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108 Cards in this Set
- Front
- Back
Normal Acid-base balance is
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1:20
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Imbalances are classified as being ____________ or ____________.
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respiratory or metabolic
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Respiratory imbalances affect _________ _________ concentrations.
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carbonic acid
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Metabolic imbalances affet the base ____________.
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bicarbonate
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Normal valuses for pH
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7.35-7.45
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Normal valuses for pCO2
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35-45 mmHg
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Normal valuses for HCO3
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20-30mmHg
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Normal valuses for pO2
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80-100 mmHg
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Normal valuses for O2 saturation is
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96-100%
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common cause of Respiratory acidosis
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*abnormalities in pulmonary ventilation leading to CO2 retention.
*Halted or hindered gas exchange *Obsructions preventing exhalation of CO2 *Impaired neuromuscular function or integerity of chest wall *Depressed Respiratory center in medullat |
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Etiology of Respiratory acidosis
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ARDS, Pneumonia, Atelectasis, COPD, emphysema, asthma, bronchial burns, chest trauma, Guillain-Barre, MS, Mysathenia gravi, Drug overdoses, anesthesia, acute alcoholism.
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Compensatory mechanisms that take place within 24 hours of Respiratory Acidosis
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Kidneys conserve HCO3 and excrete more hydrogen ions into urine
Urine becomes more acidotic |
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Clinical manisfestations or signs of respiratory acidosis
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Drowsiness, unconsciousness, disorientation, rapid, shallow respirations, tachycardia, dizziness, decreased BP, headache, Tachycardia, seizures
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Interventions for Respiratory acidosis
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Improve respiratory function, correct acidosis, assess for iatrogenic complications of interventions
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How can we improve respiratory function?
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antibiotics for infection, postural drainage, bronchodilators, inhalation therapy, breathing exercises, mechanical ventilation, oxygen therapy.
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What is the 2nd intervention in correcting respiratory acidosis? and how do we correct that?
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Correct Acidosis
through treating hyperkalemia if present and IV sodium bicarbonate |
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What is the 3rd intervention in correcting respiratory acidosis? and what are some of them?
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assess for iatrogenic complications of interventions---tetany, CO2 narcosis, rebound respiratory alkalosis, metabolic acidosis.
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What results from excreting too much CO2?
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respiratory alkalosis
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Respiratory alkalosis is almost always a result of _________?
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hyperventilation
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Hyperventilation can be caused by 1._____________ 2.____________ 3.____________
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anxiety, aftermath of severe exercise and hypoxia at high altitudes
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Compensatory Mechanisms of Respiratory alkalosis
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*Respirations decrease or even cease until CO2 levels rise enough to stimulate increase in respirations.
*Kidneys slow absorption of HCO3 and increase release of hydrogen ions causing alkaline urine |
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clinical manisfestations or signs of respiratory alkalosis are
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increased neuromuscular irritability, hyperreflexia, muscular twitching, seizures, lightheadedness,numbness and tingling in toes and fingers, tachycardia, dysrhythmias.
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What should the nurse do for a respiratory alkalosis pt.?
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Eliminate cause of hyperventilation, help person breathe more slowly and deeply (paper bag), if neurological problems is the cause, treat the primary problem.
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Most common cause of metabolic acidosis?
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overproduction of metabolically produced acids found in diabetes mellitus,
Infections with high fever, trauma, and major surgery. |
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other causes of Metabolic acidosis
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excessive ingestion of acid (aspirin, ferrous sulfate), Renal diseases( kidneys lose ability to secrete acids), abnormal loses of alkali (acute vomiting, loss of pancreatic, biliary and lower intestinal fluids
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clinical manisfestations of Metabolic acidosis
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drowsiness, coma, dehydration, n/v, diarrhea, headache,MOST COMMON is muscular twitching and deep rapid respirations (Kussmaul's breathing)
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Nursing interventions for metabolic acidosis
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restore blood volume and osmolarity
Correct HCO3 deficit assess for and prevent electrolyte imbalances (Hyperkalemia) and protect from injury. |
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Common causes of metabolic alkalosis
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excessive loss of hydrogen ions from body through vomiting and gastric suction w/o replacement of alkali
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Compensatory mechanisms of metabolic alkalosis
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hypoventilation (to keep some of the CO2), hydrogen ions are conserved and large amounts of sodium and potassium are excreted by the kidneys
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clinical manisfestations of metabolic alkalosis
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belligerence, irritable, disorientated, lethargy, shallow slow respirations, periods of apnea, tachycardia, dysrhythmias, n/v, hypertonic muscles, tingling of fingers and toes, seizures
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Nursing intervention for metabolic alkalosis
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treat primary condition, correct alkalosis, correct water sodium, chloride and potassium deficits.
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Metabolic Acidosis
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pH < 7.35
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pH indicates the number of
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Hydrogen Ions H+
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Metabolic acidosis cause
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excess acids
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Normal range for pH
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7.35 - 7.45
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The acid base imbalance of a client with diabetic ketoacidosis is called?
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Metabolic acidosis
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condition in which acid accumulates in the body
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Acidosis
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Common Causes
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Increased acid production - lactic acidosis, ketoacidosis
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Your COPD patient has an acute exacerbation of the disease-- the acid base imbalance is?
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Respiratory acidosis
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A pt. is in pain and is anxious from an accident. The acid base imbalance is?
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Respiratory alkalosis
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condition in which base substances accumulate in the body
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Alkalosis
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Common Causes
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Increased acid loss or excretion - vomiting, gastric suction, hypokalemia
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A client has been taking extra lasix for bloating. The acid base imbalance is?
