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61 Cards in this Set

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What does CO2 tell you with an ABG?
CO2--> if high, either it's respiratory acidosis, or compensating for met alk.
If low, either resp alk, or compensating for met acidosis
What does Bicarb tell you with an ABG?
If high, either met alk, or compensating for resp acidosis. If low, either met acidosis, or compensating for resp alk
T/F, the body doesn't compensate beyond normal pH?
True, overcorrection doesn't occur
Common causes of respiratory acidosis?
COPD,asthma,drugs, just what problems, and sleep apnea
Common causes metabolic acidosis?
Ethanol, diabetic ketoacidosis, uremia, lactic acidosis, methanol/ethylene Glycol , aspirin overdose , diarrhea, and carbonic anhydrase inhibitors
What does CO2 tell you with an ABG?
CO2--> if high, either it's respiratory acidosis, or compensating for met alk.
If low, either resp alk, or compensating for met acidosis
What does Bicarb tell you with an ABG?
If high, either met alk, or compensating for resp acidosis. If low, either met acidosis, or compensating for resp alk
T/F, the body doesn't compensate beyond normal pH?
True, overcorrection doesn't occur
Common causes of respiratory acidosis?
COPD,asthma,drugs, and sleep apnea
Common causes of metabolic acidosis?
Ethanol, diabetic ketoacidosis, uremia, lactic acidosis, methanol/ethylene Glycol , aspirin overdose , diarrhea, and carbonic anhydrase inhibitors
Common causes of Respiratory alkalosis?
anxiety/hyperventilation and aspirin/salicylate overdose
Common causes of metabolic alkalosis ?
Diuretics (except carbonic anhydrase inhibitors),vomiting, volume contraction, antacid use, and Hyperaldosteronism
What type of acid-base disturbance does aspirin overdose cause ?
Respiratory alkalosis and metabolic acidosis
What happens to the blood gas of patients with chronic lung conditions?
in certain people with chronic lung conditions pH may be alkaline during the day because they breathe better when awake
Should you give bicarbonate to a patient with acidosis?
For purposes of the step two boards almost never. First, try IV fluids and correction of the underlying disorder
List the signs and symptoms of Hyponatremia ?
Lethargy, mental status changes, anorexia, seizures, cramps, coma
What are the causes of Hypovolemic hyponatremia?
Dehydration, diuretics, diabetes, hyperaldosteronism.
what are the causes of Euvolemic hyponatremia?
SIADH, psychogenic polydipsia, Oxytocin use
what are the causes of hypervolemic hyponatremia?
Heart failure, Nephrotic syndrome, Cirrhosis , toxemia , renal failure
how his hyponatremia treated?
For hypovolemic hyponatremia the treatment is normal Saline. For euvolemic and hypervolemic hyponatremia treat with water/fluid restriction
What happens if hyponatremia is corrected too quickly?
You may cause brain stem damage (central pontine myelinolysis).hypertonic saline is used only when a patient has seizures from severe hyponatremia. N. S. is a better choice 99% of the time
What medication is used to treat SIADH if water restriction fails?
DEMECLOCYCLINE which induces nephrogenic diabetes insipidus
what causes false hyponatremia?
Hyperglycemia (once glucose is over 200mg/dl, Na decreases by 1.6mEq/L for each rise of 100mg/dl in glucose),Hyperproteinemia, hyperlipidemia
What causes hyponatremia in postoperative patients?
Most common cause is the combination of pain and narcotics, with aggressive administration of IV fluids
what is the classic cause of hyponatremia in pregnant patients about to deliver ?
Oxytocin, which has an antidiuretic hormone-like effect
What are the S/Sx of hypernatremia?
basically the same as hyponatremia; mental status changes/confusion, hyperreflexia, seizures, and/or coma
What causes hypernatremia?
Most common is dehydration. Watch for diuretics, diabetes insipidus, diarrhea, and renal dz as well as iatrogenic causes.
How is hypernatremia treated?
Water replacement, most of NS

* D5W should not be used for hypernatremia
S/Sx of hypokalemia?
Muscular weakness, paralysis and Ventilatory failure went smooth muscles are also affected, patients may develop ileus and/or hypotension. EKG findings include a loss of T. wave or T. wave flattening,other arrhythmias may also occur
what is the effect of pH on serum potassium?
Changes in pH caused changes in serum potassium as a result of cellular shift. alkalosis Causes hypokalemia, acidosis causes hyperkalemia. For this reason bicarbonate is given to severely hyperkalemic patients
Describe the interaction between digitalis and potassium?
The heart is particularly sensitive to hypokalemia in patients taking digitalis. Potassium levels should be monitored carefully
How should potassium be replaced?
