ABG Flashcards
What is the pH of arterial blood versus venous blood?
Arterial blood pH ranges from 7.35 -7.45
Venous blood pH ranges from 7.31-7.41
What is the acid-base balance?
The acid-base balance is a result of processes that carefully regulate hydrogen ion production and elimination. Body fluid pH is a measure of the bodies fluids free hydrogen ion level
True or false
Because it is calculated in negative logarithm units, the value of pH is inversely related to the level of free hydrogen ions. In other words, the lower the pH value of the fluid, the higher the level of free ions in that fluid
True
Keeping the pH of the blood within normal range is important because changes from the normal interfere with many functions such as…
- Changing the shape and reducing the function of hormones and enzymes
- Changing the distribution of other electrolytes, causing fluid and electrolyte imbalances
- Changing excitable membranes, making the heart, nerves, muscle, G.I. track either less or more active than normal
- Decreasing effectiveness of drugs
What are acids?
Acids are substances that release hydrogen ions when dissolved in water. And acid in solution increases the amount of free hydrogen ions in that solution
What are bases?
The base is a substance that binds free hydrogen ions in solution. Thus bases are hydrogen acceptors that lower the amount of free hydrogen ions in solution.
What are buffers?
Buffers are critically keeping body fluid pH a normal levels because they can react in two ways, either as an acid or the base. Buffers always try to bring the fluid as close as possible to the normal body fluid pH of 7.35 to 7.45
What is the most common base and common acid in the human body?
The most common base is bicarbonate
The most common acid is carbonic acid
What does that carbonic anhydrase equation show?
This equation, driven by the enzyme carbonic anhydrase, shows how hydrogen ion levels and carbon dioxide levels are DIRECTLY related to one another, so that any increase in one causes an equal increase in the other
True or false
Carbonic acid is not stable, and the body needs to keep a 1:20 ratio of carbonic acid to bicarbonate
True
True or false
The carbon dioxide content of the fluid is directly related to the amount of hydrogen ions in the fluid
True
What is the normal O2 level in an adult?
80-100 mm Hg
What is the normal CO2 level in an adult?
Arterial: 35-45 mm Hg
Venous: 40-50 mm Hg
What is the normal level of bicarbonate in an adult?
Arterial: 21-28 mm Hg
Venous: 24-29 mm Hg
What is the CO2 and pH correlation of the body?
Whenever the CO2 level changes, the pH changes to the same degree, in the opposite direction. So when the CO2 level of a liquid increases, pH drops indicating more free hydrogen ions or more acidic. On the other hand, when the CO2 level the liquid decreases, the pH arises, indicated you were free hydrogen ions or more alkaline.
What is the main buffer of the ECF?
Bicarbonate, It is kept at a level 20 times greater than that of carbonic acid
What is one factor that determines blood pH?
How much CO2 is produced by body cells during metabolism versus how rapidly that CO2 is removed by breathing
What does protein breakdown form?
Sulfuric acid
How is lactic acid formed?
Incomplete breakdown of glucose, which occurs whenever cells metabolize under anaerobic conditions, forms lactic acid
What is the first, second and third line of defense against changes in the amount of free hydrogen ions?
Buffers are the first line of defense
The respiratory system is the second line of defense
The kidneys are the third line of defense
What are buffers composed of?
Buffers are composed of chemicals are proteins
What are chemical buffers?
Chemical buffers are paired mixtures, usually a week base and an acid salt. The two most common chemical buffers are bicarbonate and phosphate.
What are protein buffers?
Protein buffers are the most common buffers. extracellular buffers are albumin and globulins. A major cell protein buffer is hemoglobin
True or false
Hemoglobin buffers hydrogen ions directly and also buffers acids formed during the production of carbon dioxide
True
True or false
Because CO2 is converted into hydrogen ions through the carbonic anhydrase reaction, the CO2 level is directly related to the hydrogen ion level
True
What actions do the kidneys take when the blood pH is not normal?
- The kidneys move bicarbonate
- Form acids
- Form ammonia
What is the first kidney pH control action?
Kidney movement of bicarbonate is the first kidney pH control action. It occurs in the kidney tubule in two ways, 1. kidney movement of bicarbonate produced elsewhere in the body and 2. kidney movement of bicarbonate produced in the kidneys.
