Final Exam Review ABG’s (2-4 Q’s) Flashcards
Which patients most commonly develop acid base imbalance problems?
COPD
Diabetes
Kidney disease
The nurse would recognize the following manifestations of Respiratory Alkalosis in a patient
Neurologic Dizziness Light-headedness Confusion Headache
Cardio
Tachycardia
Dysrhythmias (related to hypokalemia from compensation)
GI Nausea Vomiting Diarrhea Epigastric pain
Neuromuscular Tetany numbness Tingling of extremities Hyperreflexia Seizures
Respiratory
Hyperventilation
(Lungs are unable to compensate if there is a respiratory problem)
pH = 7.32 PaCO2 = 30 HCO3- = 16 PaO2 = 95
What is the interpretation of this?
This ABG is interpreted as metabolic acidosis with partial compensation. Partial compensation is occurring bc the pH remains abnormal. Full compensation would occur after the pH returns within normal limits.
In respiratory Conditions, the pH and the PACO2 to go in opposite directions
In respiratory alkalosis, the pH is up ⬆️and the PAC02 ⬇️is down.
In respiratory acidosis, the pH is down ⬇️and the PAC02 ⬆️is up.
In metabolic conditions, the pH and the HCO3 (-) go in the same direction equal the PaCO2 may also go in the same direction.
In metabolic alkalosis, pH and HCO3- are up and the PaCO2 is up ⬆️ or normal.
In metabolic acidosis, the pH and HCO3-are down ⬇️ and the PaCO2 is up ⬆️ or normal.
Proritization
Large Part of what a nurse does. In addition many NCLEX questions focus on prioritization.
Parameters for normal ABG’s
pH 7.35-7.45 PaCO2 35-45 Bicarbonate (HCO3-) 22-26 PaO2 80-100 SaO2 > 95% Base excess + or - 2.0 mEq/L
What type of medication should we assess a patient for regarding ingredients that may counter act with fluid electrolyte an acid-base imbalances
A nurse should assess the patient’s current and past use of medication. The ingredients in many drugs especially over-the-counter drugs are often hidden sources of sodium, potassium, calcium, magnesium, and other electrolytes. Many prescription drugs, including diuretics, cortical steroids, and electrolyte supplements, can cause fluid and electrolyte imbalances.
Surgery your other treatments and its effect on fluid, electrolyte, and acid-base imbalances
A nurse Should ask the patient about past present renal dialysis, kidney surgery, or bowel surgery resulting in a temporary or permanent external collecting system, such as an ileostomy.
A nurse should assess what about past health history regarding acid-base imbalances?
Question the patient about any history of problems involving the Kidneys, heart, G.I. system, or lungs that could affect the present fluid, etc. Ask about specific diseases such as diabetes, diabetes insipidus, COPD, renal failure, ulcerative colitis, and Crohn’s disease. Access for any prior fluid, electrolyte or acid base disorders.
Nutritional metabolic pattern
Ask the patient about diet and any special dietary practices diet fad diet’s any eating disorders such as anorexia or bulimia, can lead to fluid and electrolyte problems.
Elimination pattern
Make note of the patients usual bowel and bladder habits. Carefully document any deviations from the expected elimination pattern, such as diarrhea, oliguria, Polyuria, or incontinence
What is third spacing fluid and how does it occur?
It occurs when excess fluid collects in the non-functional area between cells. This fluid is trapped where it is difficult or impossible for it to move back into the cells or blood vessels. Third spacing occurs with ascites; fluid leaking into the abdominal cavity with peritonitis or pancreatitis; and edema associated with burns, trauma, or sepsis.
What are the Gerontologic considerations?
Structural changes in kidneys decrease ability to conserve water.
Hormonal changes including decreasing renin and aldosterone and increase in ADH and ANP.
Loss of subcutaneous tissue leads to increased moisture lost.
Other fluid and electrolyte imbalances
Result of therapeutic measures such as colonoscopy preparation and diuretics
What is ECF volume deficit?
