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116 Cards in this Set
- Front
- Back
What is Third Spacing
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Loss of ECF into space that does NOT affect equilibrium.
* Decrease urine output. |
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Positive electrical charge electrolyte
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CATION
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Negative electrical charged electrolyte
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ANION
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Major CATIONs
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Na, K, Ca, Mg, H
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Major ANIONs
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Cl- HCO3- HPO4- SO-
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Transcellular Fluid
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One Liter. Spinal, pericardial, synovial, intraocular, pleural, sweat digestive secretion.
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Extracellular fluid
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ECF 1/3 of fluid. For transport.
*Intravascular *Interstitial |
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Intravascular fluid
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3 liters is plasma
Rest is Erythrocyte, Leukocyte, Thrombocyte |
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Interstitial
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Lymph fluid, about 11-12 L in adult
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Osmotic Pressure
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Exerted by protein in plasma
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Hydrostatic Pressure
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Exerted on walls of blood vessels
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Osmosis
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move from Low to High solute concentration
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Diffusion
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Move from High to Low concentration
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Filtration
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Movement of water, solute to from High hydrostatic pressure to low hydrostatic pressure.
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Active Transport
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PUMP: Requires ATP. Move from low concentration to high concentration
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Kidney Filters ______
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180 L per day
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F V D
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Fluid Volume Deficit
Hypovolemia |
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F V E
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Fluid Volume Excess
Hypervolemia |
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FVD causes
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Fluid loss from vomiting
diarrhea, GI suctioning, sweating, decreased intake, no access to fluid. |
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FVD Risk factors
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Diabetes insipidus
adrenal insufficiency osmotic diureses hemorrhage coma third space shift |
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Sodium normal serum value
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135 - 145 mEq/L
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Potassium normal serum value
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3.5 - 5 mEq/L
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Calcium normal serum value
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8.6 - 10.2 mg/dL
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Magnesium normal serum value
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1.3 - 2.3 mg/dL
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Phosphate normal serum value
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2.5 - 4.5 mg/Dl
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Chloride normal serum
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97 - 107 mEq/L
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Low Ph
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Acidosis
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High Ph
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Alkalosis
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Normal Ph
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7.35 - 7.45
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Pa CO2 ABG
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35 - 45 mm Hg
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HCO3-
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22 - 26
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ABC level PaO2
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80 - 100 mm Hg
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O2 saturation
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> 94%
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Low Ph , 7.35
PaCO2 >42 |
Respiratory Acidosis
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Hi ph 7.45
paCO2 ,35 |
Respiratory Alkalosis
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Hyponatremia cause
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Causes: adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating,
MEDS: diuretics , lithium |
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Hyponatremia manifestation
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Manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping, neurologic changes
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Hypernatremia
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Causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions, unconsciousness
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Hypernatremia manifestation
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Manifestations: thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness
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Hyponatremia management
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Medical management: hypotonic electrolyte solution or D5W
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HYPO Kalemia cause
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Causes: GI losses, medications, alterations of acid-base balance, hyper-aldosterism, poor dietary intake
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HYPO Kalemia manifest
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Fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness/cramps, paresthesias, glucose intolerance, decreased muscle strength, Deep Tendon Reflex
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HYPO Kalemia management
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Management: incr dietary potassium, potassium replacement, IV for severe deficit
monitor ECG and ABGs, dietary potassium, nursing care r/to IV potassium administration |
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HypERkalemia
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MORE DANGEROUS
Causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis |
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HypERkalemia manifestation
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Manifestations: cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations, Diabetic ketoacidosis
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HypERkalemia managment
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assess serum potassium levels, mix IVs containing K+ well, monitor med affects, dietary potassium restriction/dietary teaching for patients at risk.
**Hemolysis of blood specimen or drawing of blood above IV site may result in false laboratory result |
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HYPO kalemia ECG
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Flattening of the T wave and the appearance of a U wave. Further flattening, prominent U wave
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HypERkalemia ECG
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Wide, flat P wave; wide QRS complex; and peaked T wave.
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Trousseau sign
Hypocalcemia, hypomagnesemia |
Carpal spasm(an adducted thumb, flexed wrist and metacarpo-joints, extended interphalangeal joints with fingers to-gether) will occur as ischemia of the ulnar nerve develops.
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Chvostek's sign
Hypocalcemia, hypomagnesemia |
Twitching of muscles enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped
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FVD signs/symptoms
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Acute weight loss; decr skin turgor; oliguria; conc. urine; orthostatic hypotension r/t volume depletion; weak, rapid heart rate; flattened neck veins; incr temperature; thirst; decr or delayed capillary refill; decr central venous pressure; cool, clammy, pale skin r/to peripheral vasoconstriction; anorexia; nausea; lassitude; muscle weakness; and cramps.