What is the second kidney pH control action?
The formation of acids. It occurs through the phosphate buffer and system inside of cells of the kidney tubule.
What is the third kidney pH control action?
Formation of ammonium is the third kidney pH control action. Ammonia which is converted during a normal protein breakdown, is converted into ammonium. The ammonia is first secreted into the urine, working combine with excess hydrogen ions to form ammonium. The ammonium traps the hydrogen ions in that allows them to be excreted in the urine. The result of the loss of hydrogen ions in an increase in blood PH
True or false
A pH below 6.9 or above 7.8 is usually fatal
True
How did the kidneys compensate when the blood pH is acidic?
To oppose this process, the kidney excretes more hydrogen ions increases the reabsorption of bicarbonate back into the blood
A patient with COPD has just developed respiratory distress. Vital signs are; pulse ox 88% on 2 L nasal cannula oxygen; dyspnea at rest; respirations 32 per min. The patient reports shortness of breath. Which statements apply to this clinical situation?
- Interference in alveolar capillary diffusion results in carbon dioxide retention
- The nurse should instruct the patient to use pursed lip breathing
- Interference in alveolar capillary diffusion results in acidemia
In the case of the previous question, what is the priority order of actions the nurse takes to manage this patient?
- Call the respiratory therapist
- Delegate the monitoring of vital signs to unlicensed personnel
- Page the physician immediately
- Document the incident in the patients chart
A patient with bilateral lower lobe pneumonia is diagnosed to have respiratory acidosis based on arterial blood gas results. What is this patients likely cause of respiratory acidosis?
Under elimination of carbon dioxide from the lungs
A patient is admitted to the hospital for diabetic ketoacidosis. What may likely occur with this patient?
- Metabolic acidosis
- Excessive oxidation of fatty acids
- Overproduction of hydrogen ions
A patient who recently emigrated to the US from germany, but speaks fluent english, has been admitted to the ER with diabetic ketoacidosis. On intake assessment, the patient cannot recall the medications she takes. What actions does the nurse take?
- Instruct the patient to compare a hospital list of medications to her home medications when she is discharged home
- Ask the patient or SO about the patients typical 24 hour home meal plan
- Have a social worker assess if the patient has insurance or money to pay for medications
A patient who has pancreatitis with nausea and vomiting will likely have which related alterations in acid base balance?
- Metabolic acidosis
- Serum pH value that is directly related to the concentration of hydrogen ions
- Underproduction of bicarbonate
Which statements correctly apply to acid base balance in the body?
- Renal mechanisms are stronger in regulating acid base balance but slower to respond than respiratory mechanisms
- The immediate binding of excess hydrogen ions occurs primarily in the RBCs
- Acid base balance occurs through control of hydrogen ion production and elimination
An increase in the CO2 level causes the free hydrogen level to increase and the pH to decrease, or become more……
Acidic
The ratio between carbonic acid and bicarbonate should remain at……
1:20
In the healthy person, the kidneys control……levels and the lungs control…..levels
The kidneys control bicarbonate levels and the lungs control CO2 levels
Base accepts..
Base accepts hydrogen ions
Acid…
Acid donates the hydrogen ion
What is formed in the body as a result of metabolism?
Acid
What releases or binds hydrogen ions into/from a fluid
Buffers
Measure of the bodys free hydrogen ion level
pH
What is H2CO3?
An acid
What increases as the amount of base increases?
pH
Hemoglobin is a…
buffer
Chemoreceptors response to increase in CO2
Respiratory
Binding of hydrogen ions to phosphate ions to form H2PO4
Renal
Reabsorbs HCO3
Renal
Binds H with HCO3
Chemical
Binds H with hemoglobin
Protein
Response occurs within minutes
Respiratory
The early stage of incomplete breakdown of glucose occurs whenever cells metabolize under anaerobic conditions to form lactic acid. Based on this knowledge of pathophysiology, which conditions could cause the patient to develop acidosis?
- Sepsis
- Hypovolemic shock
- Hypoventilation
Which patient with the highest risk for acidosis must the nurse care for first?
Patient with COPD, pulse ox 88% on 2 L oxygen
A patients ABG results show an increase in pH. Which condition is most likely to contribute to this lab value?
