Exam 1 Flashcards
(237 cards)
1
Q
What does the “ABCs” acronym stand for in nursing prioritization?
A
Airway, Breathing, Circulation.
2
Q
In respiratory and acid-base conditions, which should be prioritized first?
A
Always prioritize Airway and Breathing.
3
Q
Why is airway and breathing prioritized over other issues in respiratory patients?
A
Because without a patent airway and adequate oxygenation, other body systems cannot function.
4
Q
Why might a DKA patient with Kussmaul respirations not be the top priority?
A
Kussmaul respirations are a compensatory mechanism for metabolic acidosis — the airway is intact, so assess but don’t necessarily treat first.
5
Q
What are early signs of hypoxia?
A
Restlessness, anxiety, and tachypnea.
6
Q
What are late signs of hypoxia that require immediate intervention?
A
Cyanosis, confusion, bradycardia, and retractions.
7
Q
What are early signs of respiratory distress?
A
Tripod position and use of accessory muscles.
8
Q
What are late signs of respiratory distress that require immediate prioritization?
A
Silent chest, low respiratory rate (RR), and altered level of consciousness (LOC).
9
Q
What are early signs of metabolic acidosis?
A
Hyperventilation, nausea, and headache.
10
Q
What are late signs of metabolic acidosis?
A
Arrhythmias and shock.
11
Q
What is the priority action when pH is < 7.20?
A
Life-threatening acidosis → assess airway, call the provider, and draw repeat ABG.
12
Q
What does a PaCO₂ > 60 or rising indicate, and what should you do?
A
Risk of respiratory failure → prepare for intubation.
13
Q
What does a HCO₃⁻ level < 15 or > 40 suggest, and what is the priority action?
A
Severe metabolic imbalance → assess level of consciousness (LOC), administer ordered bicarbonate and fluids.
14
Q
What does a PaO₂ < 60 mean, and what should you do?
A
Indicates hypoxemia → apply oxygen immediately.
15
Q
What are the rescue medications and interventions for an asthma attack?
A
Albuterol, oxygen, high Fowler’s position.
16
Q
Why are albuterol, oxygen, and high Fowler’s position prioritized in an asthma attack?
A
Rapid bronchodilation from albuterol relieves life-threatening bronchospasm and improves airflow.
17
Q
What are the rescue interventions for a COPD exacerbation?
A
Start low-flow oxygen, administer bronchodilators and corticosteroids.
18
Q
Why is oxygen started at low flow during a COPD exacerbation?
A
To support gas exchange while avoiding CO₂ retention due to blunted respiratory drive.
19
Q
What are the priority treatments for metabolic acidosis such as DKA?
A
IV fluids and insulin.
20
Q
Why are IV fluids and insulin prioritized for DKA?
A
Fluids correct dehydration and perfusion, while insulin lowers blood glucose and halts ketone production.
21
Q
What is the use type and class of albuterol and levalbuterol?
A
Rescue; Short-acting beta₂ agonists (SABA).
22
Q
What is the purpose of SABAs like albuterol in asthma or COPD?
A
Quick relief of acute bronchospasm.
23
Q
What is the use type and class of ipratropium?
A
Rescue; Short-acting anticholinergic.
24
Q
When is ipratropium typically used?
A
As an add-on in COPD exacerbations for bronchodilation.
25
What is the use type and class of fluticasone and budesonide?
Maintenance; Inhaled corticosteroids (ICS).
26
What is the purpose of ICS like fluticasone in asthma?
Daily use to reduce airway inflammation and prevent exacerbations.
27
What is the use type and class of salmeterol and formoterol?
Maintenance; Long-acting beta₂ agonists (LABA).
28
Why are LABAs used in asthma/COPD?
To provide sustained bronchodilation; not for acute symptoms.
29
What is the use type and class of tiotropium and umeclidinium?
Maintenance; Long-acting muscarinic antagonists (LAMA).
30
What is the primary use of LAMAs like tiotropium?
Long-term COPD symptom control.
31
What are combination inhalers like Advair and Trelegy used for?
Maintenance; step-up therapy for persistent asthma or COPD symptoms.
32
What is the use type and class of montelukast (Singulair)?
Maintenance; Leukotriene receptor antagonist (LTRA).
33
When is montelukast typically used in asthma?
To prevent symptoms triggered by allergens or exercise.
34
What is the use type and class of omalizumab?
Maintenance; Biologic (asthma only).
