fluid, electrolyte, and acid base balances Flashcards
(316 cards)
1
Q
poor skin turgor pale dry skin low BP increased HR and R and Temp confused, weight loss, lethargy. In child, dark circles under eyes, lifeless, sunken fontanel
A
dehydrated patient
2
Q
weight gain
edema
high BP, increased R, SOB, JVD, cough, crackles
copious amounts of white frothy sputum which could be blood tinged. Patient in tripod position because of orthopnea. Needs O2. Low O2 sats.
A
Too much fluid/Hypervolemia
3
Q
transports nutrients to cells and wastes from cells
transports hormones, enzymes, blood cells
facilitates cellular metabolism
acts as a solvent for electrolytes and nonelectrolytes
helps maintain normal body temp
facilitates digestion and promotes elimination
acts as a tissue lubricant
A
functions of water
4
Q
found inside cells
2/3 of body fluid
40% of body weight
Most stable body fluid
A
Intracellular fluid
5
Q
fluid outside cells
A
extracellular fluid
6
Q
fluid that surrounds cells
reserve fluid
A
interstitial fluid
7
Q
fluid in blood vessels (plasma)
least stable fluid
A
intravascular fluid
8
Q
CSF, peritoneal, bile duct, biliary, synovial, intraocular, and pericardial fluids
A
transcellular
9
Q
1/3 of body fluids is
A
extracellular fluid
10
Q
60% of average healthy adult and 70-80% of healthy infants is
A
water
11
Q
solvent
A
liquid
12
Q
solute
A
any substance dissolved in solution
13
Q
requires energy
movement of ions against osmotic pressure to an area of higher pressure
A
Active transport
14
Q
passive movement of electrolytes or other particles down the concentration gradient
A
diffusion
15
Q
movement from an area of lesser to an area of greater concentration
A
osmosis
16
Q
movement across a membrane, under pressure, from higher to lower pressure
A
filtration
17
Q
water passes from an area of lesser solute concentration to greater concentration until equilibrium is established
Major force in body fluid movement and IV therapy
water moves into and out of cells and capillaries
A
Osmosis
18
Q
tendency of solutes to move freely throughout a solvent “downhill”
A
diffusion
19
Q
requires energy for movement of substances through cell membrane from lesser solute concentration to higher solute concentration
A
active transport
20
Q
passage of fluid through permeable membrane from area of higher to lower pressure
A
filtration
21
Q
concentration of solute (particles) per kg of water
A
Osmolality
22
Q
concentration of solute (particles) per liter of fluid (this does not have to be water)
A
Osmolarity
23
Q
concentration of solute (particles) in the plasma
A
serum osmolality
24
Q
275-295 milliosmoles/liter
A
Normal serum osmolality
25
If serum osmolality is high
the patient is dry
26
If serum osmolality is low
patient is wet
27
have the same osmolality as normal plasma
isotonic fluids
28
neither makes cell swell or shrink
I SO PERFECT ISOTONIC
29
no osmotic pressure difference is created so fluid remains in ECF
used to replace fluid volume quickly
given to trauma patients who are bleeding, shock, severe NVD
be careful with CHF patients
tonicity is similar to blood
Isotonic IV fluid
30
given for losses from burns and diarrhea
Normal saline 0.9%
| (sodium and chloride in water) provides no calories or free water
31
sodium, chloride, calcium, potassium, and lactate
Provides no calories or free water
Most resembles electrolyte concentration of plasma
Lactated Ringer's- LR
32
having lower osmolality than normal plasma
hypotonic
33
less than 290 mOsm\L
Hypotonic
34
pulls water out of blood vessels into cells
used to prevent and treat cellular dehydration
patients require frequent monitoring
hypotonic
35
CONTRAINDICATED in acute brain injuries, large burns, major trauma, liver disease. patients at risk for 3rd spacing, increased cranial pressure, CVA, stroke, brain surgery,
hypotonic intravenous fluid
36
fluid trapped in interstitial spaces (fluid around cell)
3rd spacing
37
5% dextrose in water
hypotonic IV fluid
38
isotonic in bag but quickly changes in body
| free water shifts from vessels into cells
5% dextrose in water
| Hypotonic IV fluid
39
provides free water to cells along with sodium and chloride
| 1/2 of each liter moves into cells and 1/2 stays in vascular space
1/2 NS- 0.45% Normal Saline
40
having a higher osmolality/tonicity than normal plasma