Nasogastric suction
Which patient is most likely to have a decrease in bicarbonate?
Patient with pancreatitis
A patient has a new onset of shallow and slow respirations. While the patients body attempts to compensate, what happens to the patients pH level?
Decreases
A patient is at risk for acid base imbalance. Which lab value indicates that the patient is acidotic?
pH is 7.30
Which type of medication increases an older adult patients risk for acid base imbalance?
Diuretics
The nurse is giving discharge instructions about medication to an older, forgetful patient, and the daughter whom the patient lives with at home. What does the nurse do to facilitate medication compliance?
- Find out how the patient organizes his or her medications at home
- Included the daughter in the discharge instructions
- Have the social worker ask the patient about his or her ability to pay for medication
- Suggest that the patient use a weekly pill organizer and have the daughter supervise medication admin.
Diabetic ketoacidosis
Hydrogen ion production
Renal failure
Hydrogen ion elimination
and base production
Dehydration
Base production
Seizures
Hydrogen ion production
Pancreatic insufficiency
Base production
Diarrhea
Base elimination
Airway obstruction examples
- Asthma
2. Bronchiolitis
Inadequate chest expansion exampes
- Muscular dystrophy
- Ascites
- Flail chest
- Hemothorax
- Hyperkalemia
Respiratory depression examples
- Morphine infusion
2. Stroke
Altered alveolar capillary diffusion examples
- Pulmonary embolus
2. Pneumonia
Which medication usage could cause metabolic acidosis?
Aspirin overdose
Which nursing assessment finding indicates a worsening of respiratory acidosis?
Use of accessory respiratory muscles
Which patient is most likely to have respiratory acidosis?
Patient with multiple rib fractures
Which patient requires assessment related to inadequate chest expansion, which places the patient at risk for respiratory acidosis?
- Patient with emphysema
2. Severely obese patient on prolonged bedrest
The nurse reviews the ECG and cardiovascular status of a patient. Which findings are early changes associated with mild acidosis?
Increased heart rate and increased cardiac output
The nurse is assessing a patient with an acid base imbalance by using gordons functional health patterns. What primary areas are affected?
- Activity exercise
- Elimination
- Cognitive perceptual
The nurse is testing the muscle strength of a patient at risk for acid base imbalance. Which technique does the nurse use to test arm strength?
The patient flexes the arms against the chest, the nurse tries to pull the arms from the chest
The nurse assesses an acidotic patients lower extremities for strength has a part of the shift assessment. What finding is the nurse expect to see?
Bilateral weakness
The nurse observes tall peaked T waves on the ECG of a patient with metabolic acidosis. Before notifying the healthcare provider, the nurse also assesses the results of which lab test?
Serum potassium
.Kussmaul respirations are signs of…
Metabolic acidosis
Shallow, rapid respirations are signs of…
Respiratory acidosis
Warm, flushed skin is a sign of…
Metabolic acidosis
Skin pale to cyanotic is a sign of…
Respiratory acidosis
Elevated PaCO2 levels is a sign of..
Respiratory acidosis
Decreased bicarbonate is a sign of…
Metabolic acidosis
What plan of care for patients metabolic ketoacidosis?
- Monitor ABG levels for decreasing pH level
- Maintains patent IV access
- Administer fluids as prescribed
- Monitor determinants of tissue oxygen delivery, such as hemoglobins
- Monitor loss of bicarbonate through the G.I. tract such as diarrhea
What is the priority intervention for patient with diabetic ketoacidosis?
Administer insulin
Which statement made by the patient indicates that here she may have an alkaline condition?
I have tingling in my fingers and toes
Which patient is most likely to have respiratory alkalosis?
Patient having a panic attack
Which type of electrolyte imbalances the nurse expect to see a patient with metabolic alkalosis?
Hypocalcemia
Which patient is most likely to develop metabolic alkalosis as a result of base excess?
Patient who had a massive blood transfusion
The nurses assessing a patient with metabolic alkalosis. Which neuromuscular finding is the most ominous and warrants immediate notification of the healthcare provider?
Tetany
The nurses caring for a patient with metabolic alkalosis secondary to diuretic medication. Which equipment is the nurse obtained to administer the correct therapy to this patient?