35
What type of asthma is treated with omalizumab?
Moderate-to-severe allergic asthma not controlled by standard therapy.
36
Why are non-selective beta-blockers risky in asthma patients?
They can cause bronchoconstriction and worsen asthma symptoms.
37
Which beta-blockers are safer in asthma and why?
Cardio-selective beta-blockers like metoprolol are preferred because they primarily target β1 receptors, but still must be used cautiously.
38
Why should NSAIDs or aspirin be avoided in some asthma patients?
They can trigger bronchospasm, especially in those with aspirin-exacerbated respiratory disease (AERD).
39
What risk do sedatives and opioids pose in COPD patients?
They suppress respiratory drive, leading to CO₂ retention and potentially hypoventilation.
40
Why are 1st-generation antihistamines a concern in COPD?
They dry out secretions and impair mucociliary clearance, increasing the risk of mucus plugging and infection.
41
How can diuretics affect patients with asthma or COPD?
They can cause hypokalemia, which increases bronchospasm risk and reduces β₂ agonist effectiveness.
42
What makes theophylline a high-risk drug in COPD/asthma?
It has a narrow therapeutic window and can become toxic when interacting with antibiotics (e.g., ciprofloxacin), seizure meds, or caffeine.
43
What risk do macrolide antibiotics (e.g., azithromycin) carry in respiratory patients?
They can prolong the QT interval and cause arrhythmias, especially when combined with theophylline or beta-agonists.
44
What is the primary cause of an asthma exacerbation?
A trigger (e.g., allergen, exercise, cold air, or infection) → bronchospasm.
45
What is the most common cause of a COPD exacerbation?
Infection (also air pollution or nonadherence).
46
What is the typical onset of asthma vs. COPD exacerbation?
Asthma: Sudden (minutes to hours); COPD: Gradual or sudden (over days).
47
What are key symptoms of an asthma exacerbation?
Wheezing, cough, chest tightness, dyspnea, and use of accessory muscles.
48
What are key symptoms of a COPD exacerbation?
Increased dyspnea, increased cough, thick purulent sputum, and fatigue.
49
What are red flags in severe asthma exacerbation?
Silent chest, cyanosis, full use of accessory muscles, retractions, and decreased LOC.
50
What are red flags in severe COPD exacerbation?
Confusion, somnolence, cyanosis, severe dyspnea, and SpO₂ < 88%.
51
What should be included in initial assessment for asthma exacerbation?
Vitals, lung sounds, peak flow (if possible), and LOC.
52
What should be included in initial assessment for COPD exacerbation?
Vitals (especially hypotension, tachypnea, tachycardia), lung sounds, and ABG if possible.
53
What ABG findings indicate severe asthma or COPD exacerbation?
↓ pH, ↑ PaCO₂, ↓ PaO₂ (respiratory acidosis with hypoxia and fatigue).
54
What are the first-line interventions for asthma exacerbation?
High-flow O₂, SABA (albuterol), SAMA (ipratropium), and systemic corticosteroids.
55
What are the first-line interventions for COPD exacerbation?
Controlled O₂ (1–2 L NC or 24–28% Venturi), nebulized SABA + SAMA, corticosteroids, ABG monitoring.
56
What advanced management may be used in severe asthma exacerbation?
IV magnesium sulfate for bronchospasm, and intubation if respiratory failure occurs.
57
What advanced management may be used in severe COPD exacerbation?
Antibiotics if infection suspected, BiPAP, and possible intubation.
58
What are the nursing priorities during an asthma attack?
Keep patient upright, provide calm reassurance, and continuously reassess.
59
What are the nursing priorities in a COPD exacerbation?
Monitor LOC and avoid over-oxygenation (which can suppress respiratory drive).
60
What key education topics should be covered after an asthma or COPD exacerbation?
• Asthma action plan
• Spacer use & inhaler technique
• Trigger avoidance
• Smoking cessation
• Home oxygen safety
• Vaccine updates (flu, pneumococcal)
61
Step 1 – Airway & Breathing: What should you assess in asthma vs. COPD?
• Asthma: Check airway patency, listen for wheezing or silent chest, assess RR, look for nasal flaring or tripod positioning.
• COPD: Assess severity of dyspnea, RR, use of accessory muscles, cough, sputum production, and breath sounds.
62
Step 2 – Oxygenation: How do oxygen goals differ for asthma and COPD?
• Asthma: Target SpO₂ > 90–92%; apply humidified oxygen as needed.
