Adult Health one - exam #4 Flashcards
comprehensive portion/ Diabetes/ Fluid electrolyte balance& acid base balance/ Perioperative & thermoregulation
Ph value for arterial blood gases
7.35-7.45
what does a low pH indicate relating to the hydrogen ions?
the higher level of ions in blood or fluid
how does the body regulate Acid-Base Balance
the first line of defence is the binding to hydrogen ions with excess acids also called the ACID-BASE BUFFER SYSTEMS
Respiratory system eliminates or retains CO2
Renal system (kidneys) very slow
Acid
release hydrogen ions in body fluids
Base
binds with hydrogen ions in body solutions
what type of body system acts withing seconds/minutes to regulate acid-base balance
Lungs
normal range of PaCO2 for ABG
35-45
PaO2 arterial blood gas range
80-100 mmHg
HCO3 (bicarb)
21-28 MEQ/L
SaO2 normal parameters ABG
95%-100%
Base excess Normal parameters ABG
-2 to +2
what indicates Metabolic
Ph and bicarb HCO3 the same raised or low
ROME
What indicates respiratory from arterial blood gases
PH is opposite from Co2
What is the normal parameters for osmolarity
270-300mOsm/L
What is a high osmolality level
> 300 mOsm/L
could indicate salty and possible dehydration
What is a low Osmolality concentration
<270 mOsm/L
indicates fluid overload
Positively charged ions are cations examples of cations are
K+,NA+,Mg+
Negatively charged ions are anions examples include
Cl-, ioide-, HCO3-
what percentage of the body is composed of water
males 60%
females 55%
what are examples of filtration in the body?
Kidneys and Capillary beds
what are examples of isotonic iv fluids
Normal saline, 0.9% sodium chloride, lactated ringers solution
what type of patients would you use isotonic solutions for
Hypotensive and Hpovolemic states
Why are older adults at an increased risk of fluid overload with isotonic solutions?
due to not always having net movement across the membrane
what are some examples of hypertonic iv fluids
4% sodium chloride
D5NS (5% dextrose in normal saline)
D5LRS ( 5% dextrose in lactated ringers solution)
what does hypertonic solutions do to the cell
they pull fluid from the cell and is used in patients hyponatremia, elevated cranial pressure or cerebral edema
what do you watch for with hypertonic iv solutions
intravascular overload (edema, crackles in lungs)
Hypotonic Iv fluid solution examples
0.45% normal saline or 1/2 NS
D5 0.45% NS
what type of patients would hypotonic solutions be used in patients
intracellular dehydration DKA, hypernatremia
what are the 3 processes associated with fluid homeostasis
Fluid intake & absorption/
Fluid distribution/
Fluid Output
what is Dehydration
Fluid intake is less than what is needed
Fluid loss from ECF
Circulating Blood volume is decreased
Older adults- high risk for dehydration
net fluid negative balance
What is fluid overload
an excess of body fluid intake/inadequate excretion of fluids
fluid/intake or retention is less than the body’s needs
Hypervolemia-excessive fluid in the ECF
can affect the cardiac/pulmonary/renal system mostly older adults
net fluid positive balance
what are the most critical electrolytes for homeostasis
Ca+, K+, MG+, and NA+
Hyperkalemia
what is it? potassium level higher than 5
what does it look like? N/V, abdominal cramps
DYSRHYTHMIAS-talll t waves
what causes it? renal failure, acidosis, burns., starvation, med
how does the nurse treat it?
Kayexalate, furosemide
Hypokalemia
what is it? <3.5 K+
what does it look like? decreased bowel sounds, muscel cramps & weakness, shallow breathing
what causes it? diuretics, alkalosis
what does the nurse do for it? administer K+ replacement IV or PO
Hypernatremia
What is it?
Na >145
What does it look like? excessive thirst, elevated temp, dry, sticky, membranes, restlessness
what causes it? Diarrhea, impaired thirst DKA
how does the nurse treat it? give hypotonic iv fluid solution
Hyponatremia
what is it? low sodium levels of <136
What does it look like? weakness, fatigue, N/V, anorexia, abdominal cramps
headache, confusion, lethargy, muscle twitching,, tremoes
what causes it? diurteic therapy, vomiting, diarrhea, excessive GI suctioning, CHF
what does the nurse do for it? administer Normal saline to restore balance and in extreme cases administer 3% sodium chloride
what happens if the sodium level is <115
leads to seizure coma and death
Hypercalcemia
What is it? Ca >10.5
what does it look like? fatigue, muscle weakness, headache, confusion, lethargy
what causes it? bone cancer and excessive calcium supplements
how does the nurse treat it? Discontinue calcium supplements and a low calcium diet
what are the 2 signs of hypocalcemia upon physical assessment
Chvostek’s and trousseaus
Hypermagnesemia
what is it? >2.1
what does it look like? flaccid muscle tone
what causes it? renal disease and excessive magnesia medication
how does the nurse treat it? discontinue the medication containing magnesium and treat with calcium gluconate, dialysis
Hypomagnesemia
what is it? <1.3
what does it look like? muscle cramps, tremors, positive chvostek signs
what is the cause? malabsorption in the gut poor diet
how does the nurse treat it? Magnesium replacement IV or PO
when magnesium is low check the potassium and calcium levels because they are best of friends they hang out together all the time
Hyperchloremia
what is it? >106
what does it look like? fatigue or weakness, excessive thirst, dry mucous membranes
what causes it? diuretic therapy, vomiting &dehydration, too much IV saline
solution
how does the nurse treat it? Iv solutions, stopping IV fluids that contain NS
Hypochloremia
what is it? <98
what does it look like? weakness, fatigue, difficulty breathing
what causes it? fluid loss, CHF, diarrhea, vomiting, metabolic alkalosis, laxatives
what does the nurse do for it? IV fluids, treat the underlying problem
normal glucose parameters
74-106 mg/dL
Hypoglycemia
what is it? blood sugar less than 74 mg/dl
what does it look like? lethargy, shakiness, confusion, diaphoresis
what causes it? type 1 diabetes mellitus/ pancreas unable to secrete insulin
what does the nurse do to treat it? glucose foods, IVFs containing dextrose
Hyperglycemia
what is it? >106 mg/dL
what does it look like? increased thirst, increased urination, feeling hungry, blurred vision,
what causes it? stress, illness, certain medications, diabetes, DKA
what does the nurse do to treat it? give insulin, treat underlying cause, in some cases it will resolve on its own
what are the different diagnostic tools to asses for diabetes
Glycosylated hemoglobin (A1C)
fasting blood glucose (FBG)
Oral glucose tolerance test
Prediabetic -BMI greater than 25 kg
what are the A1C values regarding diagnosis of diabetes
normal range: 4%-5.7%
Prediabetes range: 5.7%-6.4%
Diabetes: >6.5%