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RTH 236 > Step U - Underlying Cause > Flashcards

Step U - Underlying Cause Flashcards

1
Q

What are the four causes of acid/base abnormality?

A
  • respiratory acidemia
  • respiratory alkalemia
  • metabolic acidemia
  • metabolic alkalemia
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2
Q

In respiratory acidemia, cerebral blood flow may ____ with an increase in carbon dioxide

A

more than double

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3
Q

What are the signs of high CO2?

A
  • increased CMO
  • tachycardia
  • skin flushed
  • diaphoretic
  • bounding pulse
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4
Q

Blood flow is ____ with chronic hypercapnia

A

normal

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5
Q

What are two signs of severe hypercapnia?

A
  • hypotension

- arrhythmias

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6
Q

What is the acronym for respiratory acidemia (increase in volatile acids)?

A

C O N V E N I E N T

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7
Q

What does the C in respiratory acidemia stand for?

A

COPD code

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8
Q

What does the O in respiratory acidemia stand for?

A

oxygen excess in COPD

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9
Q

What does the 1st N in respiratory acidemia stand for?

A

neuromuscular disorders (MG, GB, ALS, polio)

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10
Q

What does the V in respiratory acidemia stand for?

A

V/Q mismatch (lung cancer)

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11
Q

What does the 1st E in respiratory acidemia stand for?

A

exhaustion (status asthmaticus)

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12
Q

What does the 2nd N in respiratory acidemia stand for?

A

neurological disorders (central sleep apnea, intracranial hypertension)

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13
Q

What does the I in respiratory acidemia stand for?

A

inadequate CMV (hyperkalemia)

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14
Q

What does the 2nd E in respiratory acidemia stand for?

A

excessive CO2 production (permissive hypercapnia, burns, sepsis)

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15
Q

What does the 3rd N in respiratory acidemia stand for?

A

narcotics and other CNS depressants

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16
Q

What does the T in respiratory acidemia stand for?

A

trauma to the respiratory center

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17
Q

What should you do on patients who have a neuromuscular disorder?

A
  • NIF

- VC

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18
Q

What are the signs and symptoms of respiratory alkalemia?

A
  • tingling
  • numbness of hands and feet
  • tachycardia
  • increased CMO
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19
Q

In respiratory alkalemia, cerebral blood flow is ____

A

decreased

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20
Q

What is the acronym of respiratory alkalemia?

A

H O R N S

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21
Q

What does the H in respiratory alkalemia stand for?

A

hypoxemia

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22
Q

What does the O in respiratory alkalemia stand for?

A

overzealous mechanical ventilation

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23
Q

What does the R in respiratory alkalemia stand for?

A

restrictive lung disorder (stimulates faster breathing)

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24
Q

What are some examples of restrictive lung disorders that cause respiratory alkalemia?

A
  • fibrosis
  • CHF
  • ARDS
  • pneumonia
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25
Q

What does the N in respiratory alkalemia stand for?

A

neurologic disorders

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26
Q

What are some examples of neurologic disorders that cause respiratory alkalemia?

A
  • infection
  • trauma
  • salicylates
  • drugs
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27
Q

What does the S in respiratory alkalemia stand for?

A

septicimia

28
Q

What drug is used to stimulate the diaphragm in patients with COPD?

A

aminophylline

29
Q

What is the acronym for metabolic acidemia caused by an increased in fixed acids?

A

T A L K

30
Q

What does the T in metabolic acidemia stand for?

A

Toxins

31
Q

What are some examples of toxins that cause metabolic acidemia?

A
  • salicylates
  • wood alcohol
  • antifreeze
  • toluene
32
Q

What does the A in metabolic acidemia stand for?

A

azotemic renal failure

33
Q

What are the 3 phases of renal failure?

A

pre
intra
post

34
Q

What are indicators that a patient is in pre renal failure?

