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272 Cards in this Set
- Front
- Back
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Respiratory rate by late adolescence:
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12-18
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A decrease in arterial oxygen concetrations stimujlate chemoreceptors. the chemoreceptors stimulate the respiratory dcenter to increase
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ventilation.
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Hydrogen, oxygen and carbon dioxide can trigger the
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chemoreceptors.
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Increase _____ concentration normally stimulates respiratoins most strongly.
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CO2
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A specimen from the oropharynx is used for a
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throat culture
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A blood volume expander which provides plasma protein:
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albumin
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Increased HR, RR and systolic BP
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Early sign of hypoxia
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Acid fast bacillus AFB serial collection 3 days identifying presence of
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TB
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Agents that decrease the intensity and frquency of coughing episodes:
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Antitussives
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Prolonged gasping inspiration followed by a very short usually inefficient expiration:
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Apneustics
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Done to evaluate acid base balance, oxygenation, measure pH, PAO2, HcO3, BE SAO2
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arterial blood sample
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Shallow breaths interrupted by apnea
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Biot's
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Included in this: hemoglobin, hemaocrit, erythrocytes count, leukocyte, and differential white cell count:
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CBC
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Check for return of the ________ when pt. is post bronchoscopy:
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gag reflux
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Very shallow breathing and temporary apnea. Common cause include: CHF, incrase intracranial pressure, or drug OD:
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Cheyne stokes
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Childhood resp
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25 per minute
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Chilling will cause ___ O2 demand
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increased
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S/S
Fatigue, lethargic, clubbed fingers and toes |
chronic hypoxia
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Used for pts with clotting factor deficiencies:
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Clotting factors and cryoprecipitate
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Coughing, sneezing and intrapleural pressure al laid in the patency of the
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respiratory tract
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A canopy placed over the frame of the bed that delivers oxygen with a cooling mechanism:
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croup tent
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Lab test to identify a specific organism and drug sensitivity
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culture and sensitivity
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Lab test to identify origin, structure, function, and pathology of cells; three early morning specimens identify cancer in lungs and specific cell types:
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cytology
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Decrease body temp decreases _________ rate.
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respiratory
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A diet deficient in iron or folic acid causes _______ and ______ that are not formed adequately.
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hemoglobin and RBCs
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Exchange of oxygen and CO2 in the alveoli:
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Diffusion
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Do not smoke when using
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bronchodilators
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Muscular skeletal changes in teh chest wall reduce the size in the chest which makes the elderly inhale smaller volumes of
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air
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This medication causes the heart to contract more forcefully, bronchioles dilate, increase in blood flow and O2 delivery to active muscles:
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epinephrine
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These increase in the blood when the hematrocrit increases:
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erythrocytes (RBCs)
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Factor that affects the rate of O2 transport from the lungs to the tissues:
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exercise
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This increases metabolism which increases rate and depth of respirations:
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exercise
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Delivers 40-60% O2 concetration at 5-8L/m
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face mask
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Delivers 30-50% O2 at 4-8L/m for those who poorly tolerate a mask:
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face tent
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Measure oxygen in the number of liter per minute:
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flow meters
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As fluid filled lungs drain, pco2 incresaes and neonates take
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1st breath
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% of blood that is erythrocytes
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hematrocrit
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Necessary for the transportation of O2 to the cells
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hemoglobin
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O2 carrying red pigment
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hemoglobin
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a. ___________ increase repiratory rate and depth.
b. ____ increases rate and depth of breating. c. ______ reduces need for oxygen |
a. high altitudes
b. heat c. cold |
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CO2 accumulates in the blood as with hyperventilation
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Hypercarbia
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Can cause hypoxia:
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hypoventilation
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Inadequate alveolar ventilatoin CO2 retained in the blood stream, occurs as a result of collapse of the alveoli
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hypoventilation
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Reduced oxygen in the blood and is characterized by low partial pressure of oxygen in arterial blood or a llow hemoglobin saturation
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hypoxemia
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Improves pulmonary ventilation, loosens respiratory secretions, facilitates respiratory gaseous exchange, expands collapsed alveoli, measures flow of air inhaled through mouthpiece, offers an incentive to improve inhalation
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incentive spirometer
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Increased body temp ______ respiratory rate
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increases
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Increasing the intake of ____ and ___ will promote oxygen transport and absorption.
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protein and iron
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In infants, lungs gradually expand with each breath reaching full inflation by ___ weeks, respriatory rate hight __________ per minutes, rates greadually decrease with age.
