Week Two Modules Flashcards
what two components are involved in acid-base balance?
the respiratory system and the renal system
the respiratory system:
the lungs help maintain a normal pH by excreting ___ and ____ through ____
the amount of CO2 in the blood directly relates to _____ concentration
CO2; water; expiration; carbonic acid concentration
with decreased respirations, more ____ remains in the blood
CO2
the renal system:
the body depends on the ____ to reabsorb and conserve all the _____ they filter
the kidneys will absorb more ____ to compensate for acidosis
kidneys; HCO3-; HCO3-
NORMAL ARTERIAL BLOOD GAS VALUES
what are the normal ranges for pH?
7.35-7.45
NORMAL ARTERIAL BLOOD GAS VALUES
what are the normal ranges for PACO2 (acid)?
35-45 mmHg
NORMAL ARTERIAL BLOOD GAS VALUES
what are the normal ranges for HCO3- (base)?
22-26
NORMAL ARTERIAL BLOOD GAS VALUES
what are the normal ranges for PaO2?
80-100 mmHg
why does respiratory acidosis happen?
when there is carbonic acid excess due to the person hypoventilating
what are some other causes of respiratory acidosis?
copd, sedative overdose, pneumonia, and pulmonary edema
why does respiratory alkalosis happen?
when there is a carbonic acid deficit which occurs with hyperventilation
what is the PRIMARY cause of respiratory alkalosis?
hypoxemia from acute pulmonary disorders
respiratory alkalosis can also occur due to ___, ____, and neurological disorders
pain; anxiety
why does metabolic acidosis happen?
this is due to base bicarbonate deficit
what are the two types of metabolic acidosis?
diabetic ketoacidosis; lactic acidosis
what are some issues that can lead to metabolic acidosis?
diarrhea, starvation, and shock
______: bicarbonate (base) excess
metabolic alkalosis
metabolic alkalosis occurs when there is a loss of acid due to ____ or _____ or a gain in HCO3- (ingesting ____)
vomiting; hypokalemia; baking soda
in RESPIRATORY CONDITIONS, the pH and CO2 go in _____ directions
in respiratory alkalosis, the pH is ___ and the PaCO2 is ____
in respiratory acidosis, the pH is ____ and the PaCO2 is ______
opposite; high; low; low; high
in METABOLIC CONDITIONS, the pH and HCO3- go in the ____ direction
in metabolic alkalosis, both the pH and HCO3- are ___
in metabolic acidosis, both the pH and HCO3- are ___
same; high; low
obstructive respiratory disorders cause an _____ or airway _____
airway obstruction; narrowing
what are some examples of obstructive respiratory disorders?
asthma, chronic bronchitis, copd, and emphysema
restrictive respiratory disorders ____ the ability of the ___ to move
impair; chest wall
what are some examples of restrictive respiratory disorders?
pneumonia; pneumothorax
what are some examples of vascular respiratory disorders?
pulmonary embolus; pulmonary edema
pneumonia is an acute infection of the ______
lung parenchyma
what are risk factors pneumonia?
abdominal surgery, age greater than 65, altered consciousness, chronic diseases
community acquired pneumonia is an acute infection of the lung occuring in patients who live in the community, such as a _____ or _____ within ___ days of onset of symptoms
long term care facility; skilled nursing facility; 14
community acquired pneumonia is the leading cause of ___ from ____
death; infection
hospital acquired pneumonia occurs in a ____, _____ patient 48 hours after admission and is not present at time of admission
hospitalized, non-intubated
ventilator acquired pneumonia occurs in patients who are _____ and happens ___ hours or longer after the patient was intubated
intubated; 48
both hospital acquired pneumonia and ventilator acquired pneumonia are associated with _____ stays
longer hospital
aspiration pneumonia occurs when a patient ____ protect their airway from ___ and _____
cannot; secretions; tube feedings
what are some risk factors that may cause a patient to not be able to protect the airway?
head injury, stroke, or anesthesia
what are some signs and symptoms of aspiration pneumonia?
fever, cough, chills, dyspnea, tachycardia, and WBC increase
when a patient has pneumonia, you can expect to hear what kinds of sounds in the lungs?
crackles, bronchial breath sounds, and wheezes
if the pneumonia patient is suffering from a fever what are some nursing interventions you can perform?
apply a cold cloth to forehead, administer acetaminophen prn
if the pneumonia patient is suffering from chills what are some nursing interventions you can perform?
apply warm blankets, put socks on the feet
patients with pneumonia are often times _____ due to increased work of breathing so what is encouraged?
dehydrated; oral fluids are encouraged and IVFs are often administered
patients with pneumonia may require a _____ and more frequent, smaller meals
high calorie diet
what causes a pneumothorax?
air entering the pleural space
if a patient has a “small” pneumothorax what are some s/s we could expect to see?
mild tachycardia and dyspnea
if a patient has a “large” pneumothorax what are some s/s we could expect to see?
