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155 Cards in this Set
- Front
- Back
- 3rd side (hint)
Jim's preference for assessing renal failure and how is it calculated?
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CrCl = (140 - age) x IBW / (Scr x 72)
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Name the 3 types of incontinence and examples of each type.
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Stress-coughing, laughing
Urge-bladder spasms Outflow-BPH |
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The mechanism of action of Proscar and Avodart is what?
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5alpha-reductase enzyme converts testosterone to its most active form, this reduces the prostates exposure to testosterone, thereby it shrinks.
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Name the alpha blockers that can be used in the tx of BPH
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Terazosin, Prazocin, Doxazocin, Tamsulosin
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What is the MOA of the alpha blockers in the urinary system?
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vasodilator, urine flows easier
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What side effect must you watch for when using alpha blockers in the tx of BPH?
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must watch BP as it will vasodialate all vessels
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What side effect do men c/o when taking Avodart or Proscar?
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decreased libido and/or impotence
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What do you give a pt. that presents with a kidney stone (list a possible 5) and tell why.
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1) IV hydration-to dilute the toxins/crystals so that stones may pass
2) Pain mgt-iv narcotis, choice based on pt allergies and provider preference 3)Change urine pH-depending on the type of the stone, works better on chr. stone developers 4) Surgical removal-urology retrieves or percutaneously 5) Ultrasound destruction-lithotripsy, busts it up into sand |
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Why do CRF pts need erythropoietin injections?
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To increase the rbc proliferation, as they have a shortened rbc life span
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Name 3 meds given to increase erythropoietin and rbc's
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Procrit, Epogen, Aranesp
10-40K units qwk |
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What is the target hgb for a CRF patient? target hct?
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hgb 11-12
hct 30 |
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What could happen to a CRF pt if their hgb got too high?
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MI, CVA, DVT
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Pts. that receive erythropoietin must also have adequate stores of what vitamins?
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B-12, folic acid
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What mineral may CRF patients need? But what must you becareful of when prescribing this med?
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iron,
iron toxicity can be deadly |
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What is Venofer? What is Ferrlecit?
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IV iron injections
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Why must CRF patients monitor their Phosphate intake?
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phosphate is renally excreted.
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What happens to a CRF pt if their phosphate level gets too high?
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then it meets up and binds to Ca and they can deposit all over the body
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What water soluble vitamins must be provided to dialysis pts and why?
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B and C as dialysis takes them out!
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When a pt presents with hyperkalemia what should be your first priority?
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protecting the heart from arrythmias
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What can you give to tx hyperkalemia?
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Calcium gluconate, sodium bicarb, insulin and glucose
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What effect does sugar have on K?
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forces it into the cells
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What do you use sodium polystyrene sulfonate for?
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binds up K in the gut, but watch out for hyponatremia
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What is aluminum hydroxide (alternagel), calcium salts (citrate, carbonate, acetate) used to tx?
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phosphate binder
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why should CRF patients avoid MOM, Mylanta, Maalox, etc?
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magnesium is eliminated thru the kidneys, CRF pts won't excrete and will develop hypermagnesia
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Why must you becareful with ACEI in CRF pts?
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renally excreted, due to the protective measures though they are worth a try
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Name 3 drug therapies for the tx of ARF
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1) Loop diuretics
2) Dopamine (low dose) although there is no evidence it works 3) Mannitol |
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Why/how does Mannitol work in the kidneys?
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A sugar solution/osmotic diuretic that helps restore perfusion to the kidneys-limiting injury to the pt
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Name the 4 goals of therapy when treating erosive GI dos
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-decrease symptoms
-decrese frequency and duration of symptoms -promote healing -prevent complications |
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Name 6 rationale for the therapy of erosive GI dos
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-increase sphincter tone of lower esophagus
-inc. esophageal acid clearance -inc. gastric emptying -protect mucosa -decrease acidity -dec. gastric volume available for reflux (doesn't work!) |
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Name the 3 major classes of drugs used to tx GERD
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-antacids
-H2 blockers -PPI's |
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What/when are antacids the drugs of choice for GI symptoms?
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acute simple symptoms, or occasional symptoms
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Name some antacids and identify which should not be given to ARF pts.