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2
40-80 |
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Hyperventilation deep and rapid breathing:
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Kussmaul's
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Stridor, harsh high pitched sound (may be heart upon inspiration), restlessness, dyspnea, abnormal breath sounds:
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lower airway
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The expandability or stretchability of lung tissue, necessary for normal inspiration:
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lung compliance
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Continual tendency of the lungs to collapse
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lung recoil
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Records emissions from radio isotope albumin injected intravenously as it circulates through the lung:
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lung scan
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The control center for rate and depth of respirations:
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MEDULLA
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Type of acidosis that will cause Kussmaul's breathing:
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Metabolic acidosis
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Low concentration 24-45% 2-6L/m
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NC
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Chemical that increases the heart rate, BP, peripheral vascular resistance, increasing the hearts workload, causes vasoconstriction; where vessels already are narrowed by atherosclerosis, tissue oxygenation can be impaired:
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nicotine
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Delivers highest O2 concentration 95-100% 10-15L/m
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NRB
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Catecholamine that increases BP causing vasoconstriction:
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norepinephrine
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Normal hematocrit in
men: women: |
Men: 40-54
Women: 37-47 |
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Oxygen saturation below _____ is life-threatening.
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70%
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Risk factor for impaired blood to the tissues and for impaired oxygenation:
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obesity
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In older adults, the chest wall becomes more ___ and less ______.
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Rigid and elastic
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Delivers 60-90% O2 at 6-10L/m reservoir bag attached allows client to rebreathe about first 3rd of exhaled air
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partial rebreather mask
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Clapping; forceful striking with cupped hands over lung bases. This can mechanically dislodge tenacious secretions;
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percussion
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Type of breathing that creates a resistance to the air flowing out of the lungs, prolonging exhalation and preventing airway collapse by maintaining positive airway pressure:
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Pursed lip breathing
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1 unit RBCs increases hematocrit by ____%
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4
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Surfactant is a
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lipoprotein
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Volume of air inspired and expired is
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tidal volume
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Low pitched snoring sound during inhalation is a sign of
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uper airway obstruction
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Delivers 24-40-50% O2 @ 4-10L/m
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venturi mask
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-relativel high pitched and loud
-equal and a length -the neck over and the trachea |
tracheal breath sound
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-major normal breath sound
-heard over most of the lungs -soft and low-pitched -inspiratory longer than expiratory sounds -may b eharsher and slightly longer if there is rapid deep ventilation (eg post-exercise) or in children who have thinner chest walls. As well, vesicular breath sounds may be softer if the patient is frail, elderly, obese, or very muscular |
Vesicular Breath Sounds
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-very loud, high-pitched and sound close to the stethoscope
-gap between the inspiratory and expiratory phases of repiration -expiratory sounds arelonger than the inspiratory sounds. If these sounds are heard anywhere other htan over the manubrium, it is usually an indication that an area of consolidation exists (ie space that usually contains air now contains fluid or solid lung tissue). |
Bronchial Breath Sound
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-intermediate intensity and pitch
-equal in length -best heard in teh 1st and 2nd ICS (anterior chdest) and between the scapulae (poster chest) - ie over the mainstem bronchi. -As wieh bronchial sounds, when these are heard anywhere other than over the mainstem bronchi, they usually indicate an area of consolidation. |
Bronovesicular Breath Sound
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Normal value:
Sodium |
1.35-1.45 mEq
|
|
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Normal value:
potassium |
3.5-5.0 mEq
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Normal value:
calcium |
4.5-5.5 mEq
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Normal value:
magnesium |
1.5-2.5 mEq
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Normal value:
phosphate |
1.8-2.6 mEq
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Normal value:
serum osmolarity |
280-300mosm/kgh2o
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Normal value:
urine pH |
4.6-8.0
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Normal value:
urine specific gravity |
1.005-1.030
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Normal value:
pH |
7.35-7.45
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Normal value:
Sodium |
1.35-1.45 mEq
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Normal value:
potassium |
3.5-5.0 mEq
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Normal value:
calcium |
4.5-5.5 mEq
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Normal value:
magnesium |
1.5-2.5 mEq
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Normal value:
pao2 |
80-100mmhg
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Normal value:
paco2 |
35-45mmhg
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Normal value:
hco3 |
22-26meq/l
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Normal value:
base excess |
-2 to +2 mEq/l
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Normal value:
O2 sat |
95-98%
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% of body weight = H2O
full term newborn |
70-80%
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% of body weight = H2O
1 year |
52-60%
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% of body weight = H20
puberty to 39 |
52-60%
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% of body weight = H2O
40-60 years |
47-55%
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% of body weight = H2O
over 60 |
46-52%
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Average Daily Fluid Requirements:
3 days 3.0kg |
250-300 mL/24hr
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Average Daily Fluid Requirements:
