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139 Cards in this Set
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Acute and chronic problems
Diagnostic tests, such as EKG, Chest x-ray, etc. Recent patient assessment Arterial blood gases (check Allen's Test) VS, blood sugar, pulse oximetry, electrolytes, BUN, creatinine, medications? |
Assessment for determining acid-base balance
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pH 7.35-7.45
PaO2 80-100mmhg SaO2 >95% PaCO2 35-45 HCO3 22-26 ? |
Normal findings in Arterial Blood Gases
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Oxygen bound to hemoglobin?
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SaO2
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Oxygen dissolved in plasma?
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PaO2
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Arterial O2 contnet x cardiac output?
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O2 transport to the tissue
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Lungs ability to get O2 into the blood.
Ability of hemoglobin to hold enough O2? |
What Arterial O2 depends on.
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SaO2?
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Oxygen bound to hemoglobin
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PaO2?
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Oxygen dissolved in plasma
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H+in solution=?
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pH
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Normal arterial pH?
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7.35-7.45
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pH compatible with life?
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6.8 - 7.8
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What determines pH?
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The amount of H+
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Increased H+=?
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Decreased pH, acidosis, <7.35
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Decreased H+=?
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Increased pH, Alkalosis, >7.45
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Increased pH is termed?
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Alkalosis, >7.45
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Decreased pH is termed?
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Acidosis, <7.35
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What are the three mechanisms that maintain pH at 7.35 - 7.45?
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Buffer system
Respiratory system Renal system |
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What is the ratio between acid (CO2) and base (HCO3)?
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1 part acid (CO2): 20 parts base (HCO3)
Ratio 1:20 |
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Primary disease may alter one side of the ratio.
Compensatory process attempts to maintain the other side of the ratio. Compensatory mechanism fails. These result in? |
Acid-Base Imbalance
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Affects the carbonic acid concentration?
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Respiratory
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Increased carbonic acid is?
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Acidosis
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Decreased carbonic acid is?
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Alkalosis
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Affects the base bicarbonate?
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Metabolic
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Decreased bicarbonate?
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Acidosis
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Increased bicarbonate?
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Alkalosis
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Acid-Base imbalance can be?
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Acute or Chronic
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Ammonia
Phosphates Proteins ? |
Other buffers
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Can dissociate into -H+ ions (acid) or base ions (Hg, plasma, & intracellular)?
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Proteins
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Affects K+, Ca++, Na+ & Cl-?
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Buffering
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Starts in minutes and tries to compensate?
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Lungs
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What is sesitive to CO2?
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Medulla oblongata
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When the medulla oblongata senses increased pCO2, what happens?
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It increases respirations to decrease CO2 & correct acidosis.
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When the medulla oblongata senses decreased pCO2, what happens?
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It decreases respirations to increase CO2 & correct alkalosis.
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35-45mmHg?
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Normal arterial pCO2
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Hours or days to compensate?
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Kidneys
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Bicarbonate is conserved by the renal tubules & H+ excreted in?
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Acidosis
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Bicarbonate is exceted by the kidney & H+ absorbed in?
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Alkalosis
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22-26 mEq?
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Normal arterial HCO3
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CO2 retention from hypoventilation.
Compensatory response to bicarbonate retention by the kidney. Findings - pH decreased, PCO2 increased, Bicarb normal or increased? |
Respiratory Acidosis
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Aspiration of foreign object.
Overdose (opioids, barbituates) Sever pneumonia Sleep apnea Pneumothorax, hemothorax Post-op abdominal surgery ? |
Causes of acute repiratory acidosis.
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COPD
Cystic fibrosis Advanced multiple sclerosis Obesity Chronic increased pCO2 >50mmHg, insensitive to CO2 drive, depend on hypoxic drive? |
Causes of chronic respiratory acidosis
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Vasodilation: Headache, flushed
Tachypnea, tachycardia, lethargic, confusion, unsonsciousness, dizziness, weakness, hypoxia, hyperkalemia ? |
Signs and Symptoms of respiratory acidosis
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Excess H+ (acid) moves into cells & pushes K+ out, leading to?
