Unit 6 Flashcards
What is acid-base balance?
The homeostasis of the hydrogen ion concentration in body fluids, maintaining a normal pH between 7.35–7.45.
What systems maintain acid-base balance?
Buffer systems, respiratory regulation (lungs), and renal regulation (kidneys).
What is the normal pH range?
7.35 – 7.45
What is the normal range for PaCO₂?
35 – 45 mm Hg
What is the normal range for HCO₃⁻?
22 – 26 mEq/L
What is the normal range for PaO₂?
80 – 100 mm Hg
What is the normal SaO₂ level?
> 95%
What are the three types of buffer systems?
- Chemical buffers
- Respiratory system
- Renal system
What is respiratory acidosis?
A condition caused by hypoventilation leading to CO₂ retention.
What are common causes of respiratory acidosis?
- COPD
- Pneumonia
- Drug overdose
- Respiratory depression
What are the ABG findings for respiratory acidosis?
- ↓ pH (<7.35)
- ↑ PaCO₂ (>45 mm Hg)
- HCO₃⁻ normal or ↑ if compensated
What are the signs and symptoms of respiratory acidosis?
- Confusion
- Drowsiness
- Headache
- Slow/shallow breathing
- Seizures and coma
- Hypotension
- Warm, flushed skin
What are nursing interventions for respiratory acidosis?
- Improve ventilation (positioning, suctioning, bronchodilators, oxygen with caution in COPD)
- Administer O2
- Put patient in Semi-Fowler’s
- Have patient turn, cough, & take deep breaths
- Pneumonia: increase fluids to thin secretions and administer antibiotics
- Monitor K+ levels
What is respiratory alkalosis?
A condition caused by hyperventilation leading to CO₂ loss.
What are common causes of respiratory alkalosis?
- Anxiety
- Pain
- Fever
- Early sepsis
What are the ABG findings for respiratory alkalosis?
- ↑ pH (>7.45)
- ↓ PaCO₂ (<35 mm Hg)
- HCO₃⁻ normal or ↓ if compensated
What are the signs and symptoms of respiratory alkalosis?
- Dizziness
- Lightheadedness
- Numbness/tingling
- Palpitations/Tachycardia
What are nursing interventions for respiratory alkalosis?
- Encourage slow breathing
- Reduce anxiety/stress
What is metabolic acidosis?
A condition caused by HCO₃⁻ loss or H⁺ gain.
What are common causes of metabolic acidosis?
- Diabetic ketoacidosis (DKA)
- Renal failure
- Diarrhea
- Lactic acidosis
What are the ABG findings for metabolic acidosis?
- ↓ pH (<7.35)
- ↓ HCO₃⁻ (<22 mEq/L)
- PaCO₂ normal or ↓ if compensating
What are the signs and symptoms of metabolic acidosis?
- Kussmaul respirations
- Confusion
- Fatigue
- Nausea
- Dysrhythmias
- Hypotension
What are nursing interventions for metabolic acidosis?
- Treat underlying cause (insulin for DKA, fluids, dialysis)
- Monitor potassium
What is metabolic alkalosis?
A condition caused by HCO₃⁻ excess or acid loss.
What are common causes of metabolic alkalosis?
- Vomiting
- NG suctioning
- Diuretic use
- Antacid overuse
What are the ABG findings for metabolic alkalosis?
- ↑ pH (>7.45)
- ↑ HCO₃⁻ (>26 mEq/L)
- PaCO₂ normal or ↑ if compensating
What are the signs and symptoms of metabolic alkalosis?
- Muscle cramps
- Tingling
- Hypokalemia
- Seizures
What are nursing interventions for metabolic alkalosis?
- Replace electrolytes (especially potassium)
- Treat cause
- Antiemetics
Define uncompensated acid-base imbalance.
Only one system abnormal.
Define partially compensated acid-base imbalance.
All values abnormal.
Define fully compensated acid-base imbalance.
pH normal, but PaCO₂ or HCO₃⁻ still abnormal.
What mnemonic helps to master acid-base balance interpretation?
ROME: Respiratory = Opposite, Metabolic = Equal.
What physiological change occurs in pregnancy regarding acid-base balance?
Mild respiratory alkalosis due to increased minute ventilation.
What happens to PaCO₂ during pregnancy?
It drops due to hyperventilation stimulated by progesterone.
How do the kidneys compensate during pregnancy?
By excreting bicarbonate (HCO₃⁻) to maintain pH balance.
What is a key consideration for fetal oxygenation in relation to maternal acid-base balance?