Slowly, like all electrolyte abnormalities. Oral is preferred, but if I. V. is necessary do not give more than 20mEq/hr. put the patient on an EKG monitor when giving IV potassium
When hypokalemia persists even after administration of significant amounts of potassium, what should you do?
check the magnesium level. when magnesium is low, the body cannot retain potassium effectively
what are the signs and symptoms of Hyperkalemia?
Weakness and paralysis may occur, but the cardiac effects are best known. EKG changes include tall, peaked T waves, widening of QRS, prolonged PR, loss of P waves, and sine-wave pattern. Asystole, and V-fib happen
what causes hyperkalemia?
Renal failure, severe tissue destruction,hyperaldosteronism, medications, and adrenal insufficiency
What should you suspect If an asymptomatic patient has hyperkalemia?
with hyperkalemia, the first consideration is whether the labsand specimen is hemolyzed,which causes a false hyperkalemia
if the specimen was not hemolyzed, what is the first treatment?
get EKG to look for Cartdiotoxicity. In general the best therapy for hyperkalemia is decreased potassium intake, and oral sodium polystyrene resin.
If the potassium level is greater than 6.5 and/or cardiotoxicity is present what do you do?
Immediate IV therapy, first give calcium gluconate, then give sodium bicarb, and glucose with insulin.
What are the S/Sx of hypocalcemia?
neuro findings; tetany. Tapping of the facial nerve elicits Chvostek's sign (contraction of facial muscles). Trousseau's sign can also happen (BP cuff elicits hand spasms)
Classic EKG findings with hypocalcemia?
QT-interval prolongation
What should you do if the calcium level is low?
First, remember that hypoproteinemia can cause it, but these pts are asymptomatic. So check albumin, and/or ionized or free Ca.
What causes hypocalcemia?
DiGeorge's syndrome (tetany 24-48 hrs after birth), Renal failure, hypoparathyroidism, Vit D deficiency, pseudohypoparathyroidism, acute pancreatitis, renal tubular acidosis
Describe relationship between low calcium and low magnesium?
It's difficult to correct hypocalcemia until hypomagnesemia also is corrected.
How does pH affect Ca levels?
alkalosis causes Ca to shift intracellularly.
What's the relationship betweeen Ca and Phosphorus?
The levels usually go in opposite directions,
What are the S/Sx of hypercalcemia?
Often aSx, but if present; Bones (osteopenia), Stones (kidney and polyuria), Groans (abd pain, anorexia, constipation, ileus, N/V), Psychiatric overtones (depression, psychosis, delirium/confusion)
EKG changes with hypercalcemia?
classically QT-interval shortening
What causes hypercalcemia?
Most commonly hyperparathyroidism. In inpatients, it's malignancy. Others include Vit A, or D intox, sarcoidosis, thiazide diuretics, familial hypocalciuric hypercalcemia, and immobilization
Why is aSx hypercalcemia usually treated?
If prolonged, it can cause nephrocalcinosis and renal failure d/t Ca salt deposits in the kidney and may result in bone dz secondary to loss of Ca
How do you Tx hypercalcemia?
First, IV fluids, then when well hydrated give Lasix to cause calcium diuresis. (Thiazides are contraindicated). For hyperparathyroidism, surgery is Tx of choice
In what clinical scenario is hypomagnesemia usually seen?
Alcoholism, Mg is wasted through the kidneys
S/Sx of hypomagnesemia?
Prolonged QT interval and possible tetany (similar to those of hypocalcemia)
In what clinical scenario is hypermagnesemia seen?
classically iatrogenic in pregnant pts who are tx for preeclampsia with Mag sulfate. Also common in renal failure.
S/Sx of hypermagnesemia?
Initial sign is decrease in DTR, then hypotension and respiratory failure occur sequentially
How is Hypermagnesemia Tx?
First stop any Mag. Remember ABCs and intubate if necessary. If stable, can give IV fluids, and Lasix can be given to cause Mg diuresis. Last resort is dialysis.
In what clinical scenarios is hypophosphatemia seen?
Seen primarily in pts with uncontrolled DM (esp diabetic ketoacidosis), and alcoholics.
S/Sx of hypophosphatemia?
Neuromuscular disturbances, rhabdo, anemia, and WBC and platelet dysfxn
What is the IV fluid of choice in trauma patients?
Lactated Ringers, second is NS
What is the IV fluid of choice in nontrauma, hypovolemic pts?
NS or Lactated Ringers. First fill the tank, then correct imbalances that kidney can't get fixed
What is the maintenance fluid of choice for pts who aren't eating?
1/2 NS with 5% dextrose in adults, and 1/4 or 1/3 NS with 5% dextrose in children
Should anything be added to the IV fluid for pts who aren't eating?
Usually KCl, 10 or 20 mEq, to a liter of IV fluid each day to prevent hypokalemia