Week 2: Fluid Balance Part 2 Flashcards
pH
Acid = less than 7.35
Base = more than 7.45
CO2 (acid- lungs) —————-HCO3 (base - kidneys)
Extracellular Buffer Systems
Minor
Hemoglobin
Proteins
Phosphates
Major***
Bicarbonate-Carbonic Acid
20 HCO3: 1 H2CO3 20:1 ratio
The Lungs
↓ RR –> CO2 –> acidosis
At risk populations:
CNS depression, lung health issues
Anything that decreases respiratory rate will cause acidosis because we aren’t excreting enough co2 - retaining co2
↑ RR –> CO2 –> alkalosis
At risk populations:
Hyperventilation
If we increase our respiratory rate (hyperventilation) will cause alkalosis – excreting a lot of CO2
The Kidneys
Regulate both H+ and HCO3-
Compensation
During Acidosis (low pH):
↑ H+ secretion ->U/O
During Alkalosis (high pH):
↑ HCO3- secretion -> U/O
Potassium Acidosis
Acidosis
High H+ ions outside the cell -> move into the cell to balance pH
In response, K+ moves outside the cell to balance electric forces -> increase serum K+
ACIDOSIS CAUSES HYPERKALEMIA
Potassium Alkalosis
Alkalosis
H+ ion inside the cell -> move outside the cell to balance pH
In response, K+ moves inside the cell to balance electric forces -> decrease serum K+
ALKALOSIS CAUSES HYPOKALEMIA
Respiratory Acidosis
LOW pH & HIGH CO2
Causes
Deficits in lung function related to airway obstruction or depression of the respiratory system
S&S
Hypoventilation, shallow, slow RR
Interventions
Monitor SpO2, RR, labs, Arterial Blood Gases
Place in Semi-Fowlers
Encourage DB&C and administer O2 treatments***
Correct cause
Respiratory Alkalosis
HIGH pH & LOW CO2
Causes
Panic Attack
S&S
Hyperventilation
Interventions
Monitor for respiratory distress
labs (Lytes), Arterial Blood Gases
Administer O2 treatments
Correct cause –> provide emotional support
Metabolic Acidosis
LOW pH & LOW HCO3
Causes
Excessive diarrhea, renal failure, DKA
S&S-Compensation
low pH -> increase RR
Interventions
Monitor respiratory distress, Arterial Blood Gases
I/O -> Lytes (potassium)
Administer IV base buffer
Correct cause
Metabolic Alkalosis
HIGH pH & HIGH HCO3
Causes
Vomiting and Excessive NG Suctioning
S&S-Compensation
high pH decrease RR
Interventions
Monitor respiratory distress, Arterial Blood Gases
I/O –> Lytes (potassium)
Administer IV K replacement
Correct cause
Respiratory Acid-Base Imbalances
Lungs=Respiratory=CO2
↓ RR –> CO2 + ↓ pH –> respiratory acidosis
↑ RR –> CO2 + ↑ pH –> respiratory alkalosis
Metabolic Acid-Base Imbalance
Kidneys=Metabolic=HCO3-
↓ HCO3- + ↓ pH –> metabolic acidosis
↑ HCO3- + ↑ pH –> metabolic alkalosis
PaCO2
RESPIRATORY (LUNGS)
Base– 35 - 40 – Acid
HCO3
METABOLIC (KIDNEYS)
Acid– 22 -26 – Base
Uncompensated
pH abnormal, other measure normal
Partially compensated
pH abnormal, other measure abnormal and opposite
Fully Compensated
pH normal, measures (1 or both) abnormal
RBC (red blood cells)
Erythropoietin: stimulates RBC production by red bone marrow, secreted by kidneys
Highs:
Erythrocytosis
Hypoxia ↑ erythropoietin
Lows:
Anemias: Loss or destruction of RBCs, ↓ erythropoietin, Bone Marrow Suppression (Cancers & Chemotherapy)
Hgb (hemoglobin)
Component of RBCs that carry oxygen
Highs:
not common
Lows:
Anemias: Loss or destruction of RBCs, ↓ erythropoietin, Bone Marrow Suppression (Cancers & Chemotherapy)
Hct (hematocrit)
RBC percentage in proportion to plasma volume
Measure of hydration, good hydration = normal-low Ht
Highs:
Fluid DEFICIT
(think RBCs very concentrated because lacking fluid)
Lows:
Fluid EXCESS
(think RBCs diluted in excess fluid)
Measure of fluid volume (hydration) good hydration means low Hct = RBC are very diluted
WBC (leukocytes)
Differential:
Neutrophils
Eosinophils
Basophils
Lymphocytes
Monocytes
Total WBCs
Normal value=healthy immune system able to reasonably defend
Highs:
leukocytosis - high WBCs
infection
Lows: leukopenia = low WBCs
Inmmuno-suppression
Hemostatis: Normal Clotting
- vasoconstriction
- formation of platelet plug (adhesion–activation and secretion–aggregation)
- Formation of fibrin clot (Clotting factors in blood [12 proteins called factors (Roman numeral)] work together to make fibrin threads woven into the platelet plug)
Plt (platelets)
Coagulation
Formed in bone marrow, reservoir in spleen
Highs: Thrombocytosis: clotting
Lows: Thrombocytopenia: bleeding
PT/INR
Measure of time for clot to form in sample