A slightly alkalotic state promotes CO₂ diffusion from fetus to mother.
What are common diagnostic tests for respiratory issues?
- Arterial blood gases (ABGs)
- Chest X-ray
- CBC
- Sputum culture
- CT scan of chest
- V/Q scan
- Pulmonary function tests (PFTs)
What are primary prevention strategies for respiratory health?
- Infection control (hand hygiene, masks)
- Smoking cessation
- Immunizations
- Healthy lifestyle
What are secondary prevention strategies for respiratory health?
- TB screening
- Early detection of respiratory conditions
What are pharmacologic collaborative interventions for respiratory conditions?
- Bronchodilators
- Corticosteroids
- Antihistamines
- Mucolytics
- Antibiotics
- Anticoagulants
What are non-pharmacologic collaborative interventions for respiratory conditions?
- Oxygen therapy
- Airway management
- Positioning
- Incentive spirometry
- Mechanical ventilation
What are common conditions linked to impaired gas exchange?
- Pneumonia
- Asthma
- COPD
- Pulmonary embolism
- Heart failure
- Anemia
- Neuromuscular disorders
What are the components of the upper respiratory tract?
- Nose
- Sinuses
- Pharynx
- Larynx
- Trachea
What are the components of the lower respiratory tract?
- Bronchi
- Bronchioles
- Alveoli
What is the definition of pleural effusion?
Excess fluid in pleural space.
What are the types of pleural effusion?
- Transudative (e.g., CHF)
- Exudative (e.g., infections, malignancy)
What are the signs and symptoms of pleural effusion?
- Dyspnea
- Chest pain
- ↓ breath sounds
- Dull percussion
What is the definition of pulmonary embolism (PE)?
Blockage of pulmonary artery (usually by thrombus).
What are some risk factors for pulmonary embolism?
- DVT
- Immobility
- Surgery
- Pregnancy
- Birth control
What are the signs and symptoms of pulmonary embolism?
- Sudden dyspnea
- Chest pain
- Tachycardia
- Hemoptysis
- Anxiety
What is the purpose of thoracentesis?
To diagnose or relieve pleural effusion.
What are nursing considerations for specimen collection in respiratory infections?
- Use aseptic technique to prevent contamination.
What is the normal SpO₂ range?
95–100%
What is the purpose of sputum culture?
To identify bacterial infections.
What are common diagnostic tests for assessing gas exchange?
- Pulse oximetry
- ABGs
- Chest X-ray
- CT scan
- Bronchoscopy
- Thoracentesis
What is the purpose of respiratory secretion specimens?
To identify pathogens causing respiratory infections and guide appropriate treatment.
What are the common types of respiratory specimens?
- Nasopharyngeal Swab
- Sputum Sample
- Tracheal Aspirate
What is a nasopharyngeal swab used for?
Detecting viruses like RSV and influenza.
What nursing considerations should be taken when collecting respiratory specimens?
- Use aseptic technique
- Collect specimens before initiating antibiotic therapy
- Ensure proper labeling and prompt transport to the laboratory
- Provide comfort measures to minimize distress during collection.
What are the goals of maintaining respiratory function?
- Maintain airway patency
- Ensure adequate oxygenation and ventilation
- Prevent complications associated with respiratory dysfunction.
What positioning intervention can facilitate lung expansion?
Elevate the head of the bed.
What is the main cause of bronchiolitis in infants and young children?
Respiratory Syncytial Virus (RSV).
What are common symptoms of bronchiolitis?
- Cough
- Wheezing
- Tachypnea
- Nasal flaring
- Feeding difficulties.
Define interpersonal violence (IPV).
The intentional use of power or force, actual or threatened, against oneself, another person, or a group, that results in or has a high likelihood of resulting in injury, death, psychological harm, or deprivation.
What are the types of interpersonal violence?
- Physical Violence
- Sexual Violence
- Emotional/Psychological Abuse
- Neglect.
What are some risk factors for child maltreatment?
- Parental substance abuse
- Mental health issues
- Domestic violence
- Poverty and social isolation.
List some warning signs of interpersonal violence.
- Unexplained injuries
- Frequent ER visits
- Delay in seeking treatment
- Fearful, anxious, submissive behavior.
What is the cycle of violence in intimate partner violence?
- Tension-Building Phase
- Acute Battering Incident
- Honeymoon Phase.
What are the primary prevention strategies for interpersonal violence?
- Education (healthy relationships, parenting skills)
- Community resources
- Screening programs.
What are the health implications of human trafficking?
- Increased risk for sexually transmitted infections (STIs)
- Unintended pregnancies
- Mental health disorders such as anxiety, depression, and PTSD.