• COPD: Target SpO₂ 88–92%; avoid over-oxygenation, use controlled O₂ (Venturi mask preferred).
63
Step 3 – Mental Status: What changes should you monitor for in asthma vs. COPD?
• Asthma: Watch for restlessness, anxiety, and ↓ LOC (early signs of hypoxia).
• COPD: Look for confusion and lethargy, which may indicate CO₂ retention.
64
Step 4 – Focused Lung Assessment: What are you listening and looking for?
• Asthma: Auscultate for wheezing or absent breath sounds; use peak flow meter if able.
• COPD: Listen for diminished sounds, wheezing, coarse crackles; assess sputum color and volume.
65
Step 5 – Medication Administration: What are first-line meds for asthma vs. COPD?
• Asthma: SABA (albuterol) via MDI or nebulizer, add ipratropium for severe cases, give systemic corticosteroids early.
• COPD: SABA/SAMA combo, systemic corticosteroids, and antibiotics if sputum is purulent.
66
Step 6 – Positioning: How should you position the patient?
• Both Asthma & COPD: Sit patient upright or in high Fowler’s to promote lung expansion and reduce work of breathing.
67
Step 7 – Monitoring Response: What should you track after interventions?
• Asthma: Reassess lung sounds and RR after bronchodilator use.
• COPD: Monitor for improved oxygenation, reduced dyspnea, and clearer lung sounds.
68
Step 8 – Labs & Imaging: What diagnostics are important?
• Asthma: ABG and chest x-ray if condition worsens.
• COPD: ABG, chest x-ray, CBC (if infection suspected), and sputum culture.
69
Step 9 – Patient Teaching: What education should be provided after stabilization?
• Asthma: Reinforce asthma action plan, inhaler + spacer use, and trigger avoidance.
• COPD: Teach smoking cessation, home O₂ safety, pursed-lip breathing, and medication adherence.
70
What are the common inhaled medications used in asthma?
SABA, ICS, and LABA.
71
When are systemic corticosteroids used in asthma?
During exacerbations for inflammation control.
72
What non-inhaled medications may be used in asthma?
Leukotriene modifiers (e.g., montelukast) and biologics for severe cases.
73
What non-drug strategies are part of asthma care?
Trigger avoidance and using an asthma action plan.
74
What inhaled medications are used in COPD?
LABA, LAMA, and SABA/SAMA combinations.
75
When are corticosteroids and antibiotics used in COPD?
During exacerbations—steroids reduce inflammation; antibiotics treat infection.
76
What other medications support COPD management?
Mucolytics and expectorants to thin and clear mucus.
77
What preventive measures are important in COPD?
Vaccinations (flu, pneumococcal) and smoking cessation.
78
When is oxygen therapy used in asthma?
Only during acute attacks or status asthmaticus.
79
When is long-term oxygen used in COPD?
If PaO₂ < 55 mmHg or SpO₂ < 88%.
80
Is airway clearance typically needed in asthma?
No—only if significant mucus is present.
81
What airway clearance techniques are used in COPD?
Chest physiotherapy, flutter valve, and hydration.
82
What procedure might be used in severe asthma?
Bronchoscopy for mucus plug removal (rare).
83
What surgeries may be done in end-stage COPD?
Bullectomy, lung volume reduction surgery (LVRS), or lung transplant.
84
When might intubation be needed in asthma?
In severe status asthmaticus with respiratory failure.
85
What ventilation support is common in COPD?
BiPAP; intubation if BiPAP fails.
86
How is asthma monitored at home?
With a peak flow meter for daily readings.
87
What monitoring tools are used in COPD?
ABGs, chest x-ray, SpO₂, and the 6-minute walk test.
88
What is the patient’s role in managing asthma?
Follow an asthma action plan, monitor peak flow, and use controller meds.
89
What is the patient’s role in managing COPD?
Use breathing techniques (e.g., pursed-lip), conserve energy, and follow treatment plans.
90
What does a peak flow meter measure?
The maximum speed of air exhaled from the lungs (L/min).
91
Who typically uses a peak flow meter?
Asthma patients, especially those with moderate-to-severe or poorly controlled asthma.
92
What is the purpose of peak flow monitoring?
• Detect airway narrowing before symptoms start
• Guide medication adjustments
• Monitor response to treatment
93
When should a peak flow meter be used?
• Daily (same time each day)
• During symptoms or exacerbations
• Before and after using bronchodilators
94
What does the Green Zone (80–100% of personal best) mean in peak flow monitoring?