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Hyperkalemia in acidosis
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Brochial dilator
Antibiotics Anticoagulation (P. emboli) Airway, C&DB, Suctioning Increased HOB, Turn Q 2 hours Oxygen, high flow-acute, low flow-chronic? |
Tx for respiratory acidosis
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Kidneys retain HCO3 & excrete H+
Decreased pH, increased pCO2 and HCO3 normal - Uncompensated Decreased pH, increased pCO2 & increased HCO3 - Partially compensated pH normal, increased pCO2 & increased HCO3 - Fully compensated? |
Compensation of Respiratory Acidosis
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Increased CO2 excretion from hyperventilation
Compensatory response of bicarb excretion by the kidney pH increased, PCO2 decreased, Bicarb may be normal or decreased? |
Repiratory Alkalosis
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Anxiety
High altitudes High fever Gram negative bacteremia are causes of? |
Acute (over ventilation) respiratory alkalosis
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Early emphysema
Cerebral tumors are causes of? |
Chronic respiratory alkalosis
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Alkalosis, hyperpnea, dizziness, tinnitus, sweating, dry mouth, chest tightness, palpitations, blurred vision, seizures and loss of consciousness, hypocalcemia (remember the 3 T's), are signs and symptoms of?
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Hyperventilation
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Cerebral vasoconstriction: lightheadedness
Inability to concentrate Decreased calcium (if alkalosis occurs rapidly) Hypokalemia, are signs and symptoms of? |
Respiratory Alkalosis
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Low H+ in ECF causes H+ to pass out of cell and ECF K+ moves into cell causing?
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Hypokalemia in alkalosis
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Remember SUCTION for?
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S&S of hypokalemia
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Rebreathe CO2 (paper bag, rebreather mask)
Medication (sedation, analgesics) Oxygenation Control fever and infections are treatments for? |
Respiratory alkalosis
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Kidneys excrete HCO3 and retain H+ in?
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Respiratory Alkalosis
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Compensation of respiratory alkalosis
Increased pH, decreased PCO2 & normal HCO3? |
Uncompensated repiratory alkalosis
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Compensation of respiratory alkalosis
Increased pH, decreased pCO2 & decreased HCO3? |
Partially compensated repiratory alkalosis
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Compensation of respiratory alkalosis
pH normal, decreased PCO2 & HCO3? |
Fully compensated respiratory alkalosis
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Gain of fixed acid: inability to excrete acid or loss of base
Compensatory response to CO2 excretion by the lungs Findings: pH decreased, PCO2 normal or decreased, Bicarb decreased? |
Metabolic Acidosis
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Severe diarrhea
Penrose GI drain Renal failure Diabetic ketoacidosis Shock, Cardiac arrest Toxin ingestion: ASA, ethylene glycol & methanol are causes of? |
Metabolic Acidosis
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Headache, confusion, Kussmaul's respirations, nausea, anorexia, vasodilation (warm, flushed), diarrhea, abdominal discomfort, hyperkalemia
are signs and symptoms of? |
Metabolic Acidosis
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Correct the cause
Bicarbonate 'O' or IV Treat elevated blood sugar Check renal status- ? Dialysis Correct diarrhea are tx for? |
Metabolic Acidosis
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Decreased pH, normal CO2, & decreased HCO3?
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Uncompensated metabolic acidosis
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Decreased pH, decreased CO2, & decreased HCO3?
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Partially compensated metabolic acidosis
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Can lungs fully compensate?
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No
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Normal is 8 - 16 mEq/L?
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Anion Gap
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Caused by diarrhea, early renal insufficiency, pancreatic or biliary fistulas?
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Normal anion gap (base loss)
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Caused by ketoacidosis (DM, starvation, alcohol), lactic acidosis, toxicity (ASA, methanol & ethylene glycol)?
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High anion gap (acid gain)
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If a low anion gap, suspect?
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FVE or hypoalbumin
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Na 139 + K 5.5 = 144.5
Cl 105 + HCO3 = 119 144.5 - 119 = 25.5 This is figuring what? |
Anion gap
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High anion gap means there is what, and the client has what?
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High anion gap means there is too much acid gain and the client has chronic renal failure.
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Loss of strong acid or gain of base
Compensatory response of CO2 retention by the lungs? |
Metabolic Alkalosis
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pH increased
PCO2 normal or increased Bicarb increased? |
Metabolic Alkalosis
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Hypokalemia
Hypocalcemia NG suction, prolonged vomiting Antacid medications Blood transfusions Cushing's syndrome are causes of? |
Metabolic Alkalosis
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Dizziness, nervous
Nausea/vomiting Tend to be dehydrated Hypokalemia S&S Hypocalcemia S&S are S&S or? |
Metabolic Alkalosis
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Treat underlying cause
Monitor for hypoxia Antiemetics Fluids Decreased diuretic, antacids, meds, steroids Electrolyte replacement are tx for? |
Metabolic Alkalosis
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Partially compensated by hypoventilation to retain CO2?
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Compensation of metabolic alkalosis
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Increased pH, normal CO2, & increased HCO3?