IV catheter and Iv start kit
Which occurrence can be a result of hyperventilation?
Respiratory alkalosis
Which patient showing symptoms of an acid-base imbalance must the nurse See first?
Patient showing activity weakness and lethargy
The patient was taken antacids for the past three days to relieve heartburn. What alteration and acid base balance for the nurse likely find in this patient?
Metabolic alkalosis
A patient with anemia has completed a blood transfusion of two units of packed red blood cells. Which imbalance will the patient likely have after the blood transfusion?
Metabolic alkalosis
The patient has hospitalized with hyperglycemia and has a blood glucose of 476 mg/DL. Which events does the nurse expect to see in this patient?
Kussmaul respirations, hypotension, metabolic acidosis
Patient having diarrhea for the past two days will likely have which abnormalities and acid-base balance?
- Over elimination of bicarbonate
2. Metabolic acidosis
A patient who has advanced muscular dystrophy will likely have which complications related to their disease?
- Hypoventilation
- Respiratory acidosis
- Under elimination of hydrogen ions
A patient who has decreased amount of hydrogen ions and a decreased amount of carbon dioxide in the body will have what response?
Decreased rate and depth of respiration
A patients arterial blood gas reveals respiratory. How odes the body compensate for this imbalance?
Renal reabsorption of bicarbonate
The nurse is caring for a patient with excessive alcohol ingestion and salicylate intoxication. What is the most likely acid base imbalance this patient will have?
Metabolic acidosis
pH 7.30, PaCO2 66, bicarbonate 38, PaO2 70
Respiratory acidosis
pH 7.52, PaCO2 45, bicarbonate 36, PaO2 95
Metabolic alkalosis
pH 7.55, PaCO2 24, bicarbonate 20, PaO2 95
Respiratory alkalosis
pH 7.28, PaCO2 24, bicarbonate 15, PaO2 95
Metabolic acidosis
pH 7.35, PaCO2 24, bicarbonate 15, PaO2 95
Metabolic acidosis
pH 7.45, PaCO2 50, bicarbonate 42, PaO2 80
Metabolic alkalosis
pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97
Normal values
A patient has a low pH level. Which other concurrent change does the nurse expect to see in this patient
Elevated serum potassium
What is the safest way to administer oxygen to a patient with chronic respiratory acidosis?
Low flow oxygen 2 ml/min via nasal cannula
Which assessment finding indicates that a patient with chronic respiratory acidosis is responding favorably to treatment?
Expectorating clear, thin mucous
In order to ensure the safety of a patient with metabolic alkalosis, which task is best to delegate to the unlicensed assistive personnel?
Clean up spills immediately
Determine whether the arterial blood values indicate an acid or alkaline condition?
PaCO2 = 66 mm Hg …….Acid
Bicarbonate = 16 mEq/L …..Acid
pH=7.55…..alkaline
pH=7.32…..Acid
What is the carbonic anhydrase equation?
CO2 + H2O—–> H2CO3—-> H + HCO3
An increase in CO2 will cause plasma pH to….
Decrease
A decrease in HCO3 will cause plasma pH to…
Decrease
An increase in lactic acid will cause plasma pH to…
Decrease
An increase in HCO3 will cause plasma pH to…
Increase
A decrease in CO2 will cause plasm pH to…
Increase
A clients is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes?
Respiratory and urinary
Increased respirations blow off carbon dioxide, which decreases the hydrogen ion concentration and the pH increases. Decreased respirations result in CO2 buildup , which increases hydrogen ion concentration and the pH falls. The kidneys either conserve or excrete bicarbonate and hydrogen ions, which helps to adjust the bodys pH. The buffering capacity of the renal system is greater than that of the pulmonary system
A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have?
7.20
What complication is prevented when a nurse addresses the needs of a client who is hyperventilating?
Carbonic acid deficit
Hyperventilation causes excessive loss of carbon dioxide, leading to carbonic acid deficit and resp. alkalosis
An arterial blood gas report indicates the clients pH is 7.25, PaCO2 is 35 mm Hg, and HCO3 is 20 mEq. Which disturbance should the nurse identify?