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Metabolic alkalosis
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Metabolic acidosis compensation
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rate and depth of respirations increase, eliminating additional CO2
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pH Up
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Alkalosis
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Interpret the ABG: ph 7.25, pCo2 54, HCO3 24, pO2 84
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Respiratory acidosis
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pH down
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acidosis
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Respiratory Acidosis
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pH < 7.35
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1st step to blood gas interpretation
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look at pH and determin a/b status
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Interpret the ABG: ph 7.50, pCo2 28, HCO3 24, pO2 70
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Respiratory Alkalosis
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Metabolic Alkalosis
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pH > 7.45
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2nd step to blood gas interpretation
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look at respiratory component to see if the imbalance is due to a respiratory reason
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Interpret the ABG: ph 7.19, pCo2 35, HCO3 26, pO2 85
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Impossible
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Metabolic alkalosis cause
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bicarb excess
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3rd step to blood gas interpretation
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look at metabolic component to determine if imbalance is due to a metabolic reason
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Interpret the ABG: ph 7.50, pCo2 40, HCO3 30, pO2 90
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Metabolic Alkalosis
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Metabolic acidosis effect on ABGs
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decrease pH
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Interpret the ABG: ph 7.35, pCo2 50, HCO3 30, pO2 60
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Compensation
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Respiratory Alkalosis
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pH 7.45
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What is the normal ratio of base to acid?
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20:1
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Interpret the ABG: ph 7.38, pCo2 30, HCO3 18, pO2 75
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Compensation
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Measures the pressure exerted by CO2 dissolved in the blood
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PCO2
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Common Causes
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Anxiety induced hyperventilation, fever, early salicylate intoxication, hperventilation with mechanical ventilator
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Metabolic alkalosis compensation
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rate and depth of respirations decrease, retaining CO2
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Respiratory component of blood gases
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PCO2
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Metabolic alkalosis effect on ABGs
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increase pH
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PCO2 normal values
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35 - 45 mmHg
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Measures the amount of bicarbonate (base) in blood
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HCO3
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Respiratory acidosis cause
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retained CO2
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The system most critically affected ( can cause death) by severe abnormalities in potassium balance is?
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The cardiovascular system
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Acidosis that results from respiratory dysfunction is called?
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Respiratory acidosis
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Metabolic component of blood gases
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HCO3
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Respiratory acidosis compensation
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Kidneys conserve bicarb to resore carbonic acid:bicarb ration of 1:20
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Chronic obstructive lung disease is a primary cause of?
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Respiratory acidosis
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HCO3 normal values
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22 - 26 mEq/L
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Common Causes
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Acute respiratory conditions (pulmonary edema, pneumonia, acute asthma), opiate OD, foreign body aspiratio0n, chest trauma
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measures the patial pressure of O2 dissolved in blood
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PO2
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Respiratory acidosis effect on ABGs
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decrease pH
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Diabetes mellitus is a primary cause of?
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Metabolic acidosis
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indicates the ability of the lungs to allow Oxygen to diffuse into bloodstream
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PO2
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Respiratory alkalosis cause
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loss of CO2
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Normal range of PO2
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80 - 100 mm Hg
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Respiratory alkalosis compensation
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Kidneys excrete bicarb and conserve H+ to restore carbonic acid: bicarb ratio
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Percentage of hemoglobin that is saturated w/ oxygen
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O2 saturation
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Respiratory alkalosis effect on ABGs
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increase pH
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each molecule of hemoglobin can carry how many molecules of oxygen?
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4
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Normal value for O2 saturation
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95 - 100%
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measures all the bases inteh blood that are available to help buffer
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Base Excess (BE)
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Normal value for base excess
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-2 to +2
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provides a more complete picture of body's ability to buffer
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Base Excess (BE)
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3 causes of respiratory acidosis
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1. primary lung function problem
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what condition is caused by increases in CO2 in blood causing an increase in H+
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respiratory acidosis
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in what condition does K+ move out of cells so H+ move into cells creating high serum potassium levels
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Acidosis
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in what condition do cells release H+ into the blood and K+ move into cells from blood serum causing low K+ levels
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Alkalosis
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in what condition does CO2 increase and HCO3 decrease?
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Acidosis
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in what condition does CO2 decrease and HCO3 increase?
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Alkalosis
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if pH is abnormal and both CO2 and HCO3 are abnormal, what is the compensation level?
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partially compensated
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if pH is abnormal and either, but not both, CO2 or HCO3 is abnormal, what is the compensation level?
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Uncompensated
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if pH is normal and both CO2 and HCO3 is abnormal, what is compensation level?
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Compensated
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what are some possible reasons for metabolic acidosis? (handout from class)
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Diabetic ketoacidosis, shock, kidney failure
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what are some reasons for respiratory acidosis (handout from class)
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sedation, shock, severe pneumonia
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what are some reasons for metabolic alkalosis
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vomiting, fever, tachypnea
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what are some reasons for respiratory alkalosis?
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hyper ventilation, pain, anxiety
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what acid/base condition is it and what may have caused it?
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part. compensated metabolic acidosis; Diabetic ketoacidosis
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HCO3: 28
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partially compensated resp. acidosis; asthma
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PCO3: 20
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partially compensated respiratory alkalosis; hyperventilation or pain
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PCO3: 32
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partially compensated metabolic alkalosis; vomiting
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HCO3: 34
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metabolic alkalosis, compensated; sedation
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