Week Two Modules Flashcards by Jennifer Flores

what two components are involved in acid-base balance?

the respiratory system and the renal system

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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

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with decreased respirations, more ____ remains in the blood

CO2

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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-

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NORMAL ARTERIAL BLOOD GAS VALUES

what are the normal ranges for pH?

7.35-7.45

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NORMAL ARTERIAL BLOOD GAS VALUES

what are the normal ranges for PACO2 (acid)?

35-45 mmHg

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NORMAL ARTERIAL BLOOD GAS VALUES

what are the normal ranges for HCO3- (base)?

22-26

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NORMAL ARTERIAL BLOOD GAS VALUES

what are the normal ranges for PaO2?

80-100 mmHg

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why does respiratory acidosis happen?

when there is carbonic acid excess due to the person hypoventilating

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what are some other causes of respiratory acidosis?

copd, sedative overdose, pneumonia, and pulmonary edema

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why does respiratory alkalosis happen?

when there is a carbonic acid deficit which occurs with hyperventilation

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what is the PRIMARY cause of respiratory alkalosis?

hypoxemia from acute pulmonary disorders

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respiratory alkalosis can also occur due to ___, ____, and neurological disorders

pain; anxiety

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why does metabolic acidosis happen?

this is due to base bicarbonate deficit

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what are the two types of metabolic acidosis?

diabetic ketoacidosis; lactic acidosis

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what are some issues that can lead to metabolic acidosis?

diarrhea, starvation, and shock

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______: bicarbonate (base) excess

metabolic alkalosis

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metabolic alkalosis occurs when there is a loss of acid due to ____ or _____ or a gain in HCO3- (ingesting ____)

vomiting; hypokalemia; baking soda

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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

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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

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obstructive respiratory disorders cause an _____ or airway _____

airway obstruction; narrowing

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what are some examples of obstructive respiratory disorders?

asthma, chronic bronchitis, copd, and emphysema

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restrictive respiratory disorders ____ the ability of the ___ to move

impair; chest wall

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what are some examples of restrictive respiratory disorders?

pneumonia; pneumothorax

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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

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

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