Chapter Two: Overview of Health Concepts for Medical surgical nursing

Question 1

define acid base balance

Answer 1

acid base balance is the maintenance of arterial blood pH between 7.35 and 7.45 though control of hydrogen ion (acid) production and elimination

Question 2

hydrogen ions are _______ while bicarbonates are______

Answer 2

hydrogen ions are acids while bicarbonates are bases

Question 3

acid base balance is largely controlled by the _______and the _____

Answer 3

acid base is largely controlled by the lungs and the kidneys

Question 4

parameters for acidosis

Answer 4

arterial blood pH < 7.35

Question 5

cause of respiratory acidosis

Answer 5

too many hydrogen ions in the body (think hypoventilation- not getting enough CO2 out)

Question 6

causes of metabolic acidosis

Answer 6

not enough bicarbonate in the body

Question 7

parameters of alkalosis

Answer 7

arterial blood pH > 7.45

Question 8

causes of respiratory alkalosis

Answer 8

not enough hydrogen ions in the body (think hyperventilation- getting too much O2 and pushing out too much CO2)

Question 9

causes of metabolic alkalosis

Answer 9

too much bicarbonate in the body

Question 10

major risk factors for acid-base imbalances include:

Answer 10

1. Poisoning (excessive salicylate-usually from Aspirin)
2. COPD (think respiratory acidosis)
3. Uncontrolled DM (especially type 1)
4. excessive emesis, diarrhea, or IV fluids

Question 11

compensation refers to what?

Answer 11

when the body detects an acid-base imbalance several mechanisms are activated in an attempt to correct the imbalance

Question 12

how to the kidneys compensate when the blood is acidotic?

Answer 12

kidneys will excrete less bicarbonate (base) in the urine than they normally do- absorb more bicarbonate

Question 13

how do the lungs compensate when the blood is acidotic?

Answer 13

lungs will respond by taking deeper slower breaths to help get rid of CO2

Question 14

how would the kidneys compensate when the blood is alkalotic

Answer 14

the kidneys would excrete more bicarbonate in the urine than normal

Question 15

how would the lungs compensate to blood that is alkalotic

Answer 15

the lungs would compensate by breathing faster to try to increase CO2 in the blood

Question 16

what should the health history for acid-base imbalance patients include?

Answer 16

1. chronic conditions that might cause imbalance (COPD/diabetes)
2. current/ recent signs and symptoms that might predispose pt to an imbalance (diarrhea/ vomiting)
3. current use of medications, OTC drugs, or herbal supplements

Question 17

what is the purpose of ABG monitoring

Answer 17

to help determine what kind of acid-base imbalance is occurring

Question 18

what is the normal PaCO2 (AKA partial pressure of CO2)

Answer 18

35-45 mmHG

Question 19

what do PaCO2 levels indicate?

Answer 19

how well the lungs are functioning in blowing off or retaining CO2 as needed

Question 20

Normal HCO3 (bicarbonate) levels

Answer 20

21-28 mEq/L
OR
21-28 mmol/L

Question 21

what do HCO3 levels indicate?

Answer 21

how well the kidneys are excreting or absorbing bicarbonate as needed

Question 22

the best way to promote acid-base balance is to:

Answer 22

practice health promotion and live a healthy lifestyle

i.e.- smoking cessation/ healthy diet/ regular exercise

Question 23

_______ is the process to control cellular growth, replication, and differentiation to maintain homeostasis

Answer 23

cellular regulation

Question 24

risk factors for impaired cellular growth include: (8 major ones)

Answer 24

1. older age (55 and over but esp. 70 and older)
2. smoking
3. physical inactivity
4. poor nutrition
5. environmental pollutants
6. certain medications (chemo)
7. radiation
8. genetic predisposition

Question 25

3 major characteristics of benign (non cancerous) cellular grown

Answer 25

1. cells mimic the original cell but in excess 2. cannot spread to other tissue or organs 3. might obstruct or compress organs

Question 26

3 major characteristics of malignant (cancerous) cellular growth

Answer 26

1. no comparison to original cell over time 2. replication of abnormal cells leads to significant invasion of health cells, tissues, and organs 3. tumor formation and invasion of other tissues/organs

Question 27

what are 3 important parts of health history when assessing cellular regulation

Answer 27

1. pt history 2. family history 3. psychosocial history

Question 28

what is important to note during physical exam when assessing cellular regulation?

