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Pathophysiology > Acid Base Abnormalities > Flashcards

Acid Base Abnormalities Flashcards

1
Q

What is the pathophysiology of HYPOnatremia ?

A
  1. Due to ↓ ECF vol
    (diuretics, adrenal insufficiency, salt-wasting renal disease)
  2. Due to extrarenal loss of Na+
    (sweating, vomiting, diarrhea, third-spacing)
  3. Due to ↑ ECF
    (hemodilution)
    a. CHF, cirrhosis, renal failure
    b. SIADH w/ normal or increased fluid volume
    c. Excessive admin of hypotonic IV fluids
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2
Q

What are the signs/symptoms of HYPOnatremia ?

A
  1. Early:
    =>GI disturbance nausea, vomiting, anorexia, diarrhea
  2. Late:
    =>Neuro headache, depression, dulled sensorium, irritability, lethargy, twitching tremors, convulsions, coma
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3
Q

What is the lab data for HYPOnatremia ?

A

1). Serum Na+/Osmolarity
=> ↓ Na<135 ,
=> ↓ osmo <275 OSM/kg

2). 24hr urine
=> ↓Na <40 mEq/L in 24 hr
↓ [ECF] ,
=>↑ >220 mEq/L 24 hr
↑ [ECF]

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4
Q

What is the treatment for HYPOnatremia ?

A
  1. Hypovolemic hyponatremia
    =>Fluid vol. replacement w/ isotonic or hypertonic NaCl
  2. Hypervolemic hyponatremia
    => Loop diuretics
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5
Q

What is the pathophysiology of HYPERnatremia ?
(Na > 145 mEQ/L)

A
  1. Due to either gain in Na+ or loss of water
  2. Hypertonicity
    a. from water loss is rare occurring in those with ↓ water intake (comatose)
    b. due to excessive water intake: hyperosmolar feeding formulas, IV solutions, or meds high in Na (Kayexalate)
    c. due to excessive Na retention (adrenal hyperfunction)
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6
Q

What are the signs/symptoms of HYPERnatremia?

A
  1. Neuro: dehydration of brain cells (thirst, restlessness, weakness, disorientation, lethargy, stupor, convulsions, coma)
  2. Peripheral and pulmonary edema
  3. Postural hypotension, wgt gain, dyspnea, elevated CVP
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7
Q

What is the lab data for HYPERnatremia?

A
  1. Na > 148 mEq/L
  2. Osmolality > 295 mOSM/kg
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8
Q

What is the treatment for HYPERnatremia?

A
  1. Admin of hypotonic fluids
  2. Diuretics to increase Na excretion.
  3. Correct slowly over a 24 hr period to avoid deterioration of brain fxn
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9
Q

What is the pathophysiology of HYPOKalemia?

A
  1. Urinary loss of K due to drug therapy ( K losing diuretics, PCN, aminoglycosides, cisplatin, glucocorticoids)
  2. Abnormal loss of GI secretions
  3. Prolonged IV therapy with K+ free solutions
  4. Rapid tissue repair following burns, trauma, or starvation
  5. Elevated insulin levels
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10
Q

What are the signs/symptoms of HYPOKalemia?

A
  1. Cardiac rhythm disturbance
  2. muscle weakness, paralysis, ileus, leg cramps, paresthesia, decreased bowel sounds
  3. production of dig toxicity in the client on dig therapy (?)
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11
Q

What is the lab data for HYPOKalemia?

A
  1. Serum K < 2.5 mEq/L
  2. ABGs ↓ pH, ↑ bicarb, ↓ Cl-
  3. ECG: flattened T waves, prominent U waves, depressed ST, prolonged QT
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12
Q

What is the treatment for HYPOKalemia?

A

Administration of K supplements

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13
Q

What is the pathophysiology of HYPERKalemia?

A
  1. Inadequate K excretion: (renal disease, hypovolemia, K-sparing diuretics, rapid blood transfusion, adrenal insufficiency)
  2. Metabolic acidosis, insulin deficit, trauma, and release of K from cells
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14
Q

What are the signs/symptoms of HYPERKalemia?