1 yr 9.5kg |
1150-1300 mL/24hr
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Average Daily Fluid Requirements:
2 yr 11.8kg |
1800-2000 mL/24hr
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Average Daily Fluid Requirements:
6 yr 20.0kg |
1800-2000 mL/24hr
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Average Daily Fluid Requirements:
10 yrs 28.7kg |
2000-2500 mL/24hr
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Average Daily Fluid Requirements:
14 yrs 45.0 kg |
2200 - 2700 mL/24hr
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Average Daily Fluid Requirements:
18 yrs 45.o kg |
2200-2700 mL/24hr
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Assess skin (color, temp, moisture, turgor, edema), mucous membranes (color, moisture), eyes (firmness)*ck[]=SIADH
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SIADH
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Dehydration in children:
Weight Loss: Mild dehydration: Moderate dehydration: Severe dehydration: |
fluid and electrolyte imbalance
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Skin: grey, cold to touch, poor skin turgor
Mucous membranes: dry oral buccal mucosa, salivation absent Eyes: sunken eyeballs, absence of tearing when crying Anterior fontanel (infant): sunken Shock: increase pulse, increase respirations, decrease BP Urine: oliguria, increase specific gravity, ammonia odor Alterations in consciousness:irritability, lethargy, stupor, coma poss., seizures, metabolic acidosis or alkalosis |
Mild: 5%
Moderate; 5-9% Severe: 10-15% |
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Extracellular most abundant cation; controls and regulates water balance:
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S/S dehydration in children
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Intracellular major cation in intracelluar fluids; vital electrolyte for skeletal, cardiac and smooth muscle activity, also acid base balance:
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sodium Na+
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Cation mostly found in skeletal system:
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potassium K+
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Cation found mostly in skeleton, intracellular fluid, neuromuscular, cardiac function:
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Ca2+
calcium |
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Carried nutrients to and from the the cells; fluid found outside the cells accounts for 1/3 of total body fluid:
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magnesium
Mg2+ |
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Intravascular extracellular fluid
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extracellular fluid
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interstitial extracellular fluid
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plasma
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transcellular fluid
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lymph
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Average fluid output:
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cerebrospinal, pleural peritoneal, synovial fluids
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Average fluid output/hr
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1400-1500ml
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The movement of the bone away from the midline of the body:
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30-50ml
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Evaluates pts. acid-base balance and oxygenation; composed of pH, PaO2, PaCO2, OCO3, base excess, O2 sat:
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abduction
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Substances combine with a carrier on the outside surface of the cell membrane and they move to the inside surface of the cell membrane:
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ABGs
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The movement of a substance across a cell membrane against its concentration gradient (from low to high concentration). In all cells, this is usually concerned with accumulating high concentrations of molecules that the cell needs, such as ions, glucose and amino acids
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active transport
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Substance produced in the posterior pituitary gland and is a major controller of fluid balance:
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ADH - Anti-diuretic hormone
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System that promotes sodium and water retention in the distal nephron:
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ADH
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Edema that is generalized throughout the body as a result of over loading of vascular fluid compartment; a generalized edema throughout the body:
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Aldosterone
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Ion that carries a charge; chloride, HCO3 (bicarbonate), HPO4 (phosphate), SO4 (sulfate):
|
anasarca
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These can cause metabolic alkalosis with N/V and convulsions:
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anions
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Regulates water excretion from the kidney, located in hypothalamus:
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antacids
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Accumulation of fluid in the abdominal cavity:
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ascites
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Released from cells in the atrium of the heart in response to excess blood volume and stretching of atrial walls; acts as a diuretic; inhibits thirst, reducing fluid intake:
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ADH
anti-diuretic hormone |
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Forms bones bones and teeth, transmitting nerve impulses, regulating muscle contractions, maintaining cardiac pacemaker, blood clotting activating enzymes:
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Atrial natriuretic factor (ANF)
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-hypoparathyoidism
-acute pancreatitis -hyperphosphatemia -thyroid carcinoma -inadequate Vit D intake -malabsorption -alkalosis -sepsis -alcohol abuse |
calcium
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-Paget's disease
-malignancy of bone |
S/S hypocalcemia
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Ions that carry equal charges; NA+, K+, Ca2+, Mg2+
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S/S hypercalcemia
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Inserted for long term IV therapy, parenteral nutrition, for chemical damaging to the veins; assess for SOB, CP, cough, hypotension, tachycardia and anxiety:
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cations
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Daily weights provide adequate assessment of
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central lines
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-hyperosmolar imbalance
-water lost from body without significant loss of electrolytes occurs in older patients because of decreased thirst sensation -prolonged fever -diabetic ketoacidosis -those receiving enteral feedings with insufficient water |
fluid status
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Continual intermingling of molecules in liquids, gases or solids brought about by the random movement of molecules; movement of particles from an area of greater concentration to an area of lower concentration
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S/S dehydration
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Do not administer hypotonic fluids to pts with _____________ or ____________disease and watch for hypovolemia.