It is also known as hypovolemia
Due to abnormal loss of body fluids, in adequate fluid intake, or plasma to interstitial fluid shift
Clinical manifestations related to loss of vascular volume as well as CNS effects
Lower blood pressure
As a nurse how do you treat fluid volume imbalances?
Correct the underlying cause and replace water and electrolytes
Orally
Blood products
Balanced IV solutions
What is fluid volume excess?
Hypervolemia
Excess Inteca fluids, abnormal retention of fluids, or interstitial to plasma fluid shift
How would a nurse care for extra cellular fluid volume and balances hypervolemia?
Remove fluid without changing electrolyte composition or osmolality of ECF
Diuretics
Fluid restriction
Restriction of sodium intake to treat ascites or pleural effusion
What is a complication in hypovolemia?
Hypovolemic shock
What are potential complications of hypervolemia?
Potential complications are pulmonary edema, and ascites
Nursing management and nursing implementation
Daily weights input an output, laboratory findings, cardiovascular care
Respiratory care, patient safety, skincare
Assessment in fluid volume and balances are
Assess for skin turgor
Fluid therapy for fluid volume Imbalances
The nurse will want to administer IV fluids as ordered
Maintain adequate oral intake assess ability to express thirst and swallow assist those with physical limitations
In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in?
Fluid movement from the cells into the interstitial space and the blood vessels
This results in Hypovolemia
What is fluid volume deficit
When a patient loses both sodium plus water
What is dehydration?
Dehydration only loses water
What are symptoms of fluid volume deficit?
Restlessness, drowsiness, lethargy, confusion, decreased skin turgor decreased capillary refill postural hypotension increased pulse decreased urine output, concentrated urine increase respiratory rate, weakness, dizziness, weight loss, seizures, coma
What are symptoms of fluid volume excess?
Headache, confusion, lethargy, peripheral edema, jugular venous distention, S3 heart sound, bounding pulse, increase blood pressure increased cardiovascular pressure Polyuria, dyspnea, crackles, pulmonary edema, muscle spasms, weight gain, seizures, coma
Assessment abnormalities for fluid and electrolyte imbalances blood pressure
Hypotension possible cause is fluid volume deficit, low calcium, high magnesium
Hypertension possible cause fluid volume excess, high calcium, low magnesium
Fluid and electrolyte imbalances respirations
Crackles possible cause fluid volume excess,
dyspnea cause fluid volume excess,
rapid respirations cause is fluid volume deficit,
restricted airway cause is low calcium high phosphate
During the postoperative care of a 76-year-old patient, the nurse monitor the patient intake and output carefully, Knowing that the patient is at risk for fluid and electrolyte imbalances primarily because?
Small Losses of Fluid are significant because body fluids account for 45% of 50% of body weight in older adults.
During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is?
Osmosis
An older woman is admitted to the medical unit with G.I. bleeding. Assessment findings that indicate fluid volume deficit include?
Weight loss and dry oral mucosa and decreased central venous pressure CVP
The nursing Care for a patient with hyponatremia and fluid volume excess includes?
Fluid restriction
The nurse should be alert for which manifestations in a patient receiving a loop diuretic?
Week, irregular pulse and poor muscle tone
Which patient is at greatest risk for developing hypermagnesemia?
A 42-year-old woman with systemic lupus erythematosus and renal failure
It is important for the nurse to assess for which manifestation in a patient who has just undergone a total thyroidectomy?
Confusion,
Circumoral numbness,
positive Chvostek’s sign (contraction of facial muscle in response to a light tap over the Facial nerve in front of the ear).
The nurse expect the long-term treatment of a patient with hyperphosphatemia from Renal failure will include
Calcium supplements
The lungs act as an acid base buffer by?
Increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.
A patient has the following arterial blood gas results
PH 7.52 (high) up to 7.45 for normal
PaCO2 =30 normal =35-45
HCO3 24
The nurse determines that these results indicate what?
Respiratory alkalosis
Why? The pH is high and the PaCO2 is low
The typical fluid replacement for the patient with a fluid volume deficit is
Lactated ringer’s solution
The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be too?
Have the patient change positions, raise their arm, and cough