A
  1. Cardiac rhythm disturbance
  2. Diarrhea, colic, anxiety, muscle tremors, twitching, weakness, respiratory paralysis
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15
Q

What is the lab data for HYPERKalemia?

A
  1. Serum K > 5.0
  2. ABGs to determine presence of acidosis.
  3. ECG: peaking of T waves
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16
Q

What is the treatment of HYPERKalemia?
(7 options)

A
  1. IV insulin to promote the transfer of K into the cell
  2. Dextrose 10-50% IV to prevent hypoglycemia
  3. NAHCO3 to ↑ pH
  4. Monitor electrolytes (K, Na, Ca, Mg, Cl)
  5. IV Ca2+ to counteract the toxic effect of K on the myocardium
  6. Kayexalate to exchange Na or Ca2+ for K in the GI tract
  7. Dialyze the client w/renal failure
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17
Q

What is the pathophysiology of HYPOcalcemia?
(<8.8 mg/dL)

A
  1. Massive transfusion with citrated blood
  2. ↓ production of PTH via surgical removal
  3. Alkalosis
    =>Ca2+ ↓ in the presence of elevated pH and bicarb
  4. Rapid admin of IV phosphate to treat hypophosphatemia.
  5. Drugs
    >Cimetidine
    >Dilantin
    >Heparin
    >Diuretics
    >Mag
    >Gentamycin
    >Cisplatin
  6. Hemodilution
  7. ↓ absorption of Ca2+ from intestines secondary to gastric/intestinal resection, fatty stools, small bowel disease, deficient intake of Vit D and CRF
  8. Phosphate retention due to renal disease
  9. Pancreatitis:
    => Pancreatic lipase breaks down fat to form FA which combines w/ Ca2+ to form insoluble Ca2+ soaps
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18
Q

What are the signs/symptoms of HYPOcalcemia?

A
  1. Tetany
  2. Convulsions
19
Q

What is the lab data for HYPOcalcemia?

A
  1. Serum Ca2+ <8.5
  2. ECG prolonged QT
  3. Mg because low Mg is associated with low Ca2+
  4. PTH ↓
20
Q

What is the treatment for HYPOCalcemia?

A

IV Ca2+
(be careful to observe for bradycardia and cardiac arrest)
Dig toxicity

21
Q

What is the pathophysiology for HYPERCalcemia?

A
  1. Due to ↑ reabsorption of Ca2+ from bone secondary to Paget’s disease
    >immobilization
    >hyperparathyroidism
  2. ↑ Ca2+ intake w/ antacids
  3. ↑ Ca2+ with excessive intake of milk
  4. ↓ renal excretion in renal failure
22
Q

What are the signs/symptoms of HYPERCalcemia?

A
  1. Bone demineralization
  2. Renal nephropathy
    due to deposition of Ca2+ in renal parenchyma and recurrent renal stones
  3. Depression of neuromuscular fxn and CNS
  4. GI ab pain
  5. Anorexia
  6. Vomiting
  7. Nausea
  8. Constipation
  9. Pancreatitis
  10. Peptic ulcer
  11. Wgt loss
23
Q

What is the lab data for HYPERCalcemia?

A

ECT: shortened QT, ST depression, widened T wave, bradycardia, heart block

PTH rules out parathyroid/non parathyroid causes

Ca levels > 10 mg/dL

24
Q

What is the treatment for HYPERCalcemia?

A
  1. Saline IV solutions and diuretics
  2. IV sodium phosphate
  3. Mithracin and Calcitonin to decrease bone resorption
25
Q

What are the clinical symptoms of Metabolic Acidosis?

A
  1. Diarrhea
  2. Headache
  3. LOC changes
  4. Twitching
  5. Kussmaul respiration
  6. Tremors
  7. Convulsions
  8. Stupor
  9. Coma
26
Q

What are the influencing factors for Metabolic Acidosis?