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diffusion
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Fluid volume excess intravascular and interstitial spaces have an increased water and sodium content; when the body starts to utilize the stored protein due to poor nutritional intake:
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kidney
heart disease |
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Have an altered thirst response which can alter the fluid and electrolyte balance
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edema
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Contain various amounts of cations and anions:
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Elderly
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Charged particles capable of conducting electricity:
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electrolyte solutions
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Depends on the informational input from the labyrinth (inner ear), vision and from stretch receptors of muscles and tendons:
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electrolytes
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Fluid in the interstitial space; accounts for 1/3 total body fluid:
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equilibrium
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Process whereby fluid and solutes move together across a membrane from one compartment to another, moves from high pressure to low pressure:
|
ECF
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Body retains both water and sodium (hypovolemia) caused by excessive sodium chloride intake, administering infusions too fast, disease process that alters the regulatory mechanisms (eg: CHF, renal failure, cirrhosis of liver, Cushing's syndrome):
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filtration
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1. body alignment (posture)
2. joint mobility 3. balance (stability) 4. coordinated movement |
fluid volume excess
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Body loses both water and electrolytes from the ECF
|
four basic elements of normal body movement
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Produced by the body in response to a specific antigen called an antibody:
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Fluid Volume Deficit (FVD)
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Measures % of whole blood composed of RBCs; increase with severe dehydration; decrease with severe over hydration; norm in males 40-50% and females 37-47%:
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globulin
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Major component of EBCs; increases with dehydration:
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hematocrit
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Homeostatic mechanisms that regulate the body fluids:
1. 2. 3. 4. 5. 6. |
hemoglobin
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Body's measurement of acidity and alkalinity:
|
1. kidneys
2. endocrine system 3. cardiovascular system 4. lungs, 5. GI 6. hormone |
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The pressure exerted by fluid within a closed system of the walls of a container in which it is contained:
|
hydrogen ion concentration
|
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S/S include:
acidosis weakness and lethagry risk for dysrhythmias coma |
hydrostatic pressure
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S/S include:
lethargy weakness anorexia N/V constipation polyuria dysrhythmias |
hypercholoremia
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S/S include:
GI hyperactivity diarrhea irritability apathy confusion muscle weakness |
hypercalcemia
|
|
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S/S include:
N/V muscle weakness paralysis decrease BP bradycardia |
hyperkalemia
|
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S/S include:
thirst tongue red, dry, swollen weakness fatigue decrease in LOC disorientation convulsions |
hypermagnesium
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S/S include:
tingling around the mouth, fingertips muscle spasms tetany |
hypernatremia
|
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D5NS
D51/2NS D5LR |
hyperphosphatemia
|
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Higher osmolarity than bodyfluids eg: 3% sodium chloride
|
hypertonic solutions
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TPN is what type of solution?
|
Hypertonic solutions
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Body retains both water and sodium:
|
Hypertonic
|
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S/S include:
numbness and tingling in extremities cramps |
hypervolemia
|
|
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S/S include:
Excess loss of Ca2+ through the GI tract, kidneys or sweating |
hypocalcemia
|
|
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S/S include:
muscle weakness leg cramps fatigue lethargy anorexia N/V decreased bowel sounds cardiac dysrhythmia ABs may show alkalosis |
hypochloremia
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|
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S/S includes:
chronic alcoholism renal failure adrenal insufficiency neuromuscular irritability positive Chvostek and Trousseau's sign |
hypokalemia
|
|
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S/S include:
lethargy confusion apprehension muscle twitching abdominal cramps anorexia vomiting nausea HA |
hypomagnesium
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S/S include:
muscles weakness pain mental changes possible seizures |
hyponatremia
|
|
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What type of solutions are
1/2NS 1/3NS |
Hypophosphatemia
|
|
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Lower osmolarity than body fluids eg: 0.45% sodium chloride
|
hypotonic
|
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Fluid lost from the intravascular compartment:
|
hypotonic
|
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Hypovolemia patients should be on what type of diet:
|
hypovolemia
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Infants and growing children have a greater fluid turnover due to increase __________ rate which can affect fluid and electrolyte balance.