Metabolic acidosis
A clients arterial blood gas report indicates pH is 7.52, PCO2 is 32 mm Hg, HCO3 is 24 mEq. What does the nurse identify as a possible cause of these results.
Excessive mechanical ventilation
The high pH and low carbon dioxide level are consistent with resp. alkalosis, which can be caused by mechanical ventilation
Normal levels of bicarbonate?
22-28
What is HCO3?
Bicarbonate, produced by kidneys
True or False
Bicarbonate and pH increase or decrease together. When one rises or falls so does the other. When bicarb is low, the pH is low = acidotic. When bicarb is high, the pH is high = alkalosis
True
True or false
If the respiratory system disturbs the acid base balance the kidneys will compensate by altering levels of bicarb and H ions
True
If PaCO2 is high______Kidneys_____bicarb and excrete____pH rises
acidosis, retain, hydrogen
vdfvfdv
Alkalosis, excrete, hydrogen
If HCO3 (bicarb) is low___ increased RR> blows off CO2> pH_____
If HCO3 is low acidosis, increased RR, blows off Co2….ph rises
Histamine and other biochemicals cause what?
Bronchioconstriction, mucosal edema, and excess mucus production
What are respiratory symptoms of anaphylaxis?
Congestion, rhinorrhea, dyspnea, and increasing resp distress with audible wheezing
On auscultation, what should you hear in the lungs of someone having an anaphylactic reaction?
Crackles, wheezes and reduced breath sounds
What happens in anaphylactic reactions..respiratory wise..
Patients may have laryngeal edema as a “lump in the throat”, hoarseness, and stridor. Distress increases as the tongue and larynx swell and more mucous is produced. Stridor and anxiety increase as the airway begins to close. Increasing bronchoconstriction can lead to reduced chest excursion and impaired air movement. Respiratory failure may follow from laryngeal edema, suffocation, or lower airway constriction causing hypoxemia. The patient is usually hypotensive and has a rapid, weak , irregular pulse. These findings are caused by vasodilation
If HCO3 is high alkolosis> decreased RR> retain CO2, pH decreases
If HCO3 is high alkalosis , decreased RR, retain CO2, pH decreases
What is the most dangerous hypersensitive reaction?
Type I hypersensitivity reaction- most dramatic and life-threatening, occurs rapidly and systemically.
**Major factor in fatal outcomes is a delay in the administration of epinphrine.
Epinephrine info
Epi (1:1000) .3-.5 mL first line drug. Given IM or IV. Works by constricting blood vessels, improves cardiac contraction, dilates bronchioles. Repeat in 5 min if needed
Influenza facts
More than 36,000 deaths per year from complications
Anti-virals only effective if taken within 24-48 hrs of onset of symptoms
Highly contagious acute viral respiratory infection
3 Strains, A, B, C
Severe headache, muscle ache, fever, chills, fatigue, weakness, anorexia
What are some anti-viral drugs to treat pandemic influenza?
oseltamivir (Tamiflu), zanamivir (Relenza
What is the definition of pneumonia?
Inflammation and consolidation of the lung tissue due to an infectious agent
What is the cause of primary pneumonia?
Primary – inhalation or aspiration of a pathogen such as bacteria or virus
What is the cause of secondary pneumonia?
Secondary – lung damage from noxious chemical
Nosocomial pneumonia can be caused by….
Gram positive or gram negative
What is the third most common nosocomial infection?
Bacterial Pneumonia: Usually caused by bacteria from upper airway or hematogenous spread: example MRSA from wound
Most deadly are streptococcus pneumoniae, haemophilus influenzae
What makes you susceptible for pneumonia?
Emphysema, age, compromised immune system, recent surgery, foley, IV line, large wound, environment (hospital)
Prioritize your nursing actions?
Lung sounds, assess resp effort, high fowlers, VS- esp temp, contact md
What are some signs of pneumonia?
Tachycardia, tachypnea, hypoxemia, elevated temp
What are manifestations of pneumonia?
Increased respiratory rate (dyspnea) >30 Tachycardia and tachypnea Hypoxemia (need O2 therapy) Cough Decreased breath sounds Sputum (blood or rust tinged) Fever (bacterial) (102-104 F) Chest pain (breathing) Blood work (WBCs >10,000/mm3) Consolidation over affected area (dull)
What is tuberculosis?