causes water to be pulled from cells into blood vessels
increases vascular volume
decreases cell water
can cause vascular overload
monitor patient closely
hypertonic IV fluids
41
increased BP
causes cells to shrink/dehydrate
helps stabilize BP, increased urine output, increased peripheral edema/3rd spacing/interstitial fluid around cells/can be damaging to veins
hypertonic IV fluids
42
excessive breakdown of fat often seen in diabetic patients
ketosis
43
provides water to cells
| provides some calories, enough to prevent ketosis
D5 1/2 NS: 5% dextrose in a 0.45% Saline
44
provides free water and calories to cells
D5NS: 5% dextrose in 0.9% saline
45
used for patients with dangerously low serum sodium levels of 115 mg/dL or less
given via IV pump
requires frequent monitoring of vitals, neuro status, lung sounds, and urinary output
Pt can become fluid overloaded. 1st sign is neuro deficit and lungs start filling with fluid
3% and 5% Saline
| Hypertonic IV fluid
46
used on a limited basis to treat hypoglycemia
given via IV push or IV pump
irritating to veins
10% or 50% Dextrose
| Hypertonic IV fluids
47
Dextran, Plasma, Hetastarch, and Albumin (protein)
colloid volume expanders
48
decrease blood volume
used to treat 3rd spacing either alone or with crystalloids
pull fluids from tissues into vessels
volume expanders
49
a large particle that normally does not pass through cell and capillary membranes, do not readily dissolve into true solutions
colloid
50
increasing the number of colloids causes an increase in
osmolality
51
salt that dissolves readily
crystalloid
52
used to treat low blood volume in burn patients
albumin
53
8 primary organs of homeostasis
kidneys, cardiovascular system, lungs, adrenal glands, thyroid gland, parathyroid glands, GI tract, and nervous system
54
normally filter 135-180 L plasma, excrete 1.5 L of urine a day
kidneys
55
pumps and carries nutrients and water in the body
cardiovascular system
56
regulate oxygen and carbon dioxide levels of blood
lungs
57
help body conserve sodium, save chloride and water, and excrete potassium
adrenal glands
58
increases blood flow in body and increases renal circulation
thyroid gland
59
regulate the level of calcium in ECF
parathyroid glands
60
absorbs water and nutrients that enter body through this route
GI tract
61
acts as a switchboard to inhibit and stimulate fluid balance (thirst center and ADH storage)
Nervous system
62
most water absorption occurs in the
colon
63
causes water retention
ADH
64
prompts fluid retention
| hormone that regulates electrolyte levels
aldosterone
65
body's own natural steroids
glucocorticoids
66
promote retention of sodium and water
| adrenal cortex makes
cortisol/glucocorticoids
67
released from cells in heart in response to excessive blood volume. promotes sodium wasting, causes fluid loss
ANP/atrial natriuretic peptide
68
found in brain tissue and stored in myocardium
| blood test used to predict CHF of fluid volume excess
BNP/brain natriuretic peptide
69
fluid and solute are lost in proportional amounts
isotonic fluid loss/hypovolemia
70
normal serum osmolality
| fluid losses are primarily in vascular space
isotonic fluid loss
71
hemorrhage, vomiting, GI suction, diarrhea, fever, excessive heat, burns, diuretics
causes of isotonic fluid loss/hypovolemia/dehydration
72
more water is lost than solute
hypertonic dehydration
73
Patient will be dry.
serum osmolality is increased, pulling fluid into the vessels from the cells
cells shrink and become dehydrated
hypertonic dehydration
74
inadequate fluid intake
severe isotonic fluid losses
diabetes insipidus
increased solute intake without proportional increase in water
causes of hypertonic dehydration
75
excessive thirst and urination
caused by inadequate ADH
Loss of 5-15 L/day
symptoms of hypertonic dehydration
76
extracellular body spaces that do not normally contain fluid
| Physiologically useless
3rd spacing fluid
77
massive trauma
malnutrition
protein deficiency
crush injuries, burns, sepsis, cancer, intestinal obstruction, abdominal surgery, liver dysfunction, starvation, cirrhosis, chronic alcoholism, heart failure, renal failure
Causes of 3rd spacing
| hypovolemia
78
Most common type of dehydration
Isotonic
79
dehydration due to N/V/D, hemorrhage, etc.