What are the common diagnostic indicators for addiction?
- Toxicology Screens
- Liver function tests
- Infectious disease screening
- Mental health evaluation.
Define addiction.
A compulsive, chronic physiological and psychological craving for a substance or behavior despite harmful consequences.
What are the key attributes of addiction?
- Compulsive Use
- Cravings
- Loss of Control
- Continued Use Despite Harm
- Tolerance & Withdrawal.
What are some populations at risk for addiction?
- Adolescents
- Older adults
- People with mental health disorders
- Those with a family history of addiction
- Trauma survivors.
What tools are commonly used for addiction assessment and screening?
- SBIRT
- CAGE
- DAST.
What is the definition of bullying?
Repeated aggressive behavior intended to hurt another individual, physically or emotionally.
What are the types of bullying?
- Physical
- Verbal
- Social/Relational
- Cyberbullying.
What nursing actions can help address bullying?
- Educate children and families
- Encourage open communication
- Collaborate with schools to implement anti-bullying programs.
What nursing interventions should be taken for suspected child maltreatment?
- Conduct thorough assessments
- Report suspicions to child protective services
- Document observations meticulously.
What should be prioritized in nursing assessment for interpersonal violence?
Ensure safety first.
What is the importance of documentation in cases of suspected abuse?
Must be factual, thorough, and free from bias or judgment.
Fill in the blank: Addiction is a primary, chronic disease of brain _______.
[reward, motivation, memory, and related circuitry].
What is the first stage of the Stages of Change Model?
Precontemplation - Not considering change
What does the Contemplation stage in the Stages of Change Model signify?
Aware of problem, thinking about change
What is involved in the Preparation stage of the Stages of Change Model?
Planning for change
What actions are taken during the Action stage of the Stages of Change Model?
Taking steps toward change
What does the Maintenance stage of the Stages of Change Model focus on?
Sustaining new behavior
True or False: Relapse is considered a failure in the Stages of Change Model.
False - Relapse is part of the process; not failure
What is a key nursing consideration when treating patients?
Maintain nonjudgmental, empathetic communication
Why is it important to assess for readiness to change?
To use the Stages of Change Model effectively
What should be prioritized in treatment to ensure patient safety?
Safety (overdose risk, withdrawal)
What harm reduction strategy can be promoted in treatment?
Needle exchange programs
Who should healthcare providers collaborate with for effective treatment?
Interdisciplinary team
Fill in the blank: ______ is a related concept that involves how individuals manage stressors.
Coping
Fill in the blank: ______ is a related concept that affects individuals’ psychological well-being.
Mental Health
Fill in the blank: ______ is a concept that includes the dynamics within family relationships.
Family Dynamics
Fill in the blank: ______ refers to policies regarding health care access and services.
Health Policy & Access to Care
What is a critical element in promoting effective communication in patient care?
Empathetic communication
Signs and symptoms of ABGs of PH 7.50 and PaCo2 30 mmHg – manifestations.
Nausea
Confusion
Tachycardia
Lightheadedness
A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
B. metabolic alkalosis
S/S of patient with deep respirations, low pH, normal Pa02, normal PaC02, low Bicarb?
Metabolic acidosis
S/S = Headache, decreased BP, hyperkalemia, muscle twitching, warm flushed skin, Nausea, vomiting, diarrhea, changes in LOC, confusion, drowsiness, Kussmaul’s Respirations
Patient on ventilator with high pH, normal Pa02, low PaC02, and normal bicarb?