Bacterial infection
Mycobacterium tuberculosis
Damages lungs or other parts of the body
Fatal if not treated properly
Highly communicable disease. Most common bacterial infection worldwide. Airborne transmission.
Far more people are infected with bacillus than actually develop active TB
As a person breathes in infected air, the bacilli go the lungs through the bronchioles. At the end of the bronchioles are alveoli, which are balloon-like sacs where blood takes oxygen from inhaled air and releases carbon dioxide into the air exhaled. TB bacilli infect the alveoli and the bodys immune system begins to fight them. Macrophages — specialized white blood cells that ingest harmful organisms — begin to surround and “wall off” the tuberculosis bacteria in the lungs, much like a scab forming over a wound. Then, special immune system cells surround and separate the infected macrophages. The mass resulting from the separated infected macrophages are hard, grayish nodules called tubercles.-Active TB spreads through the lymphatic system to other parts of the body. In these other parts, the immune system kills bacilli, but immune cells and local tissue die as well. The dead cells form masses called granulomas, where bacilli survive but dont grow. As more lung tissue is destroyed and granulomas expand, cavities develop in the lungs, which causes more coughing and shortness of breathe. Granulomas can also eat away at blood vessels which causes bleeding in the lungs, and bloody sputum.
Symptoms of tuberculosis?
- Appetite loss
- Fatigue
- Chest pain
- Coughing up blood
- Night sweats
- Pallor
Risk for TB?
Nationality. People from regions with high rates of TB — especially Africa, Asia and Latin America, are more likely to develop TB.Sex. In most of the world, more men than women are infected with TB. Men are also more likely to die of the disease.
People who inject illicit drugs
People who live or work in residential facilities
Health care professionals
The elderly
Drugs used to treat TB?
Isoniazid,
Rifampin,
Ethambutol
Pyrazinamide
TB statistics ?
If not treated, active TB can be fatal, killing up to 60% of patients. When treated, a cure can be achieved in 90% of all cases. People who have been treated for at least 2 weeks are usually no longer contagious.
What is the sympathetic NS reaction to pain?
Sympathetic nervous system reactions to pain Increased heart rate Increased blood pressure Increased respiratory rate Dilated pupils Sweating
Preemptive analgesia
technique designed to decrease pain in the postoperative period, decrease the requirements for a postoperative analgesic, prevent morbidity, and decrease hospital stay. This intervention may inhibit changes in the spinal cord- changes that can lead to a central sensitization that results in chronic pain.
Pain caused by cancer
Pain caused by cancer: nerve compression, invasion of tissue, bone metastasis, cancer treatments
Nociceptive pain
Nociceptive Pain description: sharp, burning, dull, aching, cramping, splitting, stabbing
Neuropathic pain
Neuropathic pain description: shooting, burning, fiery, shock-like, sharp, painful numbness (pins and needles)
2 specific fibers that transmit stimuli
A delta fibers
Carry rapid, sharp prickling, piercing sensations (mechanical stimuli)
C fibers
Conduct thermal, chemical, strong mechanical impulses
Slow, diffuse, dull, burning or achy
Usually produce persistent pain
True or False
Endorphins are released when large diameter fibers are stimulated. These fibers close the gate and decrease pain transmission
True
Group A fibers
A group
Fibers of the A group have a large diameter and high conduction velocity, and are myelinated fibers.
The A group consists of four types of nerve fibers:
A alpha fibers (afferent or efferent fibers)
A beta fibers (afferent or efferent fibers)
A gamma fibers (efferent fibers)
A delta fibers (afferent fibers) A delta fibers (III fibers)
III fibers carry sensory information related to pain, temperature, crude touch, and pressure.
Group B fibers
B group
Nerve fibers in this group are myelinated with a small diameter. Generally, they are the preganglionic fibers of the autonomic nervous system and have a low conduction velocity.
C group
C group
The C group fibers are unmyelinated and as the B group fibers have a small diameter and low conduction velocity. These fibers include:
Postganglionic fibers in the autonomic nervous system (ANS)
Nerve fibers at the dorsal roots (IV fiber). These fibers carry the following sensory information:
Pain
Temperature
Touch
Pressure
Itch
Normal value for pCO2?
