Step T - Treatment

Question 1

What are the two kinds of treatment?

Answer 1

• corrective

- supportive

Question 2

What does corrective treatment do?

Answer 2

reverses the underlying problem

Question 3

What does supportive treatment do?

Answer 3

treats the symptom and preserves acceptable pH

Question 4

What do you give a person when s/he is acidotic?

Answer 4

bicarb

Question 5

If the pH is normal, you should not treat ___ or ___

Answer 5

bicarbonate or CO2

Question 6

How should you treat respiratory acidosis?

Answer 6

• bronchial hygiene if possible

- initial CMV if in resp failure and pH <7.25

Question 7

What may be a greater indicator of the need for CMV than an isolated pH measurement?

Answer 7

respiratory acidemia

Question 8

How should you treat a patient with COPD?

Answer 8

• low-flow oxygen may be effective despite high CO2 levels
• noninvasive ventilation
• hypercarbia
• CMV

Question 9

What must you do to lower CO2?

Answer 9

• increase alveolar ventilation
• increase VT
• increase RR
• decrease deadspace

Question 10

What are the CMV goals for chronic CO2 retention?

Answer 10

• return CO2 to chronic normal level

- 10mmHg per hour

Question 11

What can abrupt changes in CO2 lead to?

Answer 11

• cerebral alkalosis

- vasoconstriction

Question 12

If a patient has been on a vent with lowered CO2, they may require a ____ time to wait for renal compensation

Answer 12

longer

Question 13

What is the most common cause of respiratory alkalosis?

Answer 13

hypoxemia

Question 14

How should you treat respiratory alkalosis?

Answer 14

• O2 (supportive treatment)
• breathing exercises to alleviate panic
• drugs

Question 15

If respiratory alkalosis is not due to hypoxemia, how should you treat it?

Answer 15

try breathing in a bag or tubing

Question 16

With sustained hypocapnia, CO2 is lowered to ___ ICP. It should not go below ___ and should only be used short term

Answer 16

lower; 30

Question 17

How would you reduce alveolar ventilation?

Answer 17

• decrease VT
• decrease RR
• increase VD

Question 18

For metabolic acidemia, how should you treat a pH greater than 7.10?

Answer 18

leave alone, better to treat the underlying cause

Question 19

For metabolic acidemia, how should you treat a pH lower than 7.10?

Answer 19

sodium bicarbonate

Question 20

What are some NaHCO3 complications?

Answer 20

• arterial hypercapnia
• intracellular hypercapnia
• CSF acidosis (CSF does not receive extra HCO3)
• decreased potassium can occur
• fluid overload

Question 21

When is THAM used?

Answer 21

it is no longer used but was once used to treat metabolic acidemia

Question 22

What is THAM?

Answer 22

a superior alkalizing agent that is a good buffer due to its lack of sodium and is superior to HCO3 in CSF. it comes in a powder form and must be mixed prior to administration

Question 23

What are the THAM hazards?

Answer 23

• spasms
• phlebitis
• thrombosis at site of administration

Question 24

How many ABGs are classified as metabolic alkalemia?

Answer 24

1/3

Question 25

What can cause metabolic alkalemia?

Answer 25

• IVs

- NG tubes

Question 26

How would you treat mild to moderate (pH 7.45-7.55) metabolic alkalemia?

Answer 26

• potassium replacement therapy
• KCl
• fluid replacement
• foods: bananas, beans, potatoes, fish, poultry

Question 27

How would you treat severe (pH >7.55) metabolic alkalemia?

Answer 27

dilute IV with HCl, ammonium chloride, or arginine monohydrochloride