A
  • BUN >80
  • creatinine unaffected
  • SP > 1.02
  • dark urine
  • hypotension or hypovolemia
35
Q

What are indicators that a patient is in intra renal failure?

A
  • BUN >80
  • creatinine >8
  • SP <1.015
  • clear urine
36
Q

What are indicators that a patient is in post renal failure?

A
  • low urine output (if any, usually bloody)

- BUN and creatinine cannot be measured

37
Q

What drug is given to a patient in metabolic acidemia?

A

lasix

38
Q

What drug is given to a patient in metabolic alkalemia?

A

diamox

39
Q

What is the only exception in decrease in bases due to buffering?

A

chloride

40
Q

What does the L in metabolic acidemia stand for?

A

lactic acid (most common and caused by hypovolemia)

41
Q

What are some examples that cause an increase in lactic acid?

A
  • hypoxemia
  • ethanol intake
  • liver damage
  • poisonings
42
Q

What are the causes of an increase in protein metabolism?

A
  • bleeding into stomach
  • corticosteroids
  • increase in protein intake
  • infection
  • starvation
  • surgery
  • trauma
43
Q

What are the causes of a decrease in excretion of protein?

A
  • dehydration
  • vomiting
  • diarrhea
44
Q

What should you look at to assess kidney function and what is the normal range?

A

creatinine; 0.5-1.5

45
Q

What does the K in metabolic acidemia stand for?

A

keto acidosis (diabetic crisis)

46
Q

What are the causes of keto acidosis?

A
  • hyperglycemia
  • glycosuria
  • ketouria
47
Q

What is glycosuria?

A

excess glucose in urine

48
Q

What are the signs/symptoms of keto acidosis?

A
  • vomiting
  • hyperkalemia
  • kussmauls breathing
  • boryborgymus
49
Q

What is boryborgymus?

A

swelling of the stomach

50
Q

What is ketouria?

A

accumulation of ketone bodies

51
Q

What are the causes of metabolic acidemia due to a decrease in bases?

A
  • renal tubular acidosis
  • enteric fluid loss
  • diamox
52
Q

What are the ways or diseases that cause a to have enteric fluid loss?

A
  • biliary or pancreatic disease
  • enteric drainage tubes
  • diarrhea
  • sustained deep vomiting
53
Q

What is the acronym for metabolic alkalemia?

A

H I G H B A S E

54
Q

What does the 1st H in metabolic alkalemia stand for?

A

hypokalemia, hypochloremia, hypovolemia

55
Q

What does the I in metabolic alkalemia stand for?

A

ingestion of base (milk, excessive bicarb, chewing tobacco)

56
Q

What does the G in metabolic alkalemia stand for?

A

gastric fluid loss (NG tube)

57
Q

What does the 2nd H in metabolic alkalemia stand for?

A

hyperaldosterone (increase in aldosterone increases your level of sodium bicarb)

58
Q

What does the B in metabolic alkalemia stand for?

A

blood transfusion

59
Q

Why does a blood transfusion cause metabolic alkalemia?

A

in stored blood, there is an anticoagulate called citrate. when a person metabolizes citrate, it is converted to bicarb and s/he ends up with metabolic alkalemia

60
Q

What does the A in metabolic alkalemia stand for?

A

adrenocortical hypersecretion (increase in sodium bicarb absorption)

61
Q

What does the S in metabolic alkalemia stand for?

A

steroids (increase in sodium bicarb absorption)

62
Q

What does the E in metabolic alkalemia stand for?

A

eucapnic ventilation post hypercapnia (buffering left over from metabolic acidemia)

63
Q

How many steps are there for highbase?

A

4

64
Q

What is the 1st step for highbase?

A

look for high base intake

65
Q

What is the 2nd step for highbase?

A

look for any diuretic therapy

66
Q

What is the 3rd step for highbase?

A

check hydration status (dehydration = increase in aldosterone)

67
Q

What is the 4th step for highbase?

A

check for adrenal disease

RTH 236 (21 decks)

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