35-45 mm Hg
Normal value for HCO3?
22-26 mEq
Normal value for PaO2?
80-100 mm Hg
Normal O2 sats?
98-100%
True or false
Bicarbonate and pH increase or decrease together
True
What is respiratory acidosis?
Carbonic acid excess. PaCO2 is more than 45 mm Hg
What causes respiratory acidosis?
- Hypoventilation
- COPD
- Neurologic diseases
- Drug overdose
- Over sedation
Nursing interventions for respiratory acidosis?
- Deep breathing
- Incentive spirometer
- Give Narcan
- Bronchodilators
- Elevate head of bed
What is respiratory alkalosis?
Its a carbonic acid deficit, PaCO2 less than 35 mm Hg
What causes respiratory alkalosis?
- Hyperventilation
- Pulmonary embolism
- Severe infection
- ASA overdose
- Hypoxia
Acidosis vs.alkalosis
Acidosis: get tired, difficult to arouse
Alkalosis: get hyper, tetany, numbness and tingling (ca doesnt bind so you get tetany…put brown bag over mouth rebreathe CO2)
Nursing interventions for respiratory alkalosis?
- Brown bag
- Relax
- Pursed lip breathing
- Ativan
What is metabolic acidosis?
Base bicarbonate deficit, HCO3 less than 22 mEq
What causes metabolic acidosis?
- Diarrhea
2. Diabetes mellitus
How do the lungs and kidney compensate for metabolic acidosis?
Lungs:
- Exhale CO2
- Breathing becomes hyperactive (deep and labored) Kussmaul breathing
Kidneys:
-Excrete more H+
Nursing interventions for metabolic acidosis?
Diabetic: give insulin
Eat carbs so you stop burning fat
Give immodium for diarrhea
What is metabolic alkalosis?
Base bicarbonate Excess, HCO3 more than 26 mEq
What causes metabolic alkalosis?
- Vomiting or gastric suction
- Excessive antacid usage
- Excessive diuretic use
How do the lungs and kidneys compensate for metabolic alkalosis?
Lungs
-Retain CO2 by slow, shallow breathing
Kidneys
-Retain H+ ions
Nursing interventions for metabolic alkalosis?
- Give antiemetics if vomiting
2. Some diuretics such as lasix can deplete your hydrogen ions
Failing a test
Respiratory alkalosis
-Because of hyperventilation
Broken ribs after a car accident
Respiratory acidosis
-dont breathe because it hurts
Prolonged diarrhea
Metabolic acidosis
Fever
Metabolic acidosis
Tetany
Respiratory or Metabolic alkalosis
CNS depression
Respiratory or metabolic acidosis
Neuro disease causing muscle wasting
Respiratory acidosis
HIgh glucose levels in blood
Metabolic acidosis
Pain
Respiratory alkalosis
-hyperventilation
Mountain climbing
Respiratory alkalosis
Diuretic therpay
Metabolic alkalosis
Aspirin intoxication
Respiratory alkalosis
True or false
Chronic pain is most common cause of long-term disability
True
Chronic pain is divided into what to subtypes
Chronic cancer pain, is pain associated with cancer or another progressive disease such as AIDS. Because the pain is usually life-threatening
Chronic noncancer pain, is associated with tissue injury that has healed or is not associated with cancer, such as arthritis or chronic back pain. This type of pain is the most common
Nociceptive pain
Is either visceral or somatic
Where does painful stimuli most often originate from?
In the periphery (extremities)
In the periphery, what two specific fibers transmit stimuli?
A Delta fibers, which are found primarily in the skin and muscle and C fibers, which are distributed in muscle, Periosteum, and viscera. Both of these nerve fibers are capable of accepting nociceptive stimuli
A delta fibers
Are myelinated fibers that carry rapid, sharp, freaking, or piercing sensation
C fibers
Are unmyelinated or poorly myelinated fibers that conduct thermal, chemical, and strong mechanical impulses. Pain conduction from C fibers is slow, more diffuse, and Dull, burning, or achy. Usually persistent pain
True or false
Morphing like substances called endorphins are released when a large diameter nerve fibers are stimulated. These fibers close the gate and decrease pain transmission
True
Projected pain
Pain along a specific nerve or nerves
Radiating pain
Diffuse pain around the site of origin that is not well localized
Referred pain
Pain perceived in an area distant from the site of painful stimuli
NSAIDS
Aspirin and other NSAIDs are very effective for inflammatory type pain, mild moderate postop pain, dental pain, menstrual pain, migraines, and muscle pain.