|
low sodium
|
|
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_____________ is swelling, coolness, pallor and discomfort at the site.
|
metabolic
|
|
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Perspiration looses 300-400 ml per day
Exhaled air looses 300-400 ml/day Feces looses 100 ml |
infiltration
|
|
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Fluid that surrounds cells and includes lymph:
|
insensible losses
|
|
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Fluid within all of body; 2/3 of total body fluid; contains O2, dissolved nutrients, excretory products of metabolism (such as carbon dioxide and charged particles called ions):
|
interstitial
|
|
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Contains solutes, O2, electrolytes and glucose; provides medium which metabolic process of cells takes place:
|
intracellular fluid
|
|
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Largest fluid compartment in an adult:
|
intracellular fluid
|
|
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Found within vascular system; plasma
|
Intracellular
|
|
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Involves muscle contraction or tension against resistance:
|
intravascular
|
|
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Static or setting; there is a change in muscle tension but no change in muscle length and no muscle or joint movement (cast, traction):
|
isokinetic
|
|
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Dynamic - muscle shortens to produce muscle contraction and active movement
|
isometric
|
|
|
Same osmolarity as body fluids eg: NS
|
isotonic
|
|
|
Includes:
NS LR (treats metabolic acidosis) 5% dextrose in water D5W |
isotonic
|
|
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Excessive loss from GI tract; can be caused from long term diuretic use, chronic alcohol abuse, pancreatitis, burns:
|
isotonic solutions
|
|
|
Can be caused from abnormal retention of, renal failure, adrenal insufficient
|
hypomagnesium
|
|
|
Regulates cardiac functions, transmits nerve impulses, relaxes muscle contractions, intracellular metabolism:
|
hypermagnesium
|
|
|
This acidosis can be caused by severe diarrhea:
|
magnesium
|
|
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pH less than 7.35, PaCO2 less than 38, Kussmaul's respirations, lethargic, confusion, HA, weakness, N/V, monitor ABGs, I/O, LOC, administer IV sodium bicarb carefully, treat underlying problem:
|
metabolic
|
|
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pH greater than 7.45, PACO2 greater than 45mmhg, decreased rate and depth, dizziness, hypertonic muscles, monitor I/O, LOC, V/S, IV fluids:
|
metabolic acidosis
|
|
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Water lost through respirations, skin and feces; approximately 1300ml
|
metabolic alkalosis
|
|
|
Pulling force exerted by colloids:
|
obligatory losses
|
|
|
Loss or gain of water only; osmolarlity of serum is altered:
|
oncotic pressure
|
|
|
Movement of H2O across cell membranes from less concentrated solution to the more concentrated solution; important to maintain homeostasis:
|
osmolar
|
|
|
The power of a solution to draw water across a semi-permeable membrane
|
osmolarity
|
|
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Hyposmolar imbalance of water intoxication is gained in excess of electrolytes resulting in low serum osmolarity and low serum sodium levels;water drawn in cells makes them swell:
|
osmotic pressure
|
|
|
Warmth or redness over the vein; inflammation of the vein:
|
over-hydration
|
|
|
Major anion of intracellular fluids, absorbed from intestines; involved in metabolism of fats, proteins, carbs:
|
phlebitis
|
|
|
Causes:
- TPN can cause it to shift into the cells from ECF compartment - ETOH withdrawl - acid/base imbalance |
phosphate
|
|
|
Shifts out of cells
Ex: - tissue trauma - chemo - renal failure - infants fed cow milk |
hypophosphatemia
|
|
|
Major cation in the intracellular fluid
|
hyperphosphatemia
|
|
|
-Maintains ICF osmolarity
-Transmits nerve and other electrical impulses -Regulates cardiac impulses and muscle contraction -Regulates acid base balance |
potassium
|
|
|
Causes include:
- Vomiting - Diarrhea - Gastric suctioning -Diarrhea - Heavy perspiration - Diuretics - Hyperaldosteronism - Hyper-renal failure - Hypoaldosterone - Excess or rapid infusions of K+ |
Potassium
|
|
|
This may occur in pts who are newly diagnosed with diabetes or in the individual who either did not administer enough insulin or the body requirements exceeded the supply available:
|
Hypokalemia
|
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The body will demand more insulin whenever faced with increased physical activity or serious illness. The excessive glucose and ketones within the blood cause the serum osmolarity to rise. Water will begin to exit the cells to dilute the blood and make it less hypertonic. The cells become dehydrated and the patient will develop neurological changes. Glucose and ketones will spill over into the urine causing an osmotic diuresis to occur within the kidneys. This compounds the original problem as now the cells must release more of their water and potassium, phosphate and magnesium. Acidosis promotes potassium moving out of cells to buffer the pH change (hydrogen moves into the cells, potassium moves out).
