Chapter Two: Overview of Health Concepts for Medical surgical nursing Flashcards
define acid base balance
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
hydrogen ions are _______ while bicarbonates are______
hydrogen ions are acids while bicarbonates are bases
acid base balance is largely controlled by the _______and the _____
acid base is largely controlled by the lungs and the kidneys
parameters for acidosis
arterial blood pH < 7.35
cause of respiratory acidosis
too many hydrogen ions in the body (think hypoventilation- not getting enough CO2 out)
causes of metabolic acidosis
not enough bicarbonate in the body
parameters of alkalosis
arterial blood pH > 7.45
causes of respiratory alkalosis
not enough hydrogen ions in the body (think hyperventilation- getting too much O2 and pushing out too much CO2)
causes of metabolic alkalosis
too much bicarbonate in the body
major risk factors for acid-base imbalances include:
- Poisoning (excessive salicylate-usually from Aspirin)
- COPD (think respiratory acidosis)
- Uncontrolled DM (especially type 1)
- excessive emesis, diarrhea, or IV fluids
compensation refers to what?
when the body detects an acid-base imbalance several mechanisms are activated in an attempt to correct the imbalance
how to the kidneys compensate when the blood is acidotic?
kidneys will excrete less bicarbonate (base) in the urine than they normally do- absorb more bicarbonate
how do the lungs compensate when the blood is acidotic?
lungs will respond by taking deeper slower breaths to help get rid of CO2
how would the kidneys compensate when the blood is alkalotic
the kidneys would excrete more bicarbonate in the urine than normal
how would the lungs compensate to blood that is alkalotic
the lungs would compensate by breathing faster to try to increase CO2 in the blood
what should the health history for acid-base imbalance patients include?
- chronic conditions that might cause imbalance (COPD/diabetes)
- current/ recent signs and symptoms that might predispose pt to an imbalance (diarrhea/ vomiting)
- current use of medications, OTC drugs, or herbal supplements
what is the purpose of ABG monitoring
to help determine what kind of acid-base imbalance is occurring
what is the normal PaCO2 (AKA partial pressure of CO2)
35-45 mmHG
what do PaCO2 levels indicate?
how well the lungs are functioning in blowing off or retaining CO2 as needed
Normal HCO3 (bicarbonate) levels
21-28 mEq/L
OR
21-28 mmol/L
what do HCO3 levels indicate?
how well the kidneys are excreting or absorbing bicarbonate as needed
the best way to promote acid-base balance is to:
practice health promotion and live a healthy lifestyle
i.e.- smoking cessation/ healthy diet/ regular exercise
_______ is the process to control cellular growth, replication, and differentiation to maintain homeostasis
cellular regulation
risk factors for impaired cellular growth include: (8 major ones)
- older age (55 and over but esp. 70 and older)
- smoking
- physical inactivity
- poor nutrition
- environmental pollutants
- certain medications (chemo)
- radiation
- genetic predisposition
3 major characteristics of benign (non cancerous) cellular grown
- cells mimic the original cell but in excess
- cannot spread to other tissue or organs
- might obstruct or compress organs
3 major characteristics of malignant (cancerous) cellular growth
- no comparison to original cell over time
- replication of abnormal cells leads to significant invasion of health cells, tissues, and organs
- tumor formation and invasion of other tissues/organs
what are 3 important parts of health history when assessing cellular regulation
- pt history
- family history
- psychosocial history
what is important to note during physical exam when assessing cellular regulation?
- visible/palpable masses
- pain
- difficulty breathing
what are the diagnostic tests used to diagnose impaired cellular regulation
- CT
- MRI
- colonoscopy
- endoscopy
- lab testing (biopsy/ blood work)
what is the goal of primary interventions as they pertain to cellular regulation
primary interventions aim to minimize the risk of developing impaired cellular regulation
what are the 5 primary interventions to prevent impaired cellular regulation
- minimize exposure to sun and UV
- stop smoking/ using tobacco products
- high fiber and low saturated fat intake
- increase physical activity/ regular exercise
- avoid exposure to environmental hazards
what is the purpose of secondary interventions as they pertain to cellular regulation
secondary interventions aim to detect and diagnose cellular regulation impairment early on
what is an example of secondary interventions for impaired cellular regulation?
proper and frequent screenings
________ 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
clotting
explain the 5 step process of clotting
- platelets (aka thrombocytes) circulate in blood until they are needed/ tissue injury occurs
- when a tissue injury occurs the platelets become sticky and clump together to form a semi-solid plug at injury site
- this aggregation of platelets activates the clotting cascade in which plasma proteins and enzymes work together to create a fibrin clot
- once the vasculature is repaired, the fibrinolytic system is activated to break down the clot
excess platelets or excess stickiness of platelets that leads to impaired blood flow is known as ________________
hypercoagulability
5 major risk factors for INCREASED clotting
- immobility/decrease in mobility
- polycythemia
- smoking
- diabetes
- atrial fibrillation
5 major risk factors for DECREASED clotting
- thrombocytopenia
- chemotherapeutic drugs
- corticosteroids
- liver cirrhosis
- recessive sex-links hemophilia A or B
what are the physiologic consequences of increased clotting?
- venous thrombosis
- embolus
- ischemic stroke
- pulmonary embolism
what are the s/s of deceased clotting INTERNALLY
- hemorrhagic stroke
- GI bleed (frank or occult bleeding in stool)
- hematuria (bleeding in urinary tract)
what are the s/s of decreased clotting EXTERNALLY
- epistaxis (nosebleed)
- prolonged bleeding @ sight of soft tissue injury
- purapura
s/s to look out for in pt with risk of decreased clotting
- ecchymosis
- petichiae
- prolonged bleeding
- occult or frank blood in stool or urine
- bleeding of gums or nose
s/s to look out for in pt with risk of excessive clotting
- venous thrombosis
- localized redness, swelling, or warmth
arterial thrombosis s/s
- decreased blood flow distal to obstruction
- pale/cool skin
- weak/absent pulses
2 tests used to measure clotting factor levels and bleeding time
- Prothrombin time (PT)
2. activated partial throomboplastin time (aTTP)
what test do we use to test the effectiveness of warfarin?
international normalized ratio (INR)
interventions to PROMOTE adequate clotting
- 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