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Uncompensated metabolic alkalosis
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Increased pH, increased CO2, & increased HCO3?
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Partially compensated metabolic alkalosis
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pH depends on the type, severity and acuity of each disorder, mixed respiratory alkalosis and metabolic alkalosis may bring pH into normal or near normal range, mixed respiratory acidosis and metabolic acidosis may compound the effect of lowering the pH?
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Combined repiratory and metabolic acid-base problems
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Determines if the pH is acidotic or alkalotic
Determines if the problem is respiratory or metabolic (by inverse relationship) Determines if the CO2 or the HCO3 matches the alteration in pH Determines if there is compensation? |
Blood Gas Values
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In normal relationship, if pH is increased then PCO2 is?
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Decreased
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In normal relationship, if pH is decreased then PCO2 is?
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Increased
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In normal relationship, if pH is increased then HCO3 is?
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Increased
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In normal relationship, if pH is decreased then HCO3 is?
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Decreased
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Can be:
Community acquired Hospital acquired Aspiration type Opportunistic type or be acquired by emerging pathogens (H5N1 - bird flu, Severe Acute Respiratory Syndrome - SARS)? |
Pneumonia
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Good oral care, turn q2h, mobilize ASAP, C&DB, IS, encourage smoking cessation, assess for swallowing difficulties, prevent over-sedation, check NG tube placement, and promote good hand washing -
are used to reduce? |
Nosocomial Pneumonia
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Antibiotics are used to treat some of the most common froms, antibiotic resistant strains are a growing problem, may occur on its own, at the same time as viral or after a viral URI, prevention is best?
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Bacterial Pneumonia
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What percentage of pneumonias are caused by viruses?
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50%
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With what pneumonia is there the risk of developing a secondary bacterial pneumonia?
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Viral pneumonia
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The pneumonia begins with flu like symptoms, NPC, headache, fever, muscle pain, and fatigue?
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Viral pneumonia
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"Walking pneumonia"?
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Mycoplasma pneumonia
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The pneumonia spreads easily in situations where people congregate, symptoms are often mild?
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Mycoplasma pneumonia (walking pneumonia)
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Fungi pneumonia is caused by certain types of?
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Fungi
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This pneumonia is less common?
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Fungi pneumonia
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This pneumonia is an opportunistic infection that affects people with compromised immune systems?
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Pneumocystis Carinii Pneumonia
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Fever, chills, diaphoresis, dyspnea, productive cough (thick greenish or yellow phlegm), Use of accessory muscles
are S&S of? |
Pneumonia
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Hypoxemia
Hypercapnia Atelectasis Pleural effusion Pleurisy are complications of? |
Pneumonia
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Described as "patchy" with crackles, wheezing, and mucous production?
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Bronchopneumonia
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Described as "consolidated" with bronchial breath sounds, possible dull percussion, increased fremitus, and egophony - hear 'A'?
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Lobar pneumonia
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Chest x-ray, Bronchoscopy, Sputum cultures, WBC will be increased in bacterial form and decreased in viral form, respiratory acidosis, pulse oximetry <95%, are part of diagnosing?
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Pneumonia
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What is used to view the airways and check for any abnormalities?
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Bronchoscope
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Give proper antibiotic, broncho dilators, expectorants, and corticoid steroids in the pharmacological treatment of?
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Bacterial pneumonia
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Observe respirations (pattern, rate, depth, etc.), Auscultate lungs every 4 hours, usually a chest x-ray every morning, check for nasal flaring or use of accessory muscles, check LOC, elevate HOB, bedrest - turn q2h, note ABGS to see if they are in respiratory acidosis or alkalosis, observe O2 saturation at rest - while eating - with activity, give humidified oxygen, key treatment is a lot of rest - cough and deep breath - incentive spirometer - suctioning secretions, check temperature, look at secretions, check postural drainage, and monitor the effects of breathing treatments - start with dilators?
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Treatment of pneumonia
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Check for pain - medicate if necessary, splint chest with pillow to cough, teach proper breathing techniques (slow-deep breathing), get them up when they can, rest-sleep pattern (space out their activity), assess their activity tolerance, assess their ability to do ADL's?
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More treatement for pneumonia
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Elevate HOB, check patency of NG and feeding tubes, check for swallowing difficulties, check for nausea - emesis, check for lung sounds, check for bowel sounds, and have suction available,
are prevention of? |
Aspiration Pneumonia
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Give pneumococcal vaccine, influenza vaccine, decrease exposure, give balanced nutrition, stop smoking, elminate alcohol,
are treatment for? |
Pneumonia
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TB is also known as?
