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58 Cards in this Set
- Front
- Back
Normal PO2 |
80-100 |
|
normal O2 sat |
93-100 |
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normal pH |
7.35-7.45 |
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normal PCO2: |
35-45 |
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normal HCO3 |
22-26 |
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pH levels that are compatible with life |
6.8 - 7.8 |
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Any pH less than 7.35 is: |
acidosis |
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Any pH higher than 7.45 is: |
alkalosis |
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Pco2 aka: |
PCO2, pCO2, PaCO2, Paco2 |
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PCO2 is it an acid or base? |
acid |
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Which component (respiratory or metabolic) does PCO2 represent? |
respiratory |
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Any PCO2 greater than 45 is? |
acidic/acidosis |
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Any PCO2 less than 35 is? |
alkalotic |
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HCO3 aka |
bicarbonate |
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HCO3 is an acid/base? |
base ... aka alkalotic |
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Which component (respiratory or metabolic) does HCO3 represent? |
metabolic |
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any HCO3 above 26 is? |
alkalotic/alkalosis |
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any HCO3 below 22 is? |
acidic/acidosis |
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Steps to determine if it is respiratory/metabolic acidosis/alkalosis; fully compensate/uncompensated, partially compensated? |
1. Look at PO2 first. is it between 80-100? If not, that is the most important thing. 2. Next to pH, PcO2, and HCO3 write whether each is low, normal, or high 3. Next to pH, PCO2, and HCO3 write whether it is normal, acid, or alk. 4. Looking at PCO2 and HCO3, which is the same(alk or acid) as pH?That's the system causing the problem. 5. Now look at the remaining value (PCO2 or HCO3). Is it doing the opposite of pH and the problem system? If so, it is partially compensated. Is it in the normal range? Then it is uncompensated. 6. Regardless of all other values, if pH is normal, it is fully compensated. |
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3 types of compensation? |
- fully compensated -partially compensated - uncompensate |
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partially compensated |
- have an abnormal pH - the opposite system will be out of range opposite to the problem |
|
fully compensated |
- abg's have a normal pH |
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uncompensated abgs: |
- no change in the opposite system |
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How to draw/care for a pt with ABG draw: |
1. allow 20-30 mins after suctioning or other respiratory procedure before drawing 2. document the client's temp before drawing 3. Have ice ready for the sample 4. record if pt is breathing room air or O2 5. instruct pt to breath normally, not hyperventilated (blow off CO2) 6. post-draw, hold pressure for 5 minutes; 10 mins if on anticoags |
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Acids are substances having: |
one or more H+ that can be liberated into solution. |
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Bases are substances that: |
can accept or bind H+ in a solution. |
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3 regulators of acid/base balance |
1. - chemical buffers- to neutralize 2. respiratory - works quickly/in minutes 3. urinary/metabolism- works slowly/hours-days |
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The strongest stimulus to breathe is |
an increase of carbon dioxide in the blood (Hypercapnia) |
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What electrolyte will be off in acidosis? hypo or hyper? Why? |
- Hyperkalemia - in acidosis, cells take up H+, and blood takes up K+ resulting in hyperkalemia |
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alkalosis and H+ and K+ |
- results in hypokalemia - in alkalosis, cells take up K+ and blood takes up H+, resulting in hypokalemia |
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Without regard to which system is off, what will a low pH result in and what will its affect on the CNS be? |
- Low ph=acidosis and depresses CNS |
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without regard to which system is off, what will a high pH result in and what will be its affect on the CNS be? |
- high pH=alkalosis= excitability of CNS= tetany and convulsions |
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Hypoventilation increases which one O2 or CO2 |