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Diabetic ketoacidosis (DKA)
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S/S include:
-polyuria -hypotension -weight loss -tachycardia -fatigue -irritability, lethargy, coma -N/V -initially signs of hyperkalemia -dry, flushed skin - dry mucus membranes - hypokalemia p insulin administration |
Diabetic Ketoacidosis
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Treatment:
- Rehydration usually with NS then D5W - Rapid-acting insulin - Restoration of electrolyte balance (Na with NS; K+ levels can shift from hyper to hypo p admin of insulin (causes K+ to shift back into the cells) - IV bicarbonate: given if pH <7.1. It's use is controversial as insulin therapy will correct the low bicarbonate levels - Treat Underlying cause: e.g. infection |
diabetic ketoacidosis
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Caused by most often by too little ADH produced by the pituitary gland or occasionally by the inability of the kidneys to respond to ADH. Patients will excrete large amounts (5 to 40 liters per day) of extremely dilute urine. They are at risk of serious complications as vascular volume quickly falls, serum osmolarity rises and hyponatremia results. Also as serum osmolarity rises, patients become prone to thromboemboli.
Most often caused by tumors or injury of the pituitary gland or cerebral death: |
Diabetic ketoacidosis
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S/S include:
- polyuria - signs of dehydration such as dry mucous membranes, poor skin turgor, hypotension, tachycardia - urine osmolarity decreased < 200 - urine specific gravity > 300 - serum sodium > 147 mEq/L Risk Factors: - head injury - pituitary tumors - brain death - increased ICP |
Diabetes Insipidus
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Treatment:
- Rapid rehydration with hypotonic saline to correct fluid losses then replacement is tailored to urinary losses - Exogenous vasopressin (DDAVP) - Chlorpropamid (stimulates ADH release) |
Diabetes Insipidus
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Stimulated by:
- Increased plasma volume as sensed by stretch recptors located in the left atrium & pulmonary vasculature & decreased BP as sensed by pressure receptors located in the carotid arteries - During these times increased ADH release occurs which causes the kidneys to conserve water. This extra water expands in the serum & decreased serum osmolarity & sodium levels. Decrased serum osmolarity causes water to move into first the extracellular space then the intracellular spaces, causing the brain to swell - causing increased ICP. - The increase in ECF causes an increase in aldosterone secretion which further reduces serum Na levels. Without prompt treatment the pt. will experience increased ICP due to cerebral edema & severe hyponatremia which may be fatal. - common in ICU settings |
Diabetes Insipidus
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Risk Factors:
- Oat cell carcinoma of the lung; carcinoma of the pancreas, duodenum, prostate, or thymus, and some forms of leukemia - fear, pain or stress - head trauma, brain tumors, intercranial hemorrhage, meningitis - positive pressure ventilation (stimulates pressure receptors in the carotid sinus & aortic arch) - medications such as chlorpropramide, acetaminophen, morphine, amitriptyline, thiazide diuretics, CA, chemotherapy drugs |
SIADH
Syndrome of Inappropriate Secretion of Anti Diuretic Hormone |
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Low level indicates depressed immune system:
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lymphoyte
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Causes serum and cellular fluid overload but not interstitial overload. This can be seen by fingerprint edema (when a finger is pressed over the sternum a fingerprint will be left).
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Pts at risk for electrolyte imbalances
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- COPD
- CHF - kidney disease - CA - ileostomy - elderly - young - fever - surgery - homeless |
________ and _______________
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Rate of bone loss is slowed with regular exercise in __________ and _________.
