pulmonary hygiene, hydration, supplemental O2 (not the final treatment)
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What is the pH and PaCO2 of a patient with respiratory alkalosis?
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pH > 7.45
PaCo2 < 35mmHg |
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What causes respiratory alkalosis?
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caused by any condition causing hyperventilation such as anxiety, fear, pain, fever, sepsis, pregnancy
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What are the s&s of respiratory alkalosis?
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light headedness, lethargy, confusion, seizures, deep rapid breathing, tachycardia, decreased or normal BP, hypokalemia, numbness, tingling of extremities, nausea, vomiting, hyperventilation
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Treatment of respiratory alkalosis:
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treat root cause, monitor closely for respiratory muscle fatigue, breathe in a paperbag, use venturi mask
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What are the HCO3 and pH levels of a patient with metabolic acidosis?
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HCO3 < 19-22mEq/L
pH < 7.35 |
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What causes metabolic acidosis?
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renal failure, diabetic ketoacidosis, starvation, salicylate intoxication, severe diarrhea, shock
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What are the s&s of metabolic acidosis?
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HA, confusion, decreased BP, hyperkalemia, changes in LOC, Kussmaul respirations, restlessness progressing to coma, dysrhythmias, nausea, vomiting, warm flushed skin, peripheral vasodilation, decreased cardiac output
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Treatment of metabolic acidosis:
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give sodium bicarbonate, treat root cause, dialysis for renal failure
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What are the HCO3 and pH levels of a patient with metabolic alkalosis?
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HCO3 > 26mEq/L
pH > 7.45 This is either an excess of base or loss of acid |
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What causes metabolic alkalosis?
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ingestion of antacids, excess us of bicarbonate (excess base) or gastric suctioning, vomiting, use of lactate in dialysis, excess admin of diuretics (loss of acid)
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What are the s&s of metabolic alkalosis?
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dizziness, lethargy, disorientation, dysrhythmias (tachycardia), weakness, compensatory hypoventilation, muscle twitching, muscle cramps, NVD, seizures, coma, hypokalemia, tingling of fingers and toes
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Treatment of metabolic alkalosis:
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monitor I&O, treat root cause, initiate seizure precautions, give Tagament for suctioning
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What is the normal range of PaCO2 in ABGs?
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35-45mmHg
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What is the normal range of PaO2 in ABGs?
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70-100mmHg
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Acid Base Mnemonic
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Respiratory
Opposite Metabolic Equal |
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What is the normal lab value for Calcium?
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9-11 mg/dL
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What does Ca+ do in the body?
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found in bone/teeth, aids in blood clotting, transmits nerve impulses, increased absorption in GI tract and reabsorbs in kidney tubes
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What causes hypocalcemia?
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primary and surgical hypoparathyroidism, thyroid surgery, renal failure, inadequate Vit D consumption, ETOH abuse
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What are the clinical manifestations of hypocalcemia?
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numbness and tingling of fingers and toes, + Trousseau's sign and Chvostek's sign, seizures, anxiety, impaired clotting time, tetany, irritability, hyperactive DTRs
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What are treatments for hypocalcemia?
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IV admin of calcium (gluconate) diluted with D5W and given as a slow bolus or an infusion pump, can cause dig toxicity in patients on digitalis
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Nursing interventions for hypocalcemia:
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increase dietary intake of Ca+, vitamin D therapy, initiate seizure precautions if severe, caution patients regarding high intake of ETOH, caffeine, and overuse of laxatives and antacids containing phosphorus (decreases Ca+ absorption), ask patient about diet
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Who is at an increased risk for hypocalcemia?
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Elderly and those with disabilities that spend an increased amount of time in bed (bedrest increases bone resorption)
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What causes hypercalcemia?
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malignancies and hyperparathyroidism, immobilization
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Clinical manifestations of hypercalcemia:
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muscular weakness, NV, constipation, anorexia, confusion, impaired memory, slurred speech, flank pain, plydispsia, kidney stones, coma (levels > 16), ECG changes
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Treatment of hypercalcemia:
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treat undelying cause, restrict dietary intake of Ca+, administer fluids to dilute serum Ca levels and promote renal excretion, Lasix and IV phosphate, NS may be given to drop levels (use extreme caution with IV phosphate therapy-can cause severe calcification in tissues, hypotension, tetany, and ARF)
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Nursing interventions for hypercalcemia:
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monitor Ca levels, instruct clients to avoid foods high in Ca, increase fluid intake if not contraindicated, administer meds as ordered
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What are the normal lab values for Potassium?
