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3910 Health Promotion & Caring: Client's with Health Challenges I > Week 2 Acid/Base & Hematology > Flashcards

Week 2 Acid/Base & Hematology Flashcards

1
Q

Minor Buffer Systems

A
  • Hemoglobin
  • Proteins
  • Phosphates
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2
Q

Major Buffer System

A
  • Bicarbonate-Carbonic Acid
    20 HCO3 : 1 H2CO3 = 20:1 ratio
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3
Q

Nursing Assessments Acid Base Imbalances

A
  • Arterial blood gases (ABGs) - only way to measure body pH
  • Vital signs - RR, SpO2
  • Intake/output, electrolytes
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4
Q

Potassium Acidosis

A
  • High H+ outside of cell, move into cell to balance pH
  • K+ moves outside cell to balance electric forces
  • Increase serum K+
  • Acidosis causes hyperkalemia
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5
Q

Potassium Alkalosis

A
  • H+ inside cell moves outside to balance pH
  • K+ moves inside cell to balance electric forces
  • Decrease serum K+
  • Alkalosis causes hypokalemia
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6
Q

Increased CO2

A
  • Decreased RR
  • Acidosis
  • CNS depression, lung health issues
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7
Q

Decreased CO2

A
  • Increased RR
  • Alkalosis
  • Hyperventilation
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8
Q

Acidosis Compensation

A
  • Increased RR to blow off CO2
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9
Q

Alkalosis Compensation

A
  • Decreased RR to retain CO2
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10
Q

Respiratory Acidosis

A
  • Low pH high CO2
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11
Q

Respiratory Acidosis Causes

A
  • Deficits in lung function = retain CO2
  • Airway obstruction, depression of resp system
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12
Q

Respiratory Acidosis Signs/Symptoms

A
  • Hypoventilation
  • Shallow resps
  • Low RR
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13
Q

Respiratory Acidosis Interventions

A
  1. Support breathing - semi fowlers
  2. Encourage deep breathing & coughing
  3. Administer O2
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14
Q

Respiratory Alkalosis

A
  • High pH low CO2
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15
Q

Respiratory Alkalosis Causes

A
  • Increase in RR, blow of CO2
  • Panic attack
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16
Q

Respiratory Alkalosis Signs/Symptoms

A
  • Hyperventilation
  • Increased RR
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17
Q

Respiratory Alkalosis Interventions

A
  1. Support breathing - semi fowlers
  2. Encourage deep breathing and coughing
  3. Administer O2
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18
Q

Decreased H+

A
  • Alkalosis
  • At risk: upper GI losses, loss of acid
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19
Q

Decreased HCO3-/Increased H+

A
  • Acidosis
  • At risk: lower GI, loss of base, kidney failure, inappropriate secretion of base/retention of H+
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20
Q

Acidosis Compensation

A
  • Increased H+ secretion
  • Urine output
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21
Q

Alkalosis Compensation

A
  • Increased HCO3- secretion
  • Urine output
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22
Q

Metabolic Acidosis

A
  • Low pH & low HCO3-
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23
Q

Metabolic Acidosis Causes

A
  • Lower GI losses = loss of bicarb
  • Kidney failure = inappropriate secretion of bicarb
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24
Q