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Renin-angiotensin
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Receptors in juxtaglomerular cells in kidneys causing sodium and water retention:
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Respiratory alkalosis
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-pH > 7.45
-PACO2 < 35mmhg -C/O - SOB - CP - chest tightness - difficulty concentrating - blurred vision - Monitor - V/S - ABGs - Assist client to - Breath more slowly - Breath in paper bag - Apply NRB |
Respiratory acidosis
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- pH < 7.35
- PaCO2 > 45mmhg - S/S - increase HR - increase RR - dizziness - confusion - decrease LOC - convulsions - warm flushed skin - Assess - Respiratory status - lung sounds - Monitor - Airway - I/O - V/S - ABGs - Narc antagonists - Maintain - Adequate hydration |
Sodium
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Major cation in the ECF:
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sodium
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- Renal absorption or excretion
- aldosterone increase it - re-absorbed in collecting ducts of nephrons - Regulates ECF volume and distribution - Maintains blood volume - Transmits nerve impulses and contracts muscles |
Hyponatremia
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Causes:
- GI fluid loss - sweating - diuretics - hypotonic tube foods - drinking water - excess IV D5W - head injury - AIDS - Malignant tumors |
hypernatremia
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Causes
- Loss of fluids - hyperventilation - diarrhea - water deprivation - excess salt intake - heat stroke |
Stress
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________ increases cellular metabolism blood glucose concentration, catecholaminelevels.
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Stress
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_______ can increase ADH and decrease urine output.
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water excess
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Sudden weight gain, blurred vision, H/A, and decreased fluid output compared to intake is an early sign of
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Surgery
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______________ can affect the body's ability to maintain fluid.
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gauge
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The diameter of the lumen is the _______ of the needle.
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kidneys
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The ___________ are the primary regulator of body fluids and electrolytes.
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potassium
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The ____________ is the organ that assumes the greatest responsibility for the __________________ balance.
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1500 ml
2500 ml 1000 ml |
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The normal fluid intake is _____________ ml. We need _______________ ml. We get an extra _______ ml from the food taken in during metabolic process.
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Third space syndrome
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The fluid shifts from the vascular space into an area where it is not readily accessible as ECF.
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Thirst mechanism
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_______________ is the primary regulator of fluid.
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Volume expanders
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These are used to increase blood volume following severe loss of blood. Examples are Dextran, plasma and human serum albumin.
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Anti-diuretic hormone
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You are at risk for dehydration if you have a decrease in
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Respiratory acidosis
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Risk factors include:
-alveolar gas exchange impairment (pneumonia, acute pulmonary edema, aspiration, near-drowning) -chronic lung disease (asthma, CF, emphysema -OD narcotics/sedatives that depress respiration -brain injury Manifested by: -PaCO2 above 45 mmHg -pH < 7.35 |
Respiratory alkalosis
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Risk Factors:
-Hyperventilation (anxiety, increased body temp, overventilation via mechanical vent, hypoxia, salicylate OD) Manifested by: -light-headedness -pH >7.45 -PaCO2 35 mmHg |
Metabolic acidosis
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Risk Factors include:
-Increased nonvolatile acids in the blood (renal impairment, diabetes mellitus, starvation) -Decreased bicarbonate (prolonged diarrhea) -Excess IV of NaCl Manifested by: -Kussmaul's respirations -pH <7.35 -serum bicarbonate<22 mEq/L |
Metabolic alkalosis
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Risk Factors include:
-Excess acid loss (vomiting, GI sx) -Excess use of potassium-losing diuretic -Excess adrenal corticoid hormones (Cushing's syndrome, hyperaldosteronism) -Excess bicarbonate intake (antacids, parenteral NaHCO3) Manifested by: -tetany -dizziness -dizziness -decreased RR and depth -pH > 7.45 -serum bicarbonate > 26 mEq/L |
Acid base balance
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-Relationship is critical for homeostasis
-Significant variations from normal pH ranges are notwell tolerated and may be life threatening -Balance is achieved by Respiratory and Renal systems |