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3.5-5.3 mEq/L
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What can increase potassium in the blood?
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K+ sparing diuretics, K+ supplements, blood products, ACE inhibitors, Beta adrenergic blockers, NSAIDs, heparin
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What causes hyperkalemia?
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seldom occurs in patients with normal renal function, decreased renal excretion on K+, rapid administration of K+, and movement of K+ from ICF to ECF compartment
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What are the clinical manifestations of hyperkalemia?
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dysrhythmias, irritability, parasthesias, cramps, cardiac arrest
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Treatment of hyperkalemia:
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EKG obtained, Kayexelate PO or enema (pulls K+ and H2O into intestines), IV calcium gluconate to counteract effect of K+ on heart muscle, loop diuretic, IV sodium bicarb, restrict dietary K+
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Nursing interventions for hyperkalemia:
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monitor EKG continuously, caution salt substitute, monitor lab values, teach about dietary management
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What does potassium do in the body?
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influences skeletal and cardiac muscle action, kidneys is primary regulator of potassium
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What causes hypokalemia?
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diarrhea, prolinged intestinal suctioning, recent ileostomy, intestina tumors, people who do not eat a normal diet at risk (alcoholics, anorexics, bulimics, debilitated elderly)
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What are the clinical manifestations of hypokalemia?
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weakness, fatigue, NV, parasthesias, decreased BP, leg cramps, irregular pulse, anorexia, polyuria, you may see on EKG flattened T waves, ST depression, prolonged PR interval and prominet U waves
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Treatment for hypokalemia:
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oral or IV replacement, foods high in K+ such as bananas, meat, baked potatoes, coffee, tea, cocoa, milk, eggs
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Oral potassium supplements can produce what?
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small bowel lesions. Assess for and caution about abd distention, pain and GI bleeding
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Nursing interventions for hypokalemia:
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closely monitor, place on cardiac monitor if replacing K+ via IV infusion, monitor for dig toxicity in patients taking digitalis
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How is potassium given?
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PO, IV infusion. K+ IS NEVER ADMINISTERED IV PUSH OR IM!!!
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Examples of K+ supplements:
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Chlorcon
K-door |
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Why should aged (stored) blood not be administered to patients with impaired renal function?
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Serum potassium concentration of stored blood increases due to red blood cell deterioration
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What is the normal lab values for Sodium?
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135-145 mEq/L
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What causes hyponatremia?
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vomiting, diarrhea, diaphoresis, use of diuretics, aldosterone deficiency, low sodium diet
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What are the clinical manifestations of hyponatremia?
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anorexia, NV, HA, dizziness, confusion, muscle cramps, dry skin and mucosa, increased pulse, low BP, shallow breathing, dyspnea, convulsion and death may result
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Treatment of hyponatremia:
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treat cause first, fluid and dietary management, increase dietary sodium, restrict fluid intake to a total of 800mL/day, replace fluid with LR or isotonic NS, hypertonic solutions if neuro symptoms severe
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Nursing interventions for hyponatremia:
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strict I&O, daily wts, monitor serum sodium, urine sodium and specific gravity, monitor FVO when admin fluids, identify and monitor patients at risk for
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What are the causes of hypernatremia?
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fluid deprivation, diabetes insipidus, heat stroke, near drowning in sea water, admin of IV hypertonic saline, malfunction of hemodialysis or peritoneal dialysis systems
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What are the clinical manifestions of hypernatremia in a patient
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thirst, fever, sticky mucous membranes, pulmonary edema, increased pulse, increased BP, lethargy, irritable, restless, circulatory overload, shock, resp distress, renal failure, permanent brain damage can occur
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Treatment of hypernatremia:
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decrease Na intake, promote Na excretion with diuretics, hypotonic or nonsaline isotonic solutions, monitor S/S of hypernatremia and LOC changes, restore balance
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Nursing interventions for hypernatremia:
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accurate I&O, daily wts, assess pt's response to fluids, observe for changes in neurologic signs, teach dietary management of low Na diet
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What are the normal lab values for phosphorus?
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2.5-4.5 mg/dL
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What are foods high in phosphate?
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beef, pork, turkey, milk, whole grains
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What does phosphate do in the body?
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essential to the function of muscle and RBCs, forms ATP, maintenance of acid-base balance, as well as the nervous system, provides structural support to bones and teeth
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What are the causes of hypophosphatemia?