Asthma is well-controlled — continue current treatment.
95
What does the Yellow Zone (50–79% of personal best) indicate?
Caution — airway narrowing may be starting; use rescue inhaler and reassess.
96
What does the Red Zone (<50% of personal best) signal?
Medical alert — use SABA immediately and seek emergency care.
97
What is status asthmaticus and which condition is it associated with?
A life-threatening prolonged asthma attack unresponsive to bronchodilators — unique to asthma.
98
When can respiratory failure occur in asthma and COPD?
• Asthma: During severe exacerbations or status asthmaticus
• COPD: Common in late stages or during acute exacerbations
99
What causes air trapping and hyperinflation in asthma vs. COPD?
• Asthma: Acute airway narrowing
• COPD: Chronic loss of elastic recoil and mucus plugging
100
Is barrel chest more common in asthma or COPD?
Rare in asthma; common in advanced COPD due to hyperinflated lungs.
101
What is cor pulmonale and which condition is it more common in?
Right-sided heart failure from pulmonary hypertension; rare in asthma, common in COPD.
102
Is pulmonary hypertension a complication of asthma or COPD?
Rare in asthma, but a long-term complication in COPD from chronic hypoxia.
103
How do infections impact asthma vs. COPD?
• Asthma: Viral infections often trigger attacks
• COPD: Bacterial/viral infections are common causes of exacerbations
104
How can pneumothorax occur in asthma and COPD?
• Asthma: From alveolar rupture during severe status
• COPD: From ruptured blebs or bullae (esp. in emphysema)
105
Why is osteoporosis a concern in asthma and COPD?
Long-term corticosteroid use increases risk in both.
106
Are anxiety and depression common in asthma or COPD?
Common in both due to breathlessness and quality-of-life impact.
107
How is exercise tolerance affected in asthma vs. COPD?
• Asthma: Reduced during flare-ups
• COPD: Chronically limited, affects daily activities
108
How do hypoxia and hypercapnia differ in asthma vs. COPD?
• Asthma: Hypoxia common; hypercapnia = warning sign of failure
• COPD: Often chronic; requires ABG monitoring
109
What causes sleep disturbances in asthma and COPD?
• Asthma: Nocturnal symptoms
• COPD: Common, especially with obstructive sleep apnea
110
What are key points for proper inhaler technique?
• Shake MDI before use
• Seal lips around mouthpiece, inhale deeply
• Hold breath for 10 seconds
• Use spacer with MDI
• Rinse mouth after ICS to prevent oral thrush
111
What’s the difference between rescue and maintenance inhalers?
• Rescue meds (e.g., albuterol) are for quick symptom relief
• Maintenance meds (e.g., ICS, LABA, LAMA) are for daily control, even when asymptomatic
112
Why is controller medication adherence important?
Skipping maintenance meds can lead to poor symptom control or hospitalization; daily use prevents exacerbations.
113
What are common side effects of albuterol?
Tremors and a fast heartbeat.
114
What are important ICS side effects and precautions?
• Hoarseness, oral thrush
• Prevent thrush by rinsing mouth after use
115
What’s a safety concern with LABAs in asthma?
Never use LABA alone in asthma—must be combined with an ICS.
116
What are common side effects of LAMAs (e.g., tiotropium)?
Dry mouth and constipation.
117
Why is theophylline considered high-risk?
It has a narrow therapeutic range; watch for signs of toxicity (nausea, tremors, seizures).
118
What are key teaching points for oral or inhaled steroid use?
• Rinse mouth after inhaled steroids
• Take oral steroids with food
• Monitor for mood changes, high blood sugar, infection risk
• Never stop abruptly—taper as prescribed
119
How should patients manage trigger avoidance?
• Use pre-treatment inhalers before triggers (e.g., allergens, exercise)
• Avoid environmental exposures when possible
120
What should patients know about peak flow monitoring?
• Use daily in asthma
• Follow zone system:
• Green: well-controlled
• Yellow: caution, may need meds
• Red: emergency — use rescue inhaler and seek help
121
When should patients contact their provider about rescue inhaler use?
If they need their rescue inhaler more than 2 times per week.
122
What are proper storage and timing tips for inhalers?
• Store at room temperature
• Check expiration and dose counter
• Take long-acting meds at the same time daily
123
When should a patient seek emergency help?