H2CO3 Carbonic acid
NaHCO3 Base bicarbonate |
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There are two buffers and they work in pairs:
Associated with the respiratory and renal compensatory system |
CO2
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Approximately 98% normal metabolites are in the form of
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kidneys
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Metabolic element of the acid base balance is a function of the
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H+
Na+ anhydrase |
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Process of kidneys excreting ____ into the urine and reabsorbing ____ into the blood from the renal tubules
1) active exchange ______ for H+ between the tubular cells and glomerular filtrate 2) carbonic _________ is an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cells |
H2CO3
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Acid Base Relationship
H20+CO2 = ______ = HCO3 + H+ |
pH: 7.35-7.45
PCO2: 35-45 mmHg PO2: 80-100 mmHg HCO3: 22-26 mmol/L BE:-2 - +2 SaO2:>95% |
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Normal ABGs:
pH: PCO2: PO2: HCO3: BE: SaO2: |
pH: <7.35
PCO2: >45 HCO3:<22 |
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Acidosis:
pH: PCO2: HCO3: |
pH: > 7.45
PCO2: < 35 HCO3:> 26 |
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Alkalosis:
pH: PCO2: HCO3: |
causes of Respiratory acidosis
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- emphysema
- drug OD - narcosis - respiratory arrest - airway obstruction |
Respiratory acidosis
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- think of CO2as an acid
- failure of the lungs to exhale adequate CO2 - pH <7.35 -PCO2 > 45 - CO2 + H2CO3 - decreased pH |
Metabolic Acidosis
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-Failure of kidney function
-Decreased blood HCO3 which results in decreased availability of renal tubular HCO3 for H+ excretion -pH < 7.35 -HCO3 <22 |
Causes of Metabolic Acidosis
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-renal failure
-diabetic ketoacidosis -lactic acidosis -excessive diarrhea -cardiac arrest |
Respiratory Alkalosis
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-too much CO2 exhaled (hyperventilation)
-decreased PCO2, H2CO3 insufficiency = increased pH -pH > 7.45 - PCO2 < 35 |
Causes of Respiratory Alkalosis
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-hyperventilation
-panic d/o -pain -pregnancy -acute anemia -salicylate OD |
Metabolic Alkalosis
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-Increased plasma bicarbonate
-pH > 7.45 - HCO3> 35 |
Causes of Metabolic Alkalosis
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-increased loss acid from stomach or kidney
-hypokalemia -excessive alkali intake |
PO2 NL = 80-100 mmHg
pH NL = 7.34-7.45 acidotic <7.35 alkalotic>7.45 PCO2 NL = 35-45 mmHg HCO3 NL = 22-26 mmol/L acidotic <22 alkalotic >26 |
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Analyzing an ABG:
1. PO2: NL = ______ 2. pH NL = ________ 3. PCO2 NL = _________ 4. HCO3 NL = ________ |
step 1: 80
step 3: abnormal & NL abnormal & NL step 4: pH HCO3 |
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Analyzing an ABG:
Step 1: 1. Determine PaO2 & SaO2 2. Determine oxygen status 3. Low PaO2 (< ____mmHg) means hypoxia 4. NL/elevated oxygen means adequateoxygenation Step 2: pH acidosis < 7.35 alkalosis >7.45 Step 3: Study PaCO2 & CHO3 Respiratory irregularity if PaCO2 _______ & HCO3 _____ Metaboic irregularity if HCO3 ______ & PaCO2 ____ Step 4: Determine if there is a compensatory mechanism working to try to correct the _____. (ie: If have primary respiratory acidosis will have increased PaCO2 and decreased pH. Compensation occurs when the kidneys retain _______. |
Respiratory Acidosis:
pH = 7.30 PaCO2= 60 HCO3= 26 |
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Respiratory Acidosis:
pH = PaCO2= HCO3= |
Respiratory Alkalosis:
pH = 7.50 PaCO2= 30 HCO3= 22 |
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Respiratory Alkalosis:
pH = PaCO2= HCO3= |
Metabolic Acidosis:
pH = 7.30 PaCO2= 40 HCO3= 15 |
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Metabolic Acidosis:
pH = PaCO2= HCO3= |
Metabolic Alkalosis:
pH = 7.5 PaCO2= 40 HCO3= 30 |
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Metabolic Alkalosis:
pH = PaCO2= HCO3= |
alkalosis
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Compensations:
Respiratory acidosis and metabolic _______________ |
acidosis
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Compensations:
Respiratory alkalosis and metabolic _______________ |
kidneys
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In respiratory conditions, the _______ will attempt to compensate and visa versa.
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kidneys
HCO3 |
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In chronic respiratory acidosis (COPD), the __________ increase the elimination of H+ and absorb more ________. The ABG will show NL pH, increase CO2 and increase HCO3.
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minutes
24 hours 5 days |
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Buffers kick in within________. Respiratory compensation is rapid and starts within minutes and complete within _____ hours. Kidney compensation takes hours and up to ______ days.
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physiologic condition
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Valuable information can be gained froman ABG as to the patients
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protein, calories, fiber
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