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1) NaHCO3 (sodium bicarb) can cause constipation
2)Al(OH)3-aluminum hydroxide, can cause constip. 3)Mg(OH)2-magnesium hydroxide-can cause diarrhea***NO to ARF pts 4) CaCO3-calcium carbonate, constipation***NO to ARFpts ***ARF pts cant clear Mg*** |
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How do H2's work?
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block the secretion of hydrochloric acid in the gut
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Name 4 of the top H2's
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-Tagamet
-Pepcid -Axid -Zantac |
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Why/what must you becareful when prescribing H2's?
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also blocks the metabolism of several drugs
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Name 2 popular PPI's and what is their MOA?
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-Prevacid
-Prilosec *MOA effects the parietal cells in the stomach and inhibits the push of protons into the gut |
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What type of symptoms/and or relief are pts experiencing when you consider prescribing H2's?
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Need relief in hours
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What type of symptoms/relief are pts experiencing when you consider prescribing PPI's?
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chronic relief
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What are some other drugs that can be used in the treatment of GERD?
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-reglan: for nausea, and is promotility (can cause diarrhea)
-bethanechol (urecholine)-cholinergic agonist that stimulates peristalsis -sucralfate (carafate)-binds to ulcers or injury, coating/protecting (can also bind some other drugs, so becareful) |
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What is PUD?
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peptic ulcer disease
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What are 3 main causes of PUD?
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-Nsaids-reduce prostaglandin synthesis, prostaglandins are protective in the gut
-smoking -H. pylori |
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Name 4 goals/rationale for the tx of PUD
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-dec. acid secretion
-protect mucosa -replacement treatment -antibiotics |
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What types of drugs can be used in the tx of PUD? (there are 6 listed!)
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-antacids
-H2 blockers -PPI's -misoprostol (cytotec) -sucralfate (carafate) -antibiotics (pick 2) |
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What is the main line treatment for motility disorders?
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find and treat the cause
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What are some types of treatment for constipation? there are 5 listed....
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-bulk laxatives (metamucil)
-stimulant/irritant -stool softener/surfactant -lubricant -osmotic laxative-draws H20 into the colon |
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What is the number tx of diarrhea?
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find and treat the underlying cause
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Name 2 drugs that are used in the tx of diarrhea
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-Lomotil (atropine+diphenoxylate) is an anticholinergic that acts like a narcotic
-Imodium (loperamide) |
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Name 3 drugs that can be used in the tx of N/V and their s/e
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-prochlorperazine (compazine)-can cause confusion esp. in the elderly, also can cause tortocollis that you tx with benadryl
-promethazine (phenergan)-has antihistamine properties, causes sedation -metoclopramide (reglan)-can get movement dos, tx with benadryl |
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Name 2 serotonin antagonists that can be used in the tx of N/V
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-ondansetron (zofran)
-granisitron (kytril) |
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In the treatment of UC (ulcerative colitis) and Crohn's disease (CD) what is MOA for all the meds?
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-all metabolize to a compound of mesalamine, local anti-inflammatory
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Name 4 drugs/dosages of meds in the tx of UC and CD
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-sulfasalazine (azulfidine) 500mg
-mesalamine (asacol) 400mg -olsalazine (dipentum) 250mg -mesalamine (pentasa) 250mg |
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Sulfasalzine, asacol, and dipentum work/release where in the gut?
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all release at the terminal ilium
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In a pt. with a sulfa allergy, you must becareful when prescribing which drug in the tx of UC and why?
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sulfasalazine-as it is mesalamine attached to a sulfa group. Could have allergic rxn
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What is special about Pentasa?
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works t/o the entire gut, so its is effective for dx outside the colon as well as inside
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What other types of drugs are used in the treatment of UC and CD?
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steroids-antiinflammatory
infliximab (remicade) a mono-clonal antibody that works against TNF |
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What is Entocort?
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the only steroid that is released and effective only in the colon. used in combo with mesalamine. no systemic side effects of steroids
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What are some problems that are experienced with Remicade therapy?
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-EXPENSIVE!!!
-by decreasing TNF (inflammatory regulator) the pts can begin developing strange infxn's that the TNF would normally handle without problem |
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What is a bad outcome of gallstones?
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gall stone pancreatitis
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What is primarily the PA role in the treatment of pancreatitis?
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IV nutrition, pain management, consult surgery
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What is AAC? What is the bug involved?
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diarrhea from hell, clostridium difficile
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What are the most common abx's that cause AAC?