A
  1. Renal insufficiency
  2. DKA
  3. Starvation
  4. Hypoxia
  5. Diarrhea (Loss of HCO3)
  6. Severe Infection
27
Q

What are the lab findings surrounding Metabolic Acidosis?

A
  1. Low pH
  2. pO2 WNL
  3. pCO2 WNL
  4. Low HCO3
  5. ↑ K and Cl-
28
Q

What are some nursing interventions for Metabolic Acidosis?

A
  1. Treat underlying problem
  2. NaHCO3 as ordered
  3. ↑ CHO intake for energy, fat, and protein conservation
  4. ABGs as ordered
  5. I&O
    6 Seizure precautions
  6. Frequent vital signs
29
Q

What are the clinical symptoms of Respiratory Acidosis?

A
  1. Shallow respirations
  2. Weakness
  3. LOC changes
  4. Headache
  5. Disorientation
  6. lethargy
30
Q

What are the influencing factors of Respiratory Acidosis?

A
  1. narcotic overdose
  2. COPD
  3. CNS depression
  4. Breathing excess CO2
31
Q

What are the lab findings for Respiratory Acidosis?

A
  1. Low pH
  2. Normal or low pO2
  3. pCO2
  4. Normal or low HCO3
  5. ↑ K and Cl-
32
Q

What are the nursing interventions for Respiratory Acidosis?

A
  1. Maintain airway
  2. Cough, deep breaths, turn pt frequently.
  3. O2 as ordered (low flow if COPD)
  4. Frequent vital signs
  5. Treat underlying problem
33
Q

What are the clinical symptoms of Metabolic Alkalosis?

A
  1. Decreased respirations
    2 Convulsions
  2. Tetany
  3. Hyperreflexic
34
Q

What are the influencing factors of Metabolic Alkalosis?

A
  1. vomiting (loss of HCl)
  2. severe diuresis
  3. Cushing’s Disease
  4. Ingestion of NaCO3
  5. Prolonged gastric suctioning
35
Q

What are lab findings for Metabolic Alkalosis?

A
  1. High pH
  2. pO2 WNL
  3. pCO2 WNL
  4. HCO3 high
  5. ↓ K and Cl-
36
Q

What are the nursing interventions for Metabolic Alkalosis?

A
  1. NaCl IV as ordered
  2. K replacement
  3. I&O
  4. Frequent vital signs
  5. Diet high in K and Cl
37
Q

What are the clinical symptoms of Respiratory Alkalosis?

A
  1. Increased respirations
  2. LOC changes
  3. Fever
  4. Anxiety
  5. Convulsions
38
Q

What are the influencing factors for Respiratory Alkalosis?

A
  1. Salicylate poisoning
  2. Hyperventilation
39
Q

What are the lab findings for Respiratory Alkalosis?

A
  1. high pH
  2. pO2 WNL
  3. Low pCO2
  4. High or WNL HCO3
  5. ↓ K and Cl
40
Q

What are the nursing interventions for Respiratory Alkalosis?

A
  1. Rebreather mask
  2. Relieve Anxiety
  3. Frequent vital signs
  4. Treat underlying problem
41
Q

What is Respiratory Alkalosis?

A

Occurs when low CO2 levels disrupt blood’s acid-base balance

Occurs in people with hyperventilation (rapid, uncontrollable breathing).

42
Q

What is Respiratory Acidosis?

A

Failure of ventilation and an accumulation of CO2.

Lungs can’t remove all of the CO2 from the body

43
Q

What is Metabolic Acidosis?

A

Caused by a build-up of too many acids accumulate in the body.

(Ex. build-up of body toxins, kidney failure, ingestion of certain drugs/toxins [large doses of aspirin or methanol])

44
Q

What is Metabolic Alkalosis?

A

Occurs when there is an increase in bicarbonate concentration due to loss of H+ ions from the body.

Usually, stomach acid is decreased or certain electrolyte levels drop.

Pathophysiology (1 decks)

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