• Rescue inhaler doesn’t relieve symptoms
• SpO₂ stays below 90%
• Symptoms worsen (confusion, chest tightness, cyanosis)
124
What is the primary goal of pneumonia treatment?
Clear infection and support oxygenation.
125
What is the primary goal of atelectasis treatment?
Re-expand alveoli and restore lung volume.
126
What is included in the initial assessment for pneumonia?
• Vital signs (fever, RR, O₂ sats)
• Lung sounds (crackles or diminished)
• Chest x-ray and sputum culture
127
What is included in the initial assessment for atelectasis?
• RR, SpO₂, diminished breath sounds
• Chest x-ray to confirm lung collapse
128
What are the first priority interventions for pneumonia?
• Start antibiotics promptly (after collecting cultures)
• Administer oxygen if SpO₂ < 92%
129
What are the first priority interventions for atelectasis?
• Incentive spirometry every 1–2 hours while awake
• Encourage deep breathing and coughing
130
What is the role of mobility in pneumonia care?
Ambulate as tolerated to prevent further complications.
131
What is the role of mobility in atelectasis care?
Early ambulation is essential to re-expand the lungs.
132
How is airway clearance supported in pneumonia?
• Hydration and humidified air
• Chest physiotherapy or suctioning if needed
133
How is airway clearance supported in atelectasis?
• Turn, cough, deep breathe (TCDB)
• Postural drainage or chest physiotherapy if persistent
134
What is the oxygenation target in pneumonia?
Maintain SpO₂ > 92% using nasal cannula or face mask.
135
What is the approach to oxygen therapy in atelectasis?
Use oxygen judiciously if gas exchange is impaired by collapse.
136
What medications are used for pneumonia?
• Antibiotics (based on culture)
• Antipyretics for fever
• Bronchodilators if wheezing present
137
Are medications typically used for atelectasis?
Not usually, unless there’s an underlying cause like bronchospasm.
138
What patient teaching is important for pneumonia?
• Finish all antibiotics
• Incentive spirometer 10x/hour while awake
• Increase fluid intake
139
What patient teaching is important for atelectasis?
• Use incentive spirometer properly
• Smoking cessation if applicable
140
What complications should be prevented in pneumonia?
Sepsis, respiratory failure, pleural effusion.
141
What complications should be prevented in atelectasis?
Progression to pneumonia or hypoxia.
142
What is the typical breathing pattern in pneumonia?
• Tachypnea
• Shallow breathing due to pain/infection
• Crackles or wheezing; diminished sounds in consolidated areas
143
What is the typical breathing pattern in atelectasis?
• Tachypnea and shallow breathing due to alveolar collapse
• Diminished or absent sounds at affected bases
144
What kind of pain is common with pneumonia?
• Pleuritic chest pain (sharp, worse on inspiration or cough)
• Localized to infected area
145
What kind of pain occurs with atelectasis?
• Usually mild or none
• May feel tightness or report “can’t take a full breath”
146
How does pain affect ventilation in pneumonia?
• Limits deep breathing/coughing
• Worsens secretion retention → poor gas exchange → hypoxia
147
How does alveolar collapse affect ventilation in atelectasis?
• Reduces gas exchange
• Shallow breathing worsens the collapse
148
What pain management is appropriate for pneumonia?
• Acetaminophen or NSAIDs
• Monitor for over-sedation to preserve breathing effort
149
Does atelectasis typically require pain meds?
• No, unless post-op — then use non-opioid options to avoid respiratory depression
150
What breathing support is used for pneumonia?
• Supplemental oxygen as needed
• Encourage deep breathing, coughing, and incentive spirometry
151
What breathing support is emphasized in atelectasis?
• Incentive spirometry, early ambulation
• Pursed-lip and diaphragmatic breathing
152
What nursing interventions are key in pneumonia?
• Encourage splinting with a pillow when coughing
• Reassess lung sounds and oxygen saturation frequently
153
What nursing interventions are key in atelectasis?
• TCDB: Turn, Cough, Deep Breathe every 1–2 hours
• Encourage mobility and lung expansion
154
Why might an inhaler be prescribed for pneumonia or atelectasis?
• Pneumonia: If bronchospasm or wheezing is present
• Atelectasis: To help open airways and promote alveolar expansion, especially post-op
155
What are common types of inhalers used in these conditions?
• SABA (e.g., albuterol) for acute bronchospasm
• ICS (e.g., fluticasone) to reduce inflammation
• Combination inhalers for patients with chronic respiratory issues
156
What is the correct technique for using an MDI inhaler?