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-Ampicillin
-Rocephin (ceftriaxone) -Cleocin (clindamycin) -FQ's |
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What must every healthcare worker do to prevent the transmission of AAC to themselves or others?
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WASH YOUR HANDS!, hand gel does not work
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What is the number 1 way to tx AAC?
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remove the offending agent if possible
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Name 3 drug therapies that tx AAC
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-metronidazole (flagyl) IV or PO
-vancomycin PO only! -questran (cholestyramine)-binds up the toxins in the colon |
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What is traveler's diarrhea caused by?
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parasites in water, generally self limiting, but can cause dehydration requiring hospitalization
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Name 3 drugs used in the tx of traveler's diarrhea
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-tetracycline
-bactrim -ciprofloxacin |
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What is a side effect of all 3 drugs used in the tx of traveler's diarrhea?
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photosensivity-but of the 3 cipro is the safest
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Define pancreatitis
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-hurts like hell
-usually caused by ETOH & gallstones. -blockage of the pancreatic ducts cause a backup of pancreatic enzymes which begin eating away at the pancreas |
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How do you treat pancreatitis?
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Stop the offending agent (ETOH)
IV nutrition/hydration IV narcotics consult surgery bowel rest |
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How does cystic fibrosis affect the gut?
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thick secretions in the GI tract that can clog up the pancreatic duct and develop pancreatitis, diabetes type I due to pancreatic damage. sometimes need pancreatic supplements to help with digestion
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How do you determine what type of IV fluid to order for a pt?
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Where does the pt most need fluid replacement
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The body is ___-___% water. what are its distributions?
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50-70 %
-intracellular-35% by wt -intravascular-5% by wt -interstitial-16% by wt -lymph, CSF, etc |
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What are the number 1 & 2 intracellular cations
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#1 potassium
#2 magnesium |
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What are the top 2 intracellular anions?
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#1 phosphate-needed to make ATP from ADP
#2 bicarbonate-needed to maintain acid/base balance |
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What are the number 1 & 2 extracellular cations?
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#1 sodium
#2 potassium |
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What are the # 1 & 2 extracellular anions?
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#1 chloride
#2 bicarbonate |
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What is the tonicity of blood?
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osmolality is 300mOsm-isotonic
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What does hypotonic mean?
What does hypertonic mean? What happens to the blood cells with these solutions? |
hypo- <300 mOsm, rbc's swell as the fluid goes into them
hyper->300 mOsm, rbc's shrivel up as fluid is drawn out of them |
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Which IVF is the most isotonic? and where does it distribute?
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D5W-as isotonic as you can get, it goes everywhere: cells, vascular, interstitial. and what glucose is not used is stored.
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Lactated ringers is what type of solution? What is included in LR? Why do surgeons prefer LR?
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isotonic
LR has sodium, potassium, calcium, lactate, and chloride. surgeons love it as it is good for vascular support |
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What type of solution is 0.9% normal saline?
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isotonic-is really good for tissue hydration, with some going into cells also
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D5NS is a good fluid for what?
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helps maintain vascular volume with some going into interstitial spaces
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Which saline solutions should never be given by themselves? and why?
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1/3 NS and 1/4 NS as they are too hypotonic and could/will hurt someone, must be given with other fluids!
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True or false...the more concentrated the NS the more dangerous it is
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false, the more dilute the NS the more dangerous it is...
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If your pt needs intravascular volume, (intravascular hypovolemia) what solutions could/should you use?
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NS or LR (crystalloids) as the pt needs vascular volume and these primarily stay in vascular spaces
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If your patient has intracellular dehydration, what must be added to whatever IV solution you order?
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D5W, it goes into the tissues...
so D5NS, D5LR, or just D5W |
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If your pt. needs less than 1 liter of IV fluids a day what should you do? what rate?
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discontinue it!
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How do you figure out how much fluid a pt needs a day?
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what is there estimated total volume/24 hours
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If a pt needs 3000cc's of fluid per day what is the IV rate?
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3000/24=125cc/hr
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What does TPN stand for?
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total parenteral nutrition
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What are long term indications for TPN?
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short gut syndrome, inability to absorb vitamins/minerals, cant eat for whatever reason
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What are some short term indications for TPN?
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pancreatitis, if the pt needs bowel rest
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How long can you wait before starting TPN on a patient?
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4-7 days depending on the state of your patient
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What must you have before initiating TPN therapy?