respiratory distress, shallow breathing, and oxygen desaturation
spontaneous pneumothorax happens when a _____, which is an air filled sac on the surface of the lung _____
small bleb; ruptures
what kind of characteristics make an individual “high risk” for developing blebs?
smokers, people who are tall, males, and thin
a spontaneous pneumothorax is considered a ______ pneumothorax
closed
what can cause a traumatic pneumothorax to occur?
stab wound or fence post penetration
a traumatic pneumothorax is considered ______ because there is air ____ into the pleural space
open; moving
what type of pneumothorax is considered a medical emergency?
tension pneumothorax
why is a tension pneumothorax considered an emergency?
because air puts pressure on the heart and the vessels making the cardiovascular system compromised
what are some s/s of a tension pneumothorax?
tachycardia, severe dyspnea, and diaphoresis
what is the purpose of a chest tube?
chest tubes help re-establish negative pressure by pulling out the air in the pleural space via suction
chest tubes typically have ___ chambers
3
the air collects in the _______ as it drains from the pleural space
collection chamber
the ________ prevents backflow of air into the patient
water seal chamber
the ______ applies suction to the chest drainage unit
suction control chamber
what are some tips for nursing management of chest tube drainage systems?
never elevate the drainage system to the level of the chest because fluid can drain back into the lungs; do not clamp the chest tube during transport of the patient
when should dressing changes for tube drainage systems be done?
changes should be done once a day or every 24 hours
CHEST DRAINAGE TUBES
drainage of greater than 200mls in the first hour, can indicate _______ or any respiratory distress
subcutaneous emphysema
if an individual has PACO2 levels > _____ this could be a sign of respiratory failure
45 mmHg
what are some treatments for respiratory failure?
oxygen therapy, positioning, mobilization, and bronchodilators
what are some types of noninvasive ventilatory supports?
CPAP and BiPAP
what are some good candidates for noninvasive ventilatory supports?
hypercapnic respiratory failure and COPD
what are some benefits of using noninvasive ventilatory support systems?
reduced work of breathing; improved gas exchange; shorter stays of ICU; decreased infection rates
what are some complications of CPAP or BIPAP?
gastric detention; risk of aspiration; nasal congestion
what are some ways to manage pneumothorax?
oxygen therapy, ongoing monitoring, and chest tube placement
what is the defining characteristic of COPD?
airflow limitation that is not completely reversible during exhalation
what causes airflow limitation in COPD?
its caused by loss of elastic recoil and airflow obstruction due to large amounts of mucus
during the later stage of COPD the patient may develop problems with ______ as evidenced by lower PaO2
hypoxemia
the major risk factor for developing COPD is _______
cigarette smoking
cigarette smoking causes ______ of cells which increases _____
hyperplasia; mucus production
alpha-1 antitrypsin deficiency is also known to cause what?
copd
what are some signs and symptoms of COPD?
chronic cough, dyspnea, pursed lip breathing, barrel chest, tripod position (leaning forward) fatigue, and weight loss
what are some potential problems of a patient with COPD?
hypoxemia with hypercapnia, anxiety, and weight loss related to increased wob
what is a nursing priority for a patient who has COPD?
improve gas exchange - if the patient has a low O2 level you’ll want to increase the oxygen that the patient is receiving
if a patient has COPD, on average their O2 sat will be between 88-92% so you’ll want to shoot for ____% O2 sat
90
another treatment option for a patient with COPD would be to teach the patient ______ breathing
pursed lip breathing
the purpose of pursed lip breathing is to ______, which prevents _____ and air-trapping
prolong exhalation; bronchiolar collapse
patients with COPD will also require _____, high protein diet
high calorie
it’s important to remember that a patient with COPD is using a lot of calories for breathing, so it’s important to remember to _______ at meal times
limit liquids
what are some complications that can occur due to COPD?
acute exacerbations; respiratory failure; pulmonary hypertension; cor pulmonale
what are acute exacerbations?
exacerbations are a worsening of baseline symptoms of dyspnea, cough, and sputum
often times, during COPD, the nurses will give the patient an _____ to help increase the O2 sat
albuterol nebulizer
with COPD, if the patient’s O2 sat continues to drop to less than 88% the patient will be placed on a ______
non rebreather mask
what is respiratory failure?
occurs when oxygenation, ventilation, or both are inadequate
when is a person considered to be in hypoxemic respiratory failure?
when the PaO2 is less than or equal to 60 mmHg with an FiO2 of 60% or more
what causes pulmonary hypertension?
caused by the constriction of the pulmonary vessels from hypoxia
alpha 1 antitrypsin deficiency can cause COPD because…
alpha 1 helps protect the lungs and breaks down inhaled pollutants so without it there is no protection
what are signs and symptoms of metabolic alkalosis?
tachycardia, dysrhythmias, confusion, nausea, and vomiting
what are signs and symptoms of respiratory alkalosis?
hyperventilation, tachycardia, dysrhythmias, vomiting, diarrhea, and confusion