• Shake before use
• Exhale fully
• Seal lips around mouthpiece
• Inhale slowly and deeply, hold breath for 10 seconds
• Exhale slowly
157
What is the purpose of using a spacer with an MDI?
To improve medication delivery, especially if the patient struggles with timing the spray and inhalation.
158
Why should patients rinse their mouth after using an inhaled corticosteroid?
To prevent oral thrush and hoarseness.
159
What are key timing tips for inhaler use?
• Use as prescribed, often before breathing exercises
• Wait at least 1 minute between puffs if multiple are ordered
160
What should patients monitor after inhaler use?
• Report if breathing doesn’t improve
• Watch for side effects: tremors, fast heartbeat (albuterol); hoarseness or thrush (ICS)
161
What is encouraged after using a bronchodilator inhaler?
• Use incentive spirometer
• Combine with TCDB and ambulation, especially to prevent atelectasis
162
What is the primary airway clearance goal in pneumonia?
Mobilize and clear infected secretions to improve oxygenation and reduce bacterial load.
163
What is the primary airway clearance goal in atelectasis?
Re-expand collapsed alveoli and promote mucus clearance to restore ventilation.
164
How is incentive spirometry used in pneumonia and atelectasis?
• Pneumonia: Prevents secondary atelectasis
• Atelectasis: First-line treatment—use 10 deep breaths per hour while awake
165
Why is turn, cough, deep breathe (TCDB) important?
Promotes lung expansion and clears secretions; done every 1–2 hours, especially post-op or bedridden.
166
How does ambulation help in airway clearance?
• Pneumonia: Decreases pooling of secretions
• Atelectasis: Stimulates deep breathing and improves ventilation
167
What role does hydration play in airway clearance?
• Thins secretions, making them easier to cough out
• Encourage fluids unless contraindicated
168
When is chest physiotherapy used?
• For thick or retained secretions
• May include postural drainage, percussion, vibration
• More often used if IS and ambulation are not enough
169
When is suctioning needed for airway clearance?
• If the patient has a weak or ineffective cough
• Often needed for post-op or immobile patients with impaired LOC
170
How do mucolytics and nebulizers assist with airway clearance?
• Loosen mucus (e.g., acetylcysteine, saline neb)
• More common in pneumonia; sometimes used in chronic or post-op atelectasis
171
What breathing techniques are encouraged?
• Slow, deep breaths followed by coughing
• Pursed-lip breathing (especially in atelectasis) to prolong exhalation and reduce air trapping
172
What is the normal range for pH in ABGs?
7.35 – 7.45
## Footnote
Indicates acid–base balance (low = acidic, high = alkaline)
173
What is the normal range for PaCO₂ in ABGs?
35 – 45 mmHg
## Footnote
Indicates respiratory component (low = alkalosis, high = acidosis)
174
What is the normal range for HCO₃⁻ (bicarb) in ABGs?
22 – 26 mEq/L
## Footnote
Indicates metabolic component (low = acidosis, high = alkalosis)
175
What is the normal range for PaO₂ in ABGs?
80 – 100 mmHg
## Footnote
Indicates oxygenation
176
What is the normal range for SaO₂ in ABGs?
≥ 95%
## Footnote
Indicates hemoglobin saturation with oxygen
177
What are common causes of respiratory acidosis?
• COPD
• Asthma exacerbation
• Pneumonia
• Hypoventilation (e.g., drug overdose, neuromuscular disease)
• Airway obstruction
178
Why do these conditions cause respiratory acidosis?
Poor ventilation causes CO₂ retention. CO₂ is acidic, so its buildup lowers pH → acidosis.
179
What are common causes of respiratory alkalosis?
• Anxiety/panic attack
• Pain
• Fever
• Sepsis
• High altitude
• Early stages of asthma or pneumonia
180
Why do these conditions cause respiratory alkalosis?
They lead to hyperventilation, blowing off too much CO₂ → less acid → pH increases → alkalosis.
181
What are common causes of metabolic acidosis?
• Diabetic ketoacidosis (DKA)
• Lactic acidosis (e.g., shock, sepsis)
• Renal failure
• Diarrhea
• Ingestion of toxins (e.g., aspirin)
182
Why do these conditions cause metabolic acidosis?
• Excess acid production (e.g., DKA, toxins)
• Loss of base (bicarbonate) through GI tract (e.g., diarrhea)
• Kidney failure to excrete acid
183
What are common causes of metabolic alkalosis?