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baseline labs- such as cbc, cmp, lft's, liver profile, ca, mg, pt/ptt
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You can feed a pt TPN peripherally for about a week before you will need _____?
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central venous access
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Name the 4 macronutrients of TPN and the daily requirements of each
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-protein 1gm/kg/day
-fluids 30cc/kg/day -fats 500cc 3-7 days qweek -carbohydrates 25-35 cal/kg/day |
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Protein added to TPN is important for what?
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-maintaining muscle mass
-making hormones |
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Carbs added to TPN are needed for what? What must you do with carbs for pt. in a catabolic state?
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-needed for cell nrg
-catabolic pt's need more nrg, may have to increase carbs to 50cal/kg/day |
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What 'other' components are/should be included in TPN?
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electrolytes, Mg, PO4, Ca, vitamins, trace elements and if needed insulin, vitamin K, folic acid, H2 receptor antagonist
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other than dextrose and protein
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What percentage of protein should be included in every bag of TPN?
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5%
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What is the standard % of dextrose in TPN?
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18%
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What can you count on doing for many days after the initiation of TPN therapy?
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change, change, change. you will have to alter a lot, most in first 3 days.
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What do you want to keep in mind as you are adding more drugs to a pts TPN? what do you want to avoid?
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the more you add, the more chance for a snow globe!
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What laboratory and clinical monitoring must be done in pts receiving TPN?
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-lab work (glucose, lft, lytes, mg, triglycerides, Ca, renal fcn tests, cbc, pt/ptt, etc)
-daily wt -I & O -clinical/venous status -protein status |
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What is the best marker of nutritional status? Which marker is traditionally used but is not the best?
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prealbumin is the best marker but is rarely used, typically albumin level is checked but isn't the best
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What 3 people must you consult if your pt needs TPN?
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-surgery
-nutritionist -pharmacist |
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what are the 4 major complications to TPN therapy?
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-electrolyte derangements-count on it, and adjust
-fatty liver-lft's will creep up, decrease dextrose calories and inc. fat and protein calories -sepsis-line infection -refeeding syndrome-start food back very slowly. |
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S/S of hypo Na are what?
How do you treat it? |
depressed CNS and depressed muscle fcn
-fluid restriction, correct the cause, NS IV, diurese if over hydrated |
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s/s of hyper Na? how do you treat?
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dehydration symptoms, tachycardia
-tx with dietary Na restriction, non-saline IVF to rehydrate sodium, desmopressin, or vasopressin if need ADH |
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S/S of hypo K are what? and how do you tx?
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confusion, weakness, arrhythmias.
-tx by correcting the cause, give PO K+ if asymptomatic (10-50 mEq) 1-6 x's QD, or IVPB if NPO or symptomatic, (20-40 mEq boluses) with K+ also added to base IVF. |
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If after you give K+ IV and the level still has not come up sufficiently, what should you do next?
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check the Mg level, if low give will increase the retention of the K+
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S/S of hyper K? how do you treat it?
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weakness (paralysis), arrhythmias
-correct the cause (drugs, acidosis, etc) give... -sodium polystyrene sulfonate -insulin/dextrose -correct pH if acidotic -Ca gluconate if K >7.0 |
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Hypomagnesia is usually a result of _______?
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a dietary problem
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s/s of hypo Mg are what? how do you treat?
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-correct the cause and feed them Mg, or give IVPB/IM 2-4 gms as needed
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s/s of hyper Mg are what? in what population must this be checked frequently? and how is it fixed?
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hypotension, n/v, confusion, paralysis
check OB pts frequently correct the cause, +saline, IV Ca gluconate if cardiac or resp distress |
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s/s of hypocalcemia are what? how do you fix?
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paresthesias, seizures, tetany
fix with Ca p.o. or IV |
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What else must be done in pts. with hypocalemia?
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check Mg, albumin, and vitamin D levels and then give all to them!
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what pt's are susceptible to hypercalcemia?
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CA pt's especially with bone mets
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s/s of hyper Ca? how do you tx?
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-malaise, weakness, anorexia, n/v, constipation, hyporeflexia
-tx with calcitonin nasal spray or subq or pamidronate -aggressive IV hydration to dilute the concentration |
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what usually causes hypo PO4?
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we do, its iatrogenic
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how do you treat hypo PO4?
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neutrophos (2-4 caps, po, bid) or ivpb
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what are s/s of hyperPO4? what pt. population is it seen in most often? how do you tx?