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Mycobacterium tuberculosis
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How do you determine if someone has TB?
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If they have acid-fast gram positive rods.
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It is airborne and can be latent or active?
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TB (Mycobacterium tuberculosis)
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Can be caused by drug resistance?
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TB (Mycobacterium tuberculosis)
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Visiting or living in endemic areas or residing or working in institutions like nursing homes or correctional facilities,
are related to TB? |
Exposure
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2 to 12 weeks from infection to development of positive skin test?
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Incubation period for TB
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What is the time frame of highest risk for developing active TB?
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The first 2 years.
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When you have been exposed to TB, what is the time frame for getting a skin test to establish a base line?
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Within 2 weeks.
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If the base line skin test for TB comes back negative, when do you repeat the skin test to try and establish a base line?
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In 3 months
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Weakened immune systems
Chronic diseases Steroids, Remicade, Chemo meds Poor nutrition Substance abuse are risk factors related to? |
TB
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What is the name of the skin test given to determine TB?
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Mantoux skin test (PPD)
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This test is read in 2-3 days and is a 2 step proces?
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Mantoux skin test (PPD)
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What does the Mantoux skin test (PPD) measure?
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Induration
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In the Mantoux skin test (PPD), what is it checking for?
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Bacillus Calmette-Guerin (BCG)
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What is a positive reading of the Mantoux skin test?
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>10mm for TB
>5mm for HIV |
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If the Mantoux skin test comes back as positive, what is the next step?
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A chest x-ray
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If a chest x-ray comes back abnormal in checking for TB, do they have TB?
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Yes
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Early on they may be asymptomatic, when they start to show symptoms they will have a nonproductive to productive cough, hemoptysis, afternoon low grade fever, the "biggee" is if they have night sweats, pleuritic chest pain, wt. loss, anorexia, and fatigue
are S&S for? |
TB
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It can target almost any part of the body including joints, bones, urinary tract, central nervous system, muscles, bone marrow and lymphatic system and symptoms vary depending upon the organ involved?
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TB
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Chest x-ray
Sputum culture for acid fast bacillus (AFB) Bronchoscopy are ways to diagnose? |
TB (Mycobacterium tuberculosis)
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If you have been exposed to TB, who do you report it too?
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County Health Department and CDC
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Once reported who will,
Monitor client's status, get sputum for AFB & C/S, make sure they are compliant with medications, will determine if you need institutionalized or have home isolation, will test their family for TB, and will confer with physician about treatment? |
County Health Department and the CDC
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You initiate respiratory isolation
They have a negative air-flow room You will use an N95 mask Staff precautions When trasporting patient they will be wearing a mask All family and visitors will be wearing masks when? |
If a TB patient is at risk for infection.
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When can you disontinue isolation in a TB patient?
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after 3 negative cultures
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INH
Rifampin Pyrazinamide (PZA) Ethambutol (others are streptomycin and qunolones), what type of medications are they? |
Anti-tuberculin medications
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Which TB drug?
5-20 mg/kg, max 300mg Drug interactions: phenytoin, alcohol (antabuse) Side effects: peripheral neuritis, hepatitis, hypersensitivity Check lever enzymes (AST & ALT) |
Isoniazid (INH)
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What can you give a patient to decrease neuritis if they develop neuritis while taking Isoniazid (INH)?
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Pyridoxine
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Which TB drug?
10-20mg/kg, max 600mg Drug interactions: oral contraceptives, coumadin, digoxin, oral hypoglycemics Side effects: rust discoloration in urine, fever, GI upset, hepatitis Check AST & ALT |
Rifampin (she said "big one)
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Which TB drug?
15 - 30 mg/kg, max 2 grams Side effects: hepatotoxic, uric acid, arthralgia, GI distress Check AST & ALT |
Pyrazinamide
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What can you give a patient on pyrazinamide to decrease uric acid if they have increased uric acid?
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Allopurinal
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Which TB drug?
15-25 mg/kg, max 2.5 grams Side effects: optic neuritis, rash, GI upset Check hepatic and renal labs, vision Check AST & ALT |
Ethambutol
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Cover mouth when they cough or sneeze
Use 2 tissues - place in closed waste bin Good hand washing Avoid singing, yelling (to avoid droplets) Sleep in a room alone Close room vent - open window (modified negative air pressure) are TB? |
Discharge Teachings
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Maintain treatment regime (medications, follow-up screenings, home care)
Annual PPD for those at risk Chest x-ray if symptoms reoccur New Vaccine being tested? |
Readiness for enhanced therapeutic regimen management
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