• Vomiting or NG suction
• Diuretics
• Antacid overuse
• Hypokalemia
184
Why do these conditions cause metabolic alkalosis?
• Loss of hydrogen ions (acid) from vomiting or urine
• Excess bicarbonate (base) from antacids
→ All raise pH and cause alkalosis.
185
What are the symptoms of respiratory acidosis?
• Hypoventilation, slow RR
• Confusion, drowsiness
• Headache
• Flushed skin
• ↑ PaCO₂, ↓ pH
186
What are nursing interventions for respiratory acidosis?
• Monitor respiratory status closely
• Support ventilation (BiPAP or intubation)
• Give oxygen cautiously in COPD
• Treat the cause (e.g., bronchodilators, antibiotics)
187
What are the symptoms of respiratory alkalosis?
• Hyperventilation
• Lightheadedness, dizziness
• Numbness/tingling in fingers
• Chest pain or palpitations
• ↓ PaCO₂, ↑ pH
188
What are nursing interventions for respiratory alkalosis?
• Coach slow breathing (into cupped hands or rebreather)
• Treat cause (e.g., anxiety, fever)
• Monitor neuro and cardiac status
189
What are the symptoms of metabolic acidosis?
• Kussmaul respirations (deep, rapid breathing)
• Confusion, lethargy
• Nausea, vomiting
• Warm, flushed skin
• ↓ HCO₃⁻, ↓ pH
190
What are nursing interventions for metabolic acidosis?
• Treat underlying cause (e.g., insulin for DKA, fluids for shock)
• IV bicarbonate if severe
• Monitor ABGs and electrolytes (esp. ↑ K⁺)
• Neuro/seizure precautions
191
What are the symptoms of metabolic alkalosis?
• Shallow, slow respirations
• Muscle cramps, twitching
• Irritability, confusion
• Nausea, vomiting
• ↑ HCO₃⁻, ↑ pH
192
What are nursing interventions for metabolic alkalosis?
• Treat the cause (e.g., stop NG suction, give antiemetics)
• Replace K⁺ and Cl⁻
• Monitor respiratory effort and ABGs
• Administer IV fluids (e.g., normal saline)
193
What does an ABG test measure?
Acid-base balance, oxygenation, and ventilation.
194
Where is blood drawn from during an ABG?
An artery, usually the radial artery—not a vein.
195
Why might an ABG feel more uncomfortable than a regular blood draw?
Arterial sticks go deeper and are more sensitive than venous sticks.
196
What is the purpose of an Allen’s test before an ABG?
To check for adequate collateral circulation to the hand.
197
What may need to be done with oxygen before drawing an ABG?
Oxygen may be paused briefly, if ordered, to get an accurate baseline.
198
How should the patient breathe during an ABG draw?
Normally—coach calm, steady breathing.
199
What should the patient do with their body during the procedure?
Remain completely still to avoid complications.
200
What might the patient feel during the draw?
Sharp pain or pressure.
201
How long should pressure be held after an ABG?
At least 5 minutes (longer if on anticoagulants).
202
What signs of poor circulation should patients watch for?
Numbness, tingling, pale or cool skin in the hand.
203
What site complications should be monitored?
Bleeding, hematoma, or increasing pain.
204
How should ABG results be explained to patients?
In simple terms—describe whether breathing and acid-base balance are normal or not.
205
What does “uncompensated” mean in ABGs?
The pH is abnormal and only one system is out of range.
206
Which organ is involved in uncompensated ABG imbalance?
Only the system causing the problem (lungs or kidneys).
207
What is the body doing in uncompensated states?
No compensation yet—other system hasn’t responded.
208
Give an example of an uncompensated imbalance.
Respiratory acidosis with normal HCO₃⁻.
209
What does “partially compensated” mean in ABGs?
pH is still abnormal, but both PaCO₂ and HCO₃⁻ are out of range.
210
Which organs are involved in partial compensation?
Both the lungs and kidneys are now involved.
211
What is the body doing in partially compensated states?
The opposing system is trying to fix the imbalance, but pH is not normal yet.
212
What does “fully compensated” mean in ABGs?
pH has returned to normal (7.35–7.45), but both PaCO₂ and HCO₃⁻ are still abnormal.
213
Which organs are involved in full compensation?
Both the system that caused the issue and the one compensating.
214
What is the body doing in fully compensated states?