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FVE manifestation
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Edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure and CVP, increased weight, increased UO, shortness of breath and wheezing
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FVE risk, factors
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*Risk factors: heart failure, renal failure, cirrhosis of liver
•Contributing factors: excessive dietary sodium or sodium-containing IV solutions |
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FVE managemnt
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I&O and daily weights; assess lung sounds, edema, other symptoms; monitor responses to medications- diuretics
•Promote adherence to fluid restrictions, patient teaching r/to sodium and fluid restrictions •Monitor, avoid sources of excessive sodium, including medications •Promote rest •Semi-Fowler‘s position for orthopnea •Skin care, positioning/turning |
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PHOSPHATE
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ATP and of 2,3 diphosphoglycerate; provides structural support to bones and teeth
•Primary anion of ICF •85% in bones and teeth; 14% soft tissue; < 1% in ECF •2.5 – 4.5 mg/dL |
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Hypophosphatemia cause
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Serum level below 2.5 mg/DL
•Causes: alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vit D defic, use of diuretic and antacids |
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Hypophosphatemia manifestation
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Manifestations: neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, incr suscept to infection
•Nursing manage: assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition |
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Hyper phosphatemia cause
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Serum > 4.5 mg/DL
•Causes: renal failure, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy |
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Hyper phosphatemia manifestation
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Few symptoms; soft-tissue calcifications, symptoms occur due to associated hypocalcemia
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Hyper phosphatemia managemnt
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Assessment, avoid high-phosphorus foods; teaching r/to diet, phosphate-containing substances, signs of hypocalcemia
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CHLORIDE
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97-107 serum
Major anion of ECF; Interstitial/ lymph fluid, gastric, pancreatic jc, sweat/bile/saliva •Maintain acid-base balance •Buffer in exchg of O2/CO2 in RBCs |
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Hypo chloremia cause
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Low chloride intake, GI loss, exces sweating, fever, burns, medications, metabolic alkalosis
•Loss of chloride occurs with loss of other electrolytes, potassium, sodium |
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Hypo chloremia manifest
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Agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma
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Hypochloremia mgt
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Assessment, avoid free water, encourage high-chloride foods, patient teaching r/t high chl food.
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HYPERchloremia cause
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?107 Exc NaCl infusions with water loss, head injury, dehydration, severe diarrhea, resp alkalosis, metabolic acidosis, hyperparathyroidism, medications
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Hyperchloremia manifest
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Tachypnea, lethargy, weakness, rapid, deep respirations, hypertension, cognitive changes
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Hyperchloremia mangmt
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Assessment, patient teaching r/to diet and hydration
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Maintn Acid=Base balance
3 mechanism |
1) Major ECF buffer system; bicarbonate-carbonic acid buffer system
2) Kidneys regulate bicarbonate in ECF 3) Lungs under control of medulla regulate CO2, carbonic acid in ECF |
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Other Buffer systems,
maintain acid-base balance |
1) ECF: inorganic phosphates, plasma proteins
2) ICF: proteins, organic, inorganic phosphates 3) Hemoglobin |
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Ratio of bicarb/carb acid
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20 Bicarbonate: 1 carbonic acid
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Acidosis ph
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6.81 - 7.34 ph
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pH Death
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less than 6.8
gr than 7.8 |
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Alkalosis pH
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7.45 - 7.8
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Metabolic ACIDosis
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*Low pH < 7.35
•Low bicarbonate < 22 mEq/L***cardinal feature *Low PaCO2 < =35 •Most due to renal failure, also diarrhea and diuretics |
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Metabolic ACIDosis manifestation
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headache, confusion, drowsiness, increased resp rate/depthh, decr BP, decr cardiac output, dysrhythmias, shock; gradual decr = asymptomatic until bicarbonate is 15 mEq/L or less
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Metabolic ACIDosis
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Monitor potassium for hyper/hypo
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Metabolic ALKAlosis
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* High pH >7.45
•High bicarbonate >26 mEq/L •Most due to vomiting, gastric suction, or LT diuretic use |
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Metabolic ALKAlosis manifest
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*Hypokalemia lead to alkalosis
•Sx r/to decr calcium, resp depression, tachycardia, sx of hypokalemia |
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Respiratory ACIDosis
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* Low pH <7.35
High Bicarb • High PaCO2 > 42 mm Hg •Always due to respiratory problem w defic. excretion of CO2 |
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Respiratory ALKAlosis
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* High pH >7.45
* Low HCO3 • Lower PaCO2 < 38 mm Hg •Always due to hyperventilation •Causes: anxiety, hypoxemia, gram negative bacteremia |
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Respiratory ALKAlosis manifest
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Lightheadedness, inability to concentrate, numbness and tingling, sometimes loss of consciousness