CO2 |
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High CO2 increases or decreases pH? |
decreases pH |
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Respiratory AcidosisAssessment findings |
•Hypoventilation Cyanosis •Tachycardia •Confusion Hyperthermia •Dizziness •Visual disturbances •CNS depression (think about it, in acidosis, everything slows down ... except you can't get enough air, so your heart beats faster to try to compensate) |
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Respiratory Acidosis- Possible causes |
•Drug Overdose - Increased CarbohydrateDiet •Pneumothorax, Airway Obstruction •Chronic Obstructive Pulmonary Disease•Central Nervous System trauma, Seizures,Chills•Pulmonary Edema •Sleep Apnea |
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Resp Acidosis Interventions |
•Assess Respiratory, CNS, Cardiac, &Renal Systems •Treat underlying problems •Maintain Hydration •Avoid Sedatives & Narcotics •Watch for Hyperkalemia •Give Bicarb as ordered to close the gapbetween low Bicarb (Base) and high CO2 - Acid |
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hyperventilation decreases: |
pCO2 |
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Low pCO2 increases or decreases the pH? |
increases |
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Respiratory AlkalosisAssessment findings |
•Numbness/tingling •Lightheadedness •Confusion •Tetany •Hypokalemia Hypocalcemia |
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Respiratory AlkalosisPossible Causes |
•Anxiety, Pain, Stroke• Salicylates, Opiates •Fever, Infection, Sepsis •Exercise, Marathons •Hypermetabolic states •Asthma, pneumonia, Pregnancy, Hypoxia |
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Respiratory Alkalosis Interventions |
•Assess resp, neuro, cardiac systems •Treat underlying Cause •Decrease Rate and Breathe into paper bagor use Rebreather mask. •Psychosocial interventions, Calm, Safe,Quiet•Watch for decreased Ca+ and K+ |
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High Hco3 causes: |
high pH |
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How does body compensate for high pH? |
hypoventilation (lungs save the CO2) |
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Metabolic AlkalosisAssessment findings |
•Hypoventilation •Apathy •Confusion •Paresthesia |
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Metabolic AlkalosisPossible Causes |
•Vomiting or gastric drainage. •Diuretic therapy •Severe K+ depletion. •Cushing’s syndrome, (Steroids) •Bicarbonate Administration |
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Metabolic Alkalosis Interventions |
•Assess neuro, resp,and cardiac systems •Treat underlying causes and Hypokalemia•Acetazolamide (Diamox) to increase bicarbexcretion by the kidneys •IV Lactated Ringers to close base excessgap•Seizure precautions |
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•The accumulation of metabolic acids leadsto : |
a low pH. |
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How does body compensate for low pH |
hyperventilation (lungs blow off CO2 to increase pH) |
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Metabolic AcidosisAssessment findings |
•Lethargy/drowsiness, Comatose •Kussmaul’s respirations •Twitching, Increased Reflexes •Nausea & Vomiting •Hyperkalemia, High Ammonia |
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Metabolic AcidosisPossible Causes |
•Starvation, Multi-system Shutdown •Diabetic Ketoacidosis, Cardiac Arrest •Diarrhea, Renal Disease, uremia •Trauma/burns, Lactic Acid Production• Alcohol or Salicylate intoxication •Ileostomy, Proximal colostomy, UrinaryDiversion •Total Parenteral Nutrition |
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Metabolic Acidosis Interventions |
•Assess resp, renal, neuro, cardiac, endocrinesystems •Treat underlying cause •Treat hyperkalemia •Fluid replacement •Bicarb IV and Loop Diuretics toneutralize • Strong Cation to close the Anion Gap |
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•The Strong Cations are: |
Na+ and K+. (Positive Charge) (think of the "T" in cation as a plus sign) |
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•The Strong Anions are |
Cl- and HCO3) (Negative charge) |
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•The anion gap measures . . |
the difference between Positive and negatively charged ions |
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acceptable numbers for the anion gap |
Best to be within 2, but normal to 10 |
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How do you calculate the anion gap? |
To figure the Anion Gap: • (Na+ and K+) – (Cl- and HCO3) & unmeasured anions) |
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Normal for NA K Cl HCO3 |
•Normal Na+ is: 135-145 & Normal K+ is: 3.5-5.0 •Normal Cl- is 95-105 & Normal HCO3 is: 26 |