Respiratory Alkalosis
S/S = Seizures, Kussmaul’s respirations, hyperventilation, tachycardia, low or Normal BP, hypokalemia, numbness/tingling of extremities, lethargy Confusion, lightheadedness, nausea, vomiting
Respiratory Acidosis
Treatment is aimed at the underlying disease, and may include:
*Bronchodilator drugs to reverse some types of airway obstruction
*Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or a breathing machine, if needed
*Oxygen if the blood oxygen level is low
*Treatment to stop smoking
For severe cases, a breathing machine might be needed
Metabolic Acidosis
Treatment is aimed at the underlying disease, and may include:
The earlier you’re treated, the better:
* Detoxification, if you have drug or alcohol poisoning
* Insulin, if you have DKA
* Manage your diabetes, if you have it IV fluids, given by needle through a vein in your arm
* Sodium bicarbonate, by IV
* Limit alcohol. It can increase acid buildup. It can also dehydrate you
* Drink plenty of water and nonalcoholic fluids
Respiratory Alkalosis
Treatment is aimed at the condition that causes respiratory alkalosis;
Treatment is aimed at the condition that causes respiratory alkalosis;
* Reassurance to reduce anxiety levels
* Rebreathing into a paper bag during acute episodes. Breathing into a paper bag – or using a mask that causes you to re-breathe carbon dioxide. Sometimes helps reduce symptoms when anxiety is the main cause of the condition
* Your carbon dioxide level needs to return to normal if you have respiratory alkalosis
* If you have rapid breathing caused by anxiety, taking slow, deep breaths can often improve symptoms and regulate your oxygen level
* If tests reveal that you have a low oxygen level, you’ll need to receive oxygen through a mask
* If your rapid breathing is caused by pain, then treating the pain will help bring your respiratory rate back to normal and improve your symptoms
* Tx for underlying psychological stress
Metabolic Alkalosis (Treatment)
- Correct cause if possible (eg correct pyloric obstruction, cease diuretics)
- Correct the deficiency which is impairing renal bicarbonate excretion (ie give chloride, water and K+)
- Expand ECF Volume with N/saline (and KCl if K+ deficiency)
- Rarely ancillary measures such as:
1. HCl infusion
2. Acetazolamide (one or two doses only)
3. Oral lysine hydrochloride
4. Supportive measures (eg give O2 in view of hypoventilation; appropriate monitoring and observation)
5. Avoid hyperventilation as this worsens the alkalemia
ABGS know S/s:
Vomiting – ?
Diarrhea – ?
Vomiting – alkalosis
Diarrhea – acidosis
S&S of Addiction
- Insomnia
- Headaches
- Changes in mood
- Vague physical complaints
- Overuse of mouthwash or toiletries
Pharamcotherapy in substance abuse recovery
- Methadone - opiate withdrawal
- Buprenorphine - alternative to methadone
- Suboxone - Reduces abuse of buprenorphine
- Clonidine - symptom relief for opiate withdrawal
- Nicotine gum or patches or bupropion
- Naltrexone, nalmefene, and acamprosate - acute alcohol withdrawal
- Disulfriam - alcohol addiction to prevent impulsive drinking
Patient education about Disulfiram (alcohol)
Usually requires written consent to ensure that the patient is fully informed of the risks and aware that he or she must not consume anything containing alcohol because it causes causing severe headache, nausea, vomiting, palpitations, flushing, tachycardia, chest pain, and dizziness.
Patient Teaching
Such food items as vanilla extract and over-the-counter preparations of cough medicine and mouthwash often contain alcohol and are likely to induce the side effects of disulfiram and alcohol incompatibility
No form of alcohol should be consumed for at least 2 weeks after discontinuation of disulfiram
Signs of alcohol withdrawal syndrome are
- Alterations in Mental status (irritability, deoression)
- Anorexia
- Tremors
- Seizures
- Tachycardia
- HTN
- Late signs such as: Bradycardia or Hypotension are indicative of cardiovascular collapse and the impending need for resuscitation
Heavy alcohol use leads to poor nutritional intake and also inhibits B vitamin absorption (especially vitamin B1 [thiamine]). This leads to alcohol neuropathy from irreversible brain damage with manifestations of:
- Psychosis
- Ataxia
- Abnormal eye movements
- Death
Standard treatment for alcohol withdrawal for all patients should also include daily injections of:
B-complex vitamins
Long term use of toxic substances may harm the LIVER and result in symptoms of liver failure:
- Jaundice
- Fatigue
- Abdominal discomfort
- Ascites
- Vitamin K deficiency
- Thiamine deficiency (leads to encephalopathy)
How do rebound symptoms present in addiction to stimulant vs addiction to sedation?
Stimulant drug rebound effects are sedating.
Sedation drug rebound effects manifest as agitation.
Alcohol Abuse = Minor Withdrawal Syndrome
Treatments
- Benzodiazepines (such as chlordiazepoxide [Librium], lorazepam [Ativan], or diazepam [Valium]).To stabilize vital signs, reduce anxiety, and prevent seizures and delirium
- Thiamine (prevents Wernicke’s encephalopathy)
- Multivitamins (folic acid, B vitamins)
- Magnesium sulfate (if serum magnesium is low)
- IV glucose solution
Alcohol Abuse = Major Withdrawal Syndrome
Treatments
- Continued use of benzodiazepines
- Carbamazepine (Tegretol) or phenytoin (Dilantin) to treat seizures
- Antipsychotic agents (e.g., chlorpromazine [Thorazine], haloperidol [Haldol]) if psychosis persists after benzodiazepine administration