Examples: aspirin, ibuprofen, naproxen
Acetaminophen
Unlike the rest of the non-opioid analgesics, acetaminophen or Tylenol has few anti-inflammatory properties. Healthcare providers coming prescribed acetaminophen for pain or fever. It exerts its analgesic action by blocking prefer of pain receptors, thus increasing the threshold of these receptors to painful stimuli
Opioid analgesic
For moderate to severe pain, they work centrally by blocking the release of neurotransmitters in the brain and/or spinal cord
What does equianalgesic refer to?
Refers to the dose and route of administration of one drug that produces about the same degree of analgesia as the the given dose and route of another drug
Metabolic acidosis
Four processes can result in metabolic acidosis, overproduction of hydrogen ions, under elimination of hydrogen ions, under production of bicarbonate ions, and over elimination of bicarbonate ions.
Overproduction of hydrogen ions
Overproduction of hydrogen ions can occur with excessive breakdown of fatty acids, anaerobic glucose breakdown, and excessive intake of acids. Excessive breakdown of fatty acids occurs with diabetic ketoacidosis or starvation
Under elimination of hydrogen ions
Under elimination of hydrogen ions leads to acidosis when hydrogen ions are produced at the normal rate but are not removed the same rate they’re produced. Most hydrogen ion loss occurs to the lungs and the kidneys kidney failure causes acidosis when the kidney tubule cannot secrete hydrogen ions into the urine
Under production of bicarbonate ions
Under production of bicarbonate ions leads to acidosis when hydrogen ion production and removal are normal but too few bicarbonate ions are present to balance the hydrogen ions. Such base deficits occurs when bicarbonate ions are not produce at the normal rate. Because bicarbonate is made in the kidneys and in the pancreas, kidney failure and impaired liver or pancreatic function can cause of base deficit acidosis
Over elimination of bicarbonate ions
Over elimination of bicarbonate ions leads to acidosis one hydrogen ion production and removal are normal but to many bicarbonate ions have been lost. One cause of base deficit acidosis is diarrhea
Respiratory acidosis
Respiratory acidosis results when any area of respiratory function is impaired, reducing the exchange of oxygen and carbon dioxide. This problem causes CO2 retention. Because any increase in CO2 levels cause the same increase in hydrogen ion levels, CO2 retention leads to acidosis
What respiratory problems lead to an overproduction of hydrogen ions?
- Respiratory depression
- Inadequate chest expansion
- Airway obstruction
- Reduced alveolar capillary diffusion
True or false
Metabolic and respiratory acidosis can occur at the same time
True
Early signs of mild acidosis?
Early signs include increased heart rate and cardiac output
Later signs include heart rate decreases, T waves become Tall and peaked, and QRS complexes are widened. Peripheral pulse may be hard-to-find and are easily blocked. Hypotension may occur as a result of vasodilation
Skin changes that occur with metabolic or respiratory acidosis
With metabolic acidosis breathing is unimpaired and the rate is increasing CO2 is lost. This causes vasodilation and make the skin and mucous membranes warm, dry, and pink.
With respiratory acidosis, breathing is ineffective and skin and mucous membranes are pale to cyanotic.
What is the most important type of receptor?
The most important type of opiod receptor is the mu receptor. Mu opiods causes side effects that include constipation, nausea, and vomiting, urinary retention, pruritus (itching), sedation, and respiratory depression.
What is the most important type of receptor?
The most important type of opiod receptor is the mu receptor. Mu opiods causes side effects that include constipation, nausea, and vomiting, urinary retention, pruritus (itching), sedation, and respiratory depression.
What is the most important type of receptor?
The most important type of opiod receptor is the mu receptor. Mu opiods causes side effects that include constipation, nausea, and vomiting, urinary retention, pruritus (itching), sedation, and respiratory depression.