Metabolic Acidosis Signs/Symptoms

A
  • Diarrhea
  • Kidney failure
  • Compensation by resp system to get rid of acid = increased RR
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25
Metabolic Acidosis Interventions
- Monitor increase K, may administer K removers - Correct cause administer IV base
26
Metabolic Alkalosis
- Hight pH & high HCO3
27
Metabolic Alkalosis Causes
- Upper GI losses = loss of H+
28
Metabolic Alkalosis Signs/Symptoms
- Vomiting, high volume of GI suction - S/S kidney failure - Compensation by resp - retain acid to bring back neutral decrease RR
29
Metabolic Alkalosis Interventions
- Monitor K, may administer K supplementations - Correct cause
30
Uncompensated
- pH abnormal - Other measure normal
31
Partially Compensated
- pH abnormal - Other measure abnormal + opposite
32
Fully Compensated
- pH normal - Measures (1 or both abnormal)
33
Compensation
- Will eventually break down - Correct root cause - Just because pH is normal does not mean no intervention
34
Erythrocyte Layer Components
- RBC - Hemoglobin HGB - Hematocrit Hct
35
Buffy Coat Components
- WBC - Platelets Plt
36
RBC Caution
Can have low RBC without impacting hemoglobin
37
Hemoglobin HGB
- Protein that carries oxygen
38
Hematocrit Hct
- Reflects hydration - % by volume of RBC in proportion to plasma volume
39
Low Platelets Plt
- Poor clotting, more bleeding - Thrombocytopenia
40
High Platelets
- Thrombocytosis - Clotting
41
Low Hematocrit
- Fluid overload - RBCs diluted due to excess fluid
42
High Hematocrit
- Fluid deficit - High concentration of RBC due to lack of fluid
43
Prothromin Time/Internationalized Ratio PT/INR
Clotting times 11-13 seconds
44
Low PT/INR
- Lower clotting ability - More bleeding - Thinner Blood
45
High PT/INR
- Quick Clotting
46
High RBCs
- Erythrocytosis - Chronic hypoxia - Increase erythropoietin
47
Low RBCs
- Anemias - Loss/destruction of RBCs - Decrease erythropoietin - Bone marrow suppression (cancers & chemotherapy)
48
Low Hemoglobin
- Anemias - Loss/destruction of RBCs - Decrease erythropoietin - Bone marrow suppression (cancers & chemotherapy)
49
High WBCs
- Leukocytosis - Infection
50
Low WBCs
- Leukopenia - Immunosuppression
51
Normal Clotting
1. Vasoconstriction 2. Formation of platelet plug - Adhesion - Activation & secretion - recruit more platelets - Aggregation - platelet club (not strong) block site 3. Formation of fibrin clot - Clotting factors in blood (12 factors) work to make fibrin threads woven into platelet plug
52
Blood Transfusion Cautions
1. Ensuring correct blood product is administered 2. Close monitoring for transfusion reactions
53
Pre-Transfusion Role
- Consent - Review orders (clear, complete, appropriate) - Assessment - Equipment
54
Transfusion Consent
- Obtained by physician - Only for that type of product - Description of product - Risks & benefits - Alternatives - Rationale for treatment
55
Blood Products Without Consent
- Urgent transfusion to preserve life - Patient unable to consent & substitute decision maker unavailable - No prior evidence refusing blood products (religious/personal)
56
Transfusion Order Components
- First & last name + unique identifier - Type of blood product - Number of units/amount - Rate of infusion
57
Pre-Transfusion Assessment
- Typing - Health history - Physical Assessment
58
Group/Type & Screen
- Identified patient blood type, always required - Exception, emergency give universal donor O-
59
Crossmatch
- Tests patients blood with donor blood - Required for all transfusions that are non-emergent/urgent - Decrease risk of reaction
60
Health History Questions
- Transfusion history - Past transfusion reactions - Obstetrical history - fetal blood exposure could create maternal antibodies
61
Physical Assessment
- Vitals - temp max 30 mins prior - Respiratory - CV - edema, fluid overload risk - Integumentary - rashes, petechiae, bruising
62
Pre-Transfusion Medications
- Antipyretic - history of febrile reactions - Antihistamine - history of allergic reactions - Oral route - 30mins prior - IV route - immediately prior
63
Equipment Considerations
- Saline is the only fluid that can be given with blood - Prime tubing with saline ONLY - Reaction, new saline bag, not attached to blood
64
Transfusion MUSTS
- Start transfusion within 30 minutes of picking up blood - Independent double check of blood (2 registered staff) - 5 rights of transfusion - Finish within 4 hours - Document baseline vitals - Document start & finish time + patient tolerance
65
5 Rights of Transfusion
1. Patient 2. Product 3. Amount 4. Rate 5.Time
66
Transfusion Monitoring
1. 0-15mins start SLOW (50mL/hr) monitor closely 2. 15mins recheck vitals, if stable increase rate according to orders 3. Q hour, reassess vitals & patient - Increase vitals monitoring if patient at high risk of complication/reaction 4. Instruct pt to notify immediately (hives, itching, fever, chills, SOB, pain at infusion)
67
Packed Red Blood Cells Major Uses
- Most common type of transfusion - Bleeding/anemia - S/S of impaired tissue oxygen delivery - Tachycardia, SOB, dizziness
68
Pack Red Blood Cells Administration
- Blood tubing required - Typically infuse over 1.5-2hours - Slower infusion for patients at risk for circulatory overload
69
PRBCs Impact
- Changes to Hemoglobin 4-6hrs post transfusion - 1 unit of PRBCs typically = increase 10g/L Hbg 3%Hct - No increase, think bleeding
70
Fresh Frozen Plasma Uses
- Volume expansion - massive transfusion with PRBCs - Clotting factors, coagulopathy, plasma exchange
71
Fresh Frozen Plasma Administration
- Blood tubing required - 30mins-2 hours
72
Platelets Uses
- Control/prevent bleeding - Low platelet counts - Congenital platelet dysfunction - Poor function of platelets - medications - Post cardiopulmonary bypass
73
Platelet Administration
- Blood tubing required - Infuse over 60mins
74
S/S Transfusion Reaction
- Within 6 hours post transfusion - Change in body temp***** - Shaking, chills, rigors - Hives, rash, itchiness, swelling - Dyspnea, SOB, wheezing - Hypo/hypertension - Hematuria, diffuse bleeding - Pain at IV site - Nausea, vomit - Headache
75
Minor Allergic Reaction
- Reaction to allergen in the blood component/product - Mild rash, itching, warm - Administer antihistamines - Slow transfusion - Most common reaction
76
Anaphylaxis
- Potentially fatal - Emergency, difficulty breathing, loss of airway, hives - Stop transfusion
77
Febrile Non-Hemolytic
- Self-limit reaction associated with donor WBCs/cytokines - Mild fever, rigors - Administer antipyretics - Slow transfusion
78
Bacterial Sepsis - Platelet Pool & RBCs
- Potentially fatal, bacteria introduced to blood - Room temp storage - Platelets more common - Emergency - Stop transfusion
79
Acute Hemolytic Transfusion Reaction
- Potentially fatal, blood group incompatibility - Emergency, hypotension, back pain, fever - Stop transfusion
80
Transfusion Related Acute Lung Injury TRALI
- Acute hypoxemia, no evidence of circulatory overload - Emergency, dyspnea & tachypnea, SpO2 below 90% - Stop transfusion
81
Transfusion Associated Circulatory Overload TACO
- Due to rapid transfusion - Mild fluid volume overload symptoms - Tachycardia, hypotension, SpO2 drops - Administer diuretics - Prevent by transfusing very slowly
82
Emergency Reaction
1. Stop transfusion immediately 2. Maintain IV assess, do not flush blood tubing 3. Check vitals 4. Verify patient ID matches blood bank tag & label 5. Verify blood unit number matches blood bank label & tag 6. Notify physician, remain with patient 7. Notify blood bank about reaction 8. Treat symptoms as ordered by provider

3910 Health Promotion & Caring: Client's with Health Challenges I (15 decks)

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