Isotonic
80
equal losses of fluid and particles (electrolytes)
Isotonic dehydration
81
greater losses of particles (electrolytes)
| Can lead to seizures
hypotonic dehydration
82
greater losses of fluid than electrolytes
| Can lead to brain swelling or cerebral edema
hypertonic dehydration
83
When dehydrated you lose electrolytes and potassium and water. potassium leaves cell and is in the vascular space. If rehydrated then potassium:
Moves from extracellular fluid into cells and serum potassium drops
84
```
thirst
mental status changes
concentrated urine and low urine output
dark amber or dark brown urine
dry skin
decreased skin turgor and elasticity
dry mucous membranes
sunken eyeballs
flat neck veins
skin tenting
poor skin turgor
acute weight loss
In baby, may have sunken fontanel, hypotension, decreased BP, increased HR, increased resp rate
```
assessment for dehydration
85
mental status changes
1st sign of dehydration in elderly and infants
86
in elderly you check skin turgor:
over chest
87
acute weight loss
most important sign in infants and young children of dehydration
Most accurate reflection of fluid balance
88
labs to check for dehydration
BUN, creatinine, serum electrolyte panel, urinalysis, and urine specific gravity
89
hemoconcentration
| high hematocrit and BUN (false high)
diagnostic finding in dehydration
90
high urine specific gravity
dehydration
91
normal specific gravity value
1.0053-1.030
92
high serum osmolality greater than 300 mOsm/kg
| high serum sodium greater than 150 mEq/L
hypertonic dehydration
93
Who is at risk for dehydration:
infants and young children
Elderly
People with acute or chronic illnesses
environmental causes (vigorous exercise, work outside)
diet and lifestyle (stroke, bulimia, etc.)
94
infants at risk for dehydration because of:
higher total body percentage of water 80%
kidneys are immature
larger BSA
higher metabolic rate
Watch closely because they get dehydrated quickly
95
Most at risk for dehydration:
acute and chronically ill patients
96
Why are elderly at risk for dehydration:
low amount of total body water
less muscle mass
kidneys lose function
diminished thirst mechanism
97
Who are people with acute illness that are at risk for dehydration:
surgery losses and drains
gastroenteritis
burns
cirrhosis
98
priority nursing diagnoses for dehydration:
```
deficient fluid volume
acute confusion
deficient knowledge regarding disease management
risk for electrolyte imbalance
risk for injury
altered comfort
risk for impaired skin integrity
```
99
What are nursing interventions that are appropriate for dehydration:
Oral fluid replacement: if mild patient can drink
commercial oral rehydration solutions. May only tolerate small sips at first.
AVOID FRUIT JUICE, SODA, AND SPORTS DRINKS
Parenteral fluid replacement/IV- isotonic fluids, may require bolus or TPN
daily weights, vitals, mental status and behavior, urinary output, IV infusion rate, I&0, Lung sounds.
assist with rehydration.
provide comfort measures
100
most frequently used oral replacement fluid
0.9% NS isotonic fluid
101
What should you avoid if dehydrated patient:
fruit juice, soda, and sports drinks
102
How do you weigh patient with dehydration or imbalance?
Same scale, same time of day, and same clothes or naked
103
standard urinary output
60 mL/hr
104
To measure adequacy of interventions for dehydrated patient:
```
adequate urinary output
stable HR and BP
skin with normal turgor
mucous membranes moist and pink
return to usual mental status
HCT, BUN, serum osmolality, and electrolytes return to normal
```
105
To determine patient's adequate urinary output range:
0.5 mL/hr x Wt in Kg of patient
106
excessive retention of water and sodium in ECF
hypervolemia
107
above normal amounts of water in extracellular spaces
overhydration
108
excessive ECF accumulates in tissue (interstitial) spaces
edema
109
movement of fluid from space surrounding cells to blood
interstitial-to-plasma shift
110
increased BP, bounding pulse, fast and shallow respirations, JVD, pale and cool skin, increased urinary output, rapid weight gain, edema, lung crackles, dyspnea, and ascites
signs and symptoms of hypervolemia
| too much fluid in body veins
111
more fluid that particles (usually sodium)
| serum osmolality falls, shifting fluid into cells (high and dry, low and wet)
hypotonic fluid excess-water intoxication
112
repeated plain water enemas
overuse of hypotonic fluids or too painful infusion
drinking too much water
SIADH (syndrome of inappropriate ADH)
excess ADH causes kidneys to retain water but not sodium
Psychogenic polydipsia
causes of hypotonic fluid excess-water intoxication
113
what causes hypotonic fluid excess in infants and young children:
improper mixing of formula
| giving water bottles instead of pacifier
114
severe or prolonged isotonic fluid volume excess occurs in
patients with heart failure and renal failure
115
compulsive water drinker
psychogenic polydipsia
116
how does edema form:
```
caused by hypertension
increased capillary hydrostatic pressure
decreased capillary oncotic pressure
lymphatic obstruction
sodium excess
```
117
edema is caused by
injury, inflammation, malnutrition, liver disease
118
assessment of fluid overload
```
high central venous pressure
JVD
engorged hand veins
gallop/S3
hepatomegaly and splenomegaly
anasarca
tense or bulging fontanel
peripheral edema
```
119
generalized edema
anasarca
120
check for peripheral edema in ambulatory patients in:
legs, ankles and feet
121
check for edema in nonambulatory patients in:
sacrum and back
122
2 mm
slight indentation
normal contours
associated with interstitial fluid volume 30% above normal
1+ pitting edema
123
4 mm
deeper pit after pressing
lasts longer than 1+
fairly normal contour
2+ pitting edema
124
6 mm
skin swelling obvious by inspection
remains several seconds after pressing
deep pit
3+ pitting edema
125
deep pit
8mm
remains for prolonged time after pressing, possibly minutes
frank swelling
4+ pitting edema
126
```
will not pit
skin taut, warm, shiny
May see water leaking from pores
fluid can no longer be displaced secondary to excessive interstitial fluid accumulation
no pitting
tissue palpates as firm or hard
```
Brawny edema
127
```
increased RR
irritated dry hacky cough- early sign
LIFE THREATENING
Tachypnea, dyspnea, irritated cough
Moist productive cough with white frothy sputum-late sign
labored breathing
crackles
```
Pulmonary edema
128
early sign of pulmonary edema
irritated dry hacky cough
129
late sign of pulmonary edema
moist productive cough with white frothy sputum
130
vital signs
normal heart rate, full or bounding pulse, increasing BP
third spacing
acute rapid weight gain
urinary output and concentration
polyuria in patients with normal heart and kidney function
decreased output in patients with heart or kidney disease
hypervolemia assessment
131
chest x-ray: pleural effusions
| hemodilution: HCT low, BUN low
assessment of fluid excess
132
Who is at risk for fluid volume excess:
Elderly due to decreased heart and kidney function
infants up to 2 yrs due to immature kidneys
children 2-12 yrs less stable regulatory responses
acute illness stress response promotes
chronic illness cardiovascular and renal disease
medications long term glucocorticoids promote fluid retention
133
fluid volume excess
altered comfort
risk for impaired skin integrity
knowledgeable deficit
priority nursing diagnoses for fluid volume excess
134
restrict fluid intake as ordered
Monitor lung sounds
watch for signs and symptoms of pulmonary edema: tachypnea, SOB, cough-early signs
give meds as rx'd: LOOP and thiazide diuretics, potassium sparing diuretics
Monitor electrolytes during diuretic therapy
accurate intake and output counts
monitor weight
nursing interventions for fluid volume excess
135
most accurate way to measure fluid status
monitor weight: same scale, same time of day, same clothes or naked
136
early signs and symptoms of pulmonary edema
tachypnea, SOB, cough
137
Pt teaching for excess fluid overload
teach patients with peripheral edema to elevate legs
teach about sodium restricted diet
teach risk factors for fluid volume excess
teach patient to weigh daily at home
Notify PCP of weight gain of 2.2 lbs. in 24 hrs
138
controls and regulates volume of body fluids
sodium
139
chief regulator of cellular enzyme activity and water content
potassium
140
nerve impulse, blood clotting, muscle contraction, B12 absorption
calcium
141
metabolism of carbs and proteins, vital actions involving enzymes
magnesium
142
maintains osmotic pressure in blood, produces hydrochloric acid
chloride
143
body's primary buffer system
bicarbonate
144
involved in important chemical reactions in body, cell division, and hereditary traits
phosphate
145
where sodium goes,
chloride goes too
146
the major cation of the ECF
sodium
147
normal sodium level
135-145 mEq\L
148
primary function is regulation of fluid volume
sodium
149
reabsorbed and secreted in kidneys
sodium
150
minimal loss through feces and perspiration
sodium
151
low levels can be caused by excessive water intake-heavy water drinkers
sodium
152
Adults need about 3.8 grams daily to replace daily losses and maintain blood levels
Intake should not exceed 5.8 grams daily
sodium
153
older adults, African Americans, people with chronic diseases like diabetes, hypertension, kidney disease
sodium restriction
154