Highs: Blood takes longer time to clot=bleeding risk, blood thinner
Lows: Blood clots quickly
Blood Transfusion: Packed red blood cells (PRBC)
Major uses: Most common
Bleeding or anemia - with S&S of impaired tissue oxygen delivery (tachycardia, SOB, Dizziness)
Administration:
Blood tubing required
Initiate transfusion slowly for first 15 minutes (unless there has been massive blood loss)
Transfuse for no longer than 4 hours
Expected findings:
Accurate change in Hbg 4-6 hours post-transfusion
If there is no increase, think bleeding
Blood Transfusion: Fresh Frozen Plasma
Major uses:
Volume expansion – massive transfusion with PRBCs
Clotting factors – coagulopathy, plasma exchange procedures (some
disease)
Administration:
Blood tubing required
Initiate transfusion slowly for first 15 minutes (unless there has been
massive blood loss)
Transfuse over no more than 4 hours
Blood Transfusion: Platelets
Major uses:
Control or prevent bleeding in patients with:
Thrombocytopenia (low platelet count)
Congenital platelet dysfunction
Drug-induced platelet dysfunction
Platelet dysfunction following cardiopulmonary bypass
Administration:
Blood tubing required
Initiate transfusion slowly for first 15 minutes (unless there has
been massive blood loss)
Transfuse over no more than 4 hours
Blood Transfusion Nursing Practice: Pre Transfusion
Pre-Transfusion
- Consent
- Review transfusion orders (clear, complete and appropriate!)
- Assessment
- Equipment
Nursing Practice Pre Transfusion: Consent
consent obtained by PHYSICIAN
Blood products can only be given without consent in the following circumstances:
Urgent transfusion needed to preserve life AND
Patient unable to consent and substitute decision maker unavailable AND
No evidence of prior reason for refusing blood products due (religious/personal)
Blood transfusion nursing practice: Orders
must be ordered by a physician or authorized practitioner
Blood Transfusion nursing practice: assessments
Take vitals - TEMP is critical (30 mins prior to transfusion)
Respiratory assessment
CV assessment (Edema, fluid overload risk, history of CHF)
Integumentary (rashes, petechiae, bruising)
Blood Transfusion Medication for febrile reactions
antipyretic - fever
Common S&S Post Transfusion
Common S&S
FeverShaking, chills or rigorsHives, rash, itchiness, swelling Dyspnea, SOB, wheezing Hypo/hypertension Hematuria, diffuse bleedingPain at IV site Nausea, Vomiting Headache
Febrile Non-Hemolytic Reaction
Mild usually self-limiting reaction associated with donor white blood cells or cytokines in the blood component/product.
Usually presents with fever and/or rigors (shaking).
Acute Hemolytic Transfusion Reaction
Potentially fatal reaction caused by blood group incompatibility. Can also be caused by chemical hemolysis (e.g. incompatible solutions) or mechanical hemolysis (e.g. improper storage).
Key signs are hypotension, back pain, fever.
Transfusion Related Acute Lung Injury (TRALI)
Acute hypoxemia with evidence of new bilateral lung infiltrates on X-Ray and no evidence of circulatory overload. Patients often require ventilatory support. Usually occurs within 1-2 hours of start of transfusion and rarely after 6 hours. Usually resolves within 24-72 hours with death occurring in 5-10%. Cause not fully understood. Postulated to be related to donor or recipient antibodies acquired through pregnancy or transfusion.
Transfusion Associated Circulatory Overload (TACO)
Circulatory overload from excessively rapid transfusion and/or in patients at greater risk for overload (e.g. very young, elderly, impaired cardiac function). Preventative measures include slower transfusion rates and pre-emptive diuretics for patients at risk.
Hypotensive Reaction
Bradykinin-mediated hypotension. Characterized by profound drop in blood pressure usually seen in patients on ACE Inhibitors unable to degrade bradykinin in blood component/product.
In event of a reaction: Blood Transfusion
- Stop the transfusion immediately
- Maintain IV access for treatment but do not flush the blood tubing
- Check VS
- Verify the patient ID matches the blood bank label and tag
- Verify the blood unit number matches the blood bank label and tag
- Notify physician but remain with patient
- Notify the blood bank about the reaction (follow organizational policy)
- Treat patient’s symptom as ordered by physician