Answer 28

- visible/palpable masses - pain - difficulty breathing

Question 29

what are the diagnostic tests used to diagnose impaired cellular regulation

Answer 29

- CT - MRI - colonoscopy - endoscopy - lab testing (biopsy/ blood work)

Question 30

what is the goal of primary interventions as they pertain to cellular regulation

Answer 30

primary interventions aim to minimize the risk of developing impaired cellular regulation

Question 31

what are the 5 primary interventions to prevent impaired cellular regulation

Answer 31

1. minimize exposure to sun and UV 2. stop smoking/ using tobacco products 3. high fiber and low saturated fat intake 4. increase physical activity/ regular exercise 5. avoid exposure to environmental hazards

Question 32

what is the purpose of secondary interventions as they pertain to cellular regulation

Answer 32

secondary interventions aim to detect and diagnose cellular regulation impairment early on

Question 33

what is an example of secondary interventions for impaired cellular regulation?

Answer 33

proper and frequent screenings

Question 34

________ is a multi-step process in which blood forms a protein based structure in an area of tissue injury to stop excess bleeding while still maintaining whole body perfusion

Answer 34

clotting

Question 35

explain the 5 step process of clotting

Answer 35

1. platelets (aka thrombocytes) circulate in blood until they are needed/ tissue injury occurs 2. when a tissue injury occurs the platelets become sticky and clump together to form a semi-solid plug at injury site 3. this aggregation of platelets activates the clotting cascade in which plasma proteins and enzymes work together to create a fibrin clot 5. once the vasculature is repaired, the fibrinolytic system is activated to break down the clot

Question 36

excess platelets or excess stickiness of platelets that leads to impaired blood flow is known as ________________

Answer 36

hypercoagulability

Question 37

5 major risk factors for INCREASED clotting

Answer 37

1. immobility/decrease in mobility 2. polycythemia 3. smoking 4. diabetes 5. atrial fibrillation

Question 38

5 major risk factors for DECREASED clotting

Answer 38

1. thrombocytopenia 2. chemotherapeutic drugs 3. corticosteroids 4. liver cirrhosis 5. recessive sex-links hemophilia A or B

Question 39

what are the physiologic consequences of increased clotting?

Answer 39

- venous thrombosis - embolus - ischemic stroke - pulmonary embolism

Question 40

what are the s/s of deceased clotting INTERNALLY

Answer 40

- hemorrhagic stroke - GI bleed (frank or occult bleeding in stool) - hematuria (bleeding in urinary tract)

Question 41

what are the s/s of decreased clotting EXTERNALLY

Answer 41

- epistaxis (nosebleed) - prolonged bleeding @ sight of soft tissue injury - purapura

Question 42

s/s to look out for in pt with risk of decreased clotting

Answer 42

- ecchymosis - petichiae - prolonged bleeding - occult or frank blood in stool or urine - bleeding of gums or nose

Question 43

s/s to look out for in pt with risk of excessive clotting

Answer 43

- venous thrombosis | - localized redness, swelling, or warmth

Question 44

arterial thrombosis s/s

Answer 44

- decreased blood flow distal to obstruction - pale/cool skin - weak/absent pulses

Question 45

2 tests used to measure clotting factor levels and bleeding time

Answer 45

1. Prothrombin time (PT) | 2. activated partial throomboplastin time (aTTP)

Question 46

what test do we use to test the effectiveness of warfarin?

Answer 46

international normalized ratio (INR)

Question 47

interventions to PROMOTE adequate clotting

Answer 47

- educate pt to report unusual bleeding/ bruising immediately - drink adequate fluids - avoid crossing the legs - ambulate frequently - stop smoking - be alert for redness, swelling, and warmth of lower extremities