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Health and Illness 324 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the range for pH?

A

7.35 to 7.45

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2
Q

What is the range for pCO2?

A

35 to 45

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3
Q

What is the range for HCO3?

A

22 to 26

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4
Q

Which organ compensates for respiratory alkalosis/acidosis?

A

kidneys

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5
Q

Which organ compensates for metabolic alkalosis/acidosis?

A

lungs

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6
Q

What are the degrees of compensation?

A

uncompensated: pH abnormal and one other abnormal

partially compensated: all 3 abnormal

fully compensated: pH normal but others abnormal

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7
Q

What happens when the compensatory mechanisms fail?

A

cell dysfunction

acidosis: decreased mental state, LOC

alkalosis: decreased mental state, LOC and has other neurological manifestations, may cause dysrhythmias

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8
Q

How does the kidney compensate for acidosis/alkalosis?

A

conserve bicarbonate and excretes acid by: secreting free hydrogen, combing hydrogen with ammonia, excrete weak acids

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9
Q

What are manifestations of respiratory acidosis?

A

reduced mental status
hypoventilation
arrhythmias

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10
Q

What are interventions for respiratory acidosis?

A

encourage cough and deep breathe, bronchodilators, reverse or hold sedation, monitor electrolytes, treat underlying condition, bipap or intubation

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11
Q

What are manifestations of metabolic acidosis?

A

kussmaul breathing
electrolyte imbalance
changes in mental status

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12
Q

What are interventions for metabolic acidosis?

A

treat underlying cause, monitor labs and I/O, diet changes, may need hemodialis

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13
Q

What are the interventions for respiratory alkalosis?

A

slow breathing down, monitor labs, treat underlying cause

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14
Q

What are the interventions for metabolic alkalosis?

A

treat underlying cause, antiemetics, monitor output and electrolytes

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15
Q

What are the causes of metabolic acidosis?

A

diabetic ketoacidosis, lactic acidosis, starvation, renal failure, shock, salicylate overdose, sepsis, severe diarrhea (loss of bicarb in stool)

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16
Q

What are the causes of metabolic alkalosis?

A

hypokalemia
GI conditions/surgeries that require bowel rest: vomiting, nasogastric suctioning, diuretic therapy, excess or overuse of antacids

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17
Q

What are the causes of respiratory acidosis?

A

hypoventilation, chest trauma, drug overdose (sedative or barbiturate), airway obstruction (COPD, asthma, pnuemonia), neuromuscular disease, pulmonary edema

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18
Q

What are the causes of respiratory alkalosis?

A

hyperventilation, anxiety, high altitude (hypoxemia), pregnancy, fever, salicylate overdose

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19
Q

What are the requirements of CKD?

A

GFR<60 for 3 months or more

OR

prolonged kidney damage for 3 months of more including pathological abnormalities or markers of damage, includes abnormalities in blood or urine tests or imaging studies

20
Q

What are risk factors of CKD?

A

diabetes, HTN, heart disease, obesity, AKI, autoimmune and genetic disease, family hx of CKD, nephrotoxic drugs (NSAIDs, aminoglycosides, contrast dye)

21
Q

What is uremia?

A

inability to remove waste products and therefore it deposits the urea crystals (uremic frost), occurs typically once GFR <10mL/min

22
Q

What are the stages of CKD?

A

Stage 1: GFR>/=90, mild kidney damage
Stage 2: GFR = 60-89, mild kidney damage
Stage 3: GFR = 30-59, mild to moderate kidney damage, symptoms will begin to display
Stage 4: GFR = 15-29, moderate to severe kidney damage, begin to think about renal replacement therapy
Stage 5: GFR<15, end-stage kidney disease, kidneys are close to failure or have completely failed

23
Q

Why are infants and older adults at high risk for acid base imabalances?

A

infants have an immature renal system

older adults have reduced size and ability of nephrons

24
Q

Who is at risk for respiratory acidosis?

A

infants, older adults, small children, opioid and alcohol dependent

25
Who is at risk for metabolic acidosis?
diabetics, alcoholics, children, mental health concerns, older adults, infants
26
Who is at risk for respiratory alkalosis?
pregnant people, mental health concerns, acute illness
27
Who is at risk for metabolic alkalosis?
acute illness, PMH of GERD, pregnancy
28
How do you determine acidosis/alkalosis when fully compensated?
use an adjusted pH of 7.4 if the initial pH>7.4 = alkalosis if initial pH<7.4 = acidosis
29
What are symptoms of CKD?
fluid/electrolyte imbalance and/or fluid retention acid/base imbalance hormone/nutrient imbalance: renin (dysfunctional kidneys sense low blood flow (d/t low GFR) and thereby increase renin to increase BP and try and compensate for low GFR), erythropoietin, decrease in vitamin D causing a decrease in calcium absorption uremia and uremic frost
30
What happens to the labs in renal disease?
decrease in: GFR, bicarb, hemoglobin, and calcium increase in: creatinine, BUN, potassium, phosphorous, proteinuria
31
What medications are used for renal disease?
ACE, ARBs, and diuretics
32
What are clinical indications for dialysis?
uremia, fluid overload, persistant metabolic disturnabnces (hyperkalemia, metabolic acidosis, hyper/hypocalcemia, hyperphosphatemia), pericarditis, HTN that is not responsive to medications
33
What is the goal of hemodialysis?
removes accumulated solute from a patient who has total or near-total loss of kidney function it will NOT increase hemoglobin levels, it focuses on balancing electrolytes and removing wastes
34
What are nursing considerations for before and/or after hemodialysis?
hold HTN and IV medications before assess weight before and after
35
What is acidosis?
pH<7.35, hydrogen ion concentration increases, bicarb level decreases caused by retention of too much acid or loss of too much base
36
What is alkalosis?
pH>7.45, hydrogen ion concentration decreases, bicarb level increases
37
What is exposome?
measure of all exposures of an individual in a lifetime (including external and internal environment) and how those exposures relate to health
38
What are the goals of pharmacogenomics?
reduce adverse drug rxn fewer hospitalizations personalize treatment improve efficiency and dose selection discover new drug targets find new uses for old medications
39
What is the difference between pharmacogenetics and pharmacogenomics?
genetics: how does genetic variation of one or a few genes affect individual's drug response genomics: genome-wide role of human variation in drug response, includes identifying biological pathways and applying genomic technologies in drug discovery, disposition, and function
40
What are some recent advances with pharmacogenomics?
using gene expression to: ID new drugs, develop new drugs, ID new uses for older drugs treatment of certain diseases: CF, HIV (ID those who may have hypersensitivity to a particular drug), organ transplant (predict dose requirements for immunosuppression)
41
How can nurses use pharmacogenomics?
minimize adverse drug rxn ensure appropriate dose for pt's genetic profile educate patients and families of testing standard care for more drugs and preemptive tests real world application of precision health
42
What are some challenges of pharmacogenomics?
limited data only from genes limited clinical utility of inconclusive results do studies ID effects on clinically relevant outcomes? does pharmacogenomic testing provide valuable information in addition to what is already known from careful clinical assessment? diversity problem
43
What are some ways to improve diversity in genetics and genomics?
genotype those populations then apply data to assess population-specific risk consider the impact of environmental and contextual variability self-identified race differs from ancestry
44
What is toxic stress?
prolonged activation of stress response systems in absence of protective relationships
45
What is trapped parenting?
parents are afraid to leave the household in fear of deportation

Health and Illness 324 (5 decks)

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