The opposing system has successfully balanced the pH, even though both values remain abnormal.
215
What IV fluids are used for metabolic acidosis?
Normal saline (0.9% NaCl), Lactated Ringer’s, Dextrose with insulin (for DKA).
216
Why are these IV fluids used in metabolic acidosis?
• Replace fluid loss (e.g., DKA, diarrhea)
• LR lactate is converted to bicarbonate
• Dextrose prevents hypoglycemia during insulin therapy
217
What are key nursing considerations for metabolic acidosis IV therapy?
• Monitor for hyperkalemia
• Use LR cautiously in liver failure
• Monitor glucose and ketones in DKA
218
What IV fluid is used for metabolic alkalosis?
Normal saline (0.9% NaCl) with potassium chloride (KCl).
219
Why is NS with KCl given in metabolic alkalosis?
• Corrects volume depletion
• Replaces lost chloride and potassium (vomiting, NG suction)
220
What are nursing considerations for metabolic alkalosis IV therapy?
• Monitor for hypokalemia and hypochloremia
• Watch for fluid overload
221
Are IV fluids a main treatment in respiratory acidosis?
No—primary treatment is airway support, not fluids.
222
When might IV fluids be used in respiratory acidosis?
NS may be given if the patient is hypotensive to support perfusion.
223
What are nursing considerations in respiratory acidosis?
• Focus on airway management (oxygen, bronchodilators, ventilation)
• Avoid fluid overload
• Monitor ABGs
224
Are IV fluids routinely used in respiratory alkalosis?
No—focus is on treating the cause of hyperventilation.
225
When might IV fluids be given in respiratory alkalosis?
NS may be given if the patient is hypovolemic.
226
What are nursing considerations for respiratory alkalosis?
• Create a calm environment
• Encourage slow breathing
• Use analgesics or antipyretics if pain or fever is the cause
227
Which fluids match these ABG imbalances?
• NS + KCl → Metabolic alkalosis (vomiting, NG suction)
• LR or NS → Metabolic acidosis (diarrhea, DKA, shock)
• Limit fluids in respiratory disorders—focus on breathing
228
ABG: pH 7.31, PaCO₂ 48, HCO₃⁻ 24
Uncompensated Respiratory Acidosis
## Footnote
pH ↓, CO₂ ↑, HCO₃⁻ normal
229
ABG: pH 7.50, PaCO₂ 30, HCO₃⁻ 23
Uncompensated Respiratory Alkalosis
## Footnote
pH ↑, CO₂ ↓, HCO₃⁻ normal
230
ABG: pH 7.29, PaCO₂ 34, HCO₃⁻ 16
Uncompensated Metabolic Acidosis
## Footnote
pH ↓, HCO₃⁻ ↓, CO₂ is decreasing (compensating) but pH still acidic
231
ABG: pH 7.44, PaCO₂ 29, HCO₃⁻ 19
Partially Compensated Respiratory Alkalosis
## Footnote
High-normal pH, CO₂ ↓, HCO₃⁻ ↓ → both systems affected
232
ABG: pH 7.36, PaCO₂ 52, HCO₃⁻ 28
Fully Compensated Respiratory Acidosis
## Footnote
Normal pH (low end), CO₂ ↑, HCO₃⁻ ↑ → kidneys compensated
233
ABG: pH 7.20, PaCO₂ 60, HCO₃⁻ 19
Partially Compensated Respiratory Acidosis
## Footnote
pH ↓, CO₂ ↑, HCO₃⁻ ↓ → both systems abnormal, pH still acidotic
234
ABG: pH 7.56, PaCO₂ 47, HCO₃⁻ 34
Uncompensated Metabolic Alkalosis
## Footnote
pH ↑, HCO₃⁻ ↑, CO₂ normal
235
ABG: pH 7.38, PaCO₂ 33, HCO₃⁻ 18
Fully Compensated Metabolic Acidosis
## Footnote
Normal pH (low end), HCO₃⁻ ↓, CO₂ ↓
236
ABG: pH 7.12, PaCO₂ 20, HCO₃⁻ 10
Partially Compensated Metabolic Acidosis
## Footnote
pH ↓, HCO₃⁻ ↓, CO₂ ↓ (lungs trying to compensate)
237
ABG: pH 7.47, PaCO₂ 37, HCO₃⁻ 29
Uncompensated Metabolic Alkalosis
## Footnote
pH ↑, HCO₃⁻ ↑, CO₂ normal