•Correct cause of hyperventilation |
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ABG level all normal
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pH 7.35 - 7.45
•PaCO2 35 - 45 mm Hg •HCO3ˉ 22 - 26 mEq/L •PaO2 80 to 100 mm Hg •Oxygen saturation >94% |
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ABG level of PaCO2
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35 - 45 mm Hg
PaCO2 (40) |
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ABG level of HCO3-
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22 - 26 mEq/
HCO3- (24) |
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ABG level of PaO2
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80 to 100 mm Hg
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Respiratory ACIDosis
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PH HCO3 Pa CO2
< 7.35 > = 26 > 45 D up = up |
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Metabolic ACIDosis
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PH HCO3 Pa CO2
< 7.35 < 22 < = 35 D D D= |
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Respiratory ALKAlosis
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PH HCO3 Pa CO2
> 7.45 < = 22 < 35 Up D = D |
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Metabolic ALKalosis
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PH HCO3 Pa CO2
> 7.45 > 26 > = 45 Up up up = |
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Imbalance chart
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pH HCO Paco2
*Resp acidosis D up = up •Resp alkalosis up D = D •Metabolic acidosis D D D = •Metabolic alkalosis up up up = |
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Creatinine
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end product of muscle metabolism. Better indicator of renal function than BUN bc does not vary with protein intake/metabolic state. Normal serum 0.7 to 1.4 mg/dL
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Hematacrit
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Volume percentage of RBC (erythrocytes) in whole blood and normally Male = 42% to 52%
Female 35% to 47% |
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Increase Hematocrit
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dehydration and polycythemia,
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Decrease hematocrit
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overhydration and anemia.
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Urine sodium
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Normal urine sodium levels range from 75 to 200mEq/24 hours
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Urine sodium indicates
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hyponatremia and acute renal failure.
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Urine specimen sodium level
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more than 40 mEq/L of sodium in random specimen.
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Function of Kidney
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Regulation of ECF volume and osmolality by selective retention and excretion of body fluids
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BUN
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Amino acid breakdown = ammonia then converted to urea and expeled in urine.
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Normal BUN
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normal BUN is 10 to 20 mg/dL
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Factors that increase BUN
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decreased renal function,GI bleeding, dehydration, increased protein intake, fever, and sepsis.
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Factors that decrease BUN
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end-stage liver disease, a low-protein diet, starvation, expanded fluid volume (pregnancy)
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Urine Specific Gravity
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kidneys’ ability to excrete or conserve water. The specific gravity of urine is compared to weight of distilled water, which has a specific gravity of 1.000. The normal range of urine specific gravity is 1.010 to 1.025.
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Range of Urine Specific Gravity
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The normal range of urine specific gravity is 1.010 to 1.025
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Function of Kidney
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Regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion •Regulation of pH of ECF by retention of hydrogen ions
•Excrete of metabolic wastes, toxic substances |
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ALKALOSIS
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High PH
High bicarbonate can be produced by a gain of bicarbonate or a loss of H+ |
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ACIDOSIS
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Low PH
Low Bicarbonate a gain of hydrogen ion or a loss of bicarbonate |
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Respiratory
Acidosis |
In resp acidosis, excess hydrogen is excreted in the urine in exchg for bicarbonate ions.
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Respiratory Alkalosis
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resp alkalo-sis, the renal excretion of bicarbonate increases, and hydrogen ions are retained
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Metabolic Acidosis
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In metabolic acidosis, the compensatory mechanisms increase the ventilation rate and the renal retention of bicarbonate.
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Metabolic Alkalosis
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In metabolic alkalosis, the respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2
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D5W solution
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has Serum osmolality of 252 mOsm/L
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Normal saline
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Normal saline (0.9% sodium chloride) solution has a total osmolality of 308 mOsm/L.
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Electrolyte solutions:
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if the total electrolyte content (anions + cations)
ISOTONIC approx 310 mEq/L, hyPOtonic content < 250 mEq/L, hypertonic content > 375 mEq/L. osmolality of plasma is ap-proximately 300 mOsm/L |
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osmolality of plasma
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300 mOsm/L
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Respiratory acidosis.
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Chronic respiratory acidosis occurs with pulmonary diseases such as chronic emphysema and bronchitis, sleep apnea, and obesity.
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