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intracellular shift of PO4 from serum into cells, increased urinary excretion of PO4, severe protein-calorie malnutrition, overabundance of simple carb intake, chronic alcoholism
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What are the clinical manifestations of hypophosphatemia?
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muscle weakness, parasthesias, confusion, seizures, coma, tissue hypoxia, bone pain, resp failure, increased risk for infection (depresses activity of granulocytes), chest pain, tenderness
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What is the goal of treatment for hypophosphatemia?
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PREVENTION
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What are treatments for hypophosphatemia?
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oral or IV replacement, increase PO4 in patients receiving TPN
Be careful in IV replacement-can cause tetany from hypocalcemia and calcifications in tissues from hyperphosphatemia |
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Nursing interventions for patients with hypophosphatemia?
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identify those patients with or at risk for, monitor them closely, prevent infection, monitor PO4 levels, increase foods rich in PO4
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What are the causes of hyperphosphatemia?
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most common cause is renal failure. Others include increased intake, decreased output or a shift from ICF to ECF.
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A high serum phosphate tends to cause?
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low serum calcium concentrations
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What are the clinical manifestations of hyperphosphatemia in a patient?
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tetany, tachycardia, anorexia, NV, muscle weakness, soft tissue calcifications of the lungs, heart, kidneys and cornea, s/s of hypocalcemia
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What are treatments for a patient with hyperphosphatemia?
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treat underlying disorder when possible, restrict dietary phosphate, loop diuretics, volume replacement with saline, dialysis, Calcitrol given to bind phosphorus in GI tract
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Nursing interventions for patients with hyperphosphatemia:
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monitor I&O (decreased urinary output can increase PO4 and MD should be notified), consume foods low in PO4, educate to avoid phosphate containing substances such as laxatives and enemas
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What are the normal lab values for magnesium?
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1.5-2.5 mEq/dL
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What does magnesium do in the body?
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plays a role in carb and protein metabolism, important for neuromuscular function, act peripherally to produce vasodilation and decrease peripheral resistance, predominantly found in bone and soft tissue and eliminated by the kidneys
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What are good sources of magnesium in food?
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green leafy veggies, nuts, seeds, legumes, whole grains, seafood, PB
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What are the causes of hypomagnesemia?
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ETOH withdrawal, admin of tube feedings and TPN, loss may occur through diarrhea, fistulas or NG suction. Any small bowel disrupt
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What are the clinical manifestations of hypomagnesemia in a patient?
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neuromuscualr irritability, + Trousseau's and Chvostek's signs, insomnia, mood changes, seizures, delirium, hallucinations, psychoses, ECG changes, laryngeal stridor
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What are the treatments for a patient with hypomagnesemia?
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diet, IV Mg via an infusion pump, can also be given orally or added to TPN
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A bolus dose of Mg given too rapidly can produce?
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alterations in cardiac conduction leading to heart block or asystole
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Nursing interventions for hypomagnesemia:
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assess VS during IV admin of Mg, seizure precautions if severe, eat a diet rich in Mg, counseling regarding ETOH abuse
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What are the causes of hypermagnesemia?
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rare imbalance, usually caused by renal failure, untreated DKA, admin of Mg, Addison's disease, execessive use of antacids, laxatives, lithium toxicity, use of opioids and anticholinergics
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What are the clinical manifestations of hypermagnesemia in a patient?
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flushing, hypotension, muscle weakness, drowsiness, depressed resp, cardiac arrest, coma, ECG changes
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What are the treatments for patients with hypermagnesemia?
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loop diuretic for those with adequate renal function, NaCl or LR can be given IV, IV calcium gluconate reverses effects in emergency situations, always have calcium gluconate available for pregnant client on Mg sulfate for PIH
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Nursing interventions for hypermagnesemia:
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monitor VS, note hypotension and shallow resp, don't admin Mg containing meds to pts with renal failure or insufficiency, use caution when admit parentally
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Nursing interventions for a patient with a diagnosis of hyponatremia includes all othe following except:
a. assessing for symptoms of nausea and malaise b. encouraging the intake of low-sodium liquids, such as coffee or tea c. monitoring neuroligic status d. restricting tap water intake |
B. encouraging the intake of low-sodium liquids, such as coffee or tea
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The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except:
a. hypocalcemia b. hypoglycemia c. hypokalemia d. hypoxemia |
b. hypoglycemia
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