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-calcium phosphate deposits, hypocalcemia
-renal dialysis pts -restrict PO4 in diet, dietician consult, give PO 4 binders, IV NS + diuretics |
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Name the water soluble vitamins
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B1-thiamine, alcoholics need
B2-riboflavin-dont care B6-pyridoxine, seen in INH therapy, hyperemesis gravidarum, linezolid neuropathy (put on B6) B12-cyanocobalamin) folic acid-macrocytic anemia niacin-antilipemic agent C-ascorbic acid |
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Name the fat soluble vitamins
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a-gd for skin and eyes
d-gd for ca and po4 absorption e-gd as antioxidant k-gd for coagulation |
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Acid/base balance...buffers soak up ____ ions
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hydrogen
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the kidney's regulate what in regards to acid/base balance?
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hydrogen and bicarb
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the respiratory system regulates what in regards to acid/base balance?
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CO2
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what are 3 important buffers in the body?
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-PO 4
-hgb -proteins |
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what are 3 important 'blood elements' in regards to acid/base balance?
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-HCO3
-pCO2 -buffers (PO4, hgb, proteins) |
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what is the normal pH of the blood?
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7.35-7.45
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If a pt's pH is 7.29, this means they are _?
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acidotic
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What is the range in which the pH is 'incompatible with life'?
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<6.8 or >7.8
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if a pt's pH is 7.62, this means that they are__?
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alkolotic
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what is the normal pO2 level?
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80-100
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what is the normal pCO2 level?
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35-45
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what is the normal bicarb level?
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22-26
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What is rule number one in the treatment of acid/base disorders?
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treat the underlying cause!
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what is the normal anion gap?
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10-14
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how do pt's try to compensate for acid/base disturbances?
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-resp. rate, either blowing off or retaining CO2
-kidneys get involved by secreting H+ ions or bicarb into the blood stream |
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how are acid/base disturbances named?
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1st-the source of the problem
2nd-via the pH |
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a pt with a pH of 7.44, pCO2 of 31, bicarb that is normal then goes low due to hyperventilation is in ______?
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respiratory alkalosis-inc. pH and dec. CO2 due to hyperventilation, the bicarb level goes down as the kidneys begin to secret bicarb to help regulate the pH.
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what is the treatment of respiratory alkalosis?
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treat the cause, the pain, anxiety, etc...give them a paper sack so that they can rebreath their co2.
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What is a classic sign of respiratory alkalosis?
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perioral parasthesias
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a pt with a pH of 7.33, pCO2 of 51, bicarb is normal then goes high due to respiratory failure is in _?
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respiratory acidosis-due to hypoventilation the body is not able to expire CO2, so the kidneys begin to retain bicarb to compensate for the for the low pH
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what is the treatment of respiratory acidosis?
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-ventilate the patient so that the lungs can exchange O2 for CO2
-if the pH is <7.0 can give Na bicarb, if not <7.0 you could over shoot,and cause other problems. |
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a pt. presents with a pH of 7.27, pCO2 normal then goes low to 28, bicarb 19, this pt is in __?
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metabolic acidosis
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metabolic acidosis is usually a result of what?
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DKA, ASA overdose, sepsis
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what respiratory problem can lead to metabolic acidosis?
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kussmaul respirations
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what is the tx of metabolic acidosis?
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treat the underlying cause, IVF, Na bicarb if the pH is<7.0 but watch the K+ closely
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a pt presents with a pH of 7.54, pCO2 that is normal at first then goes high at 53, bicarb high at 33 what is this?
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metabolic alkalosis due to usually alkali overdose (tums) or loop diuretics
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what is the tx of metabolic alkalosis?
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-remove the offender
-can give PPI to decrease the H+ release in the gut |
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combined acidosis is described as what?
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low pH, high pCO2, low bicarb, must tx both problems or pt. dies, very poor outcome and the pt may not return to baseline if you do save them
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combined alkalosis is described as what?
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high pH, low pCO2, high bicarb, very rare!
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resp. alkalosis/metabolic acidosis, what might the bld gases show?
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ph-normal, pCO2-low, HCO3-low. pt may be partially or totally compensated
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respiratory acidosis/metabolic alkalosis, what might the bld gases show?
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pH-normal, pCO2-high, bicarb-high will see in chr. copd pts. tx the acute illness (such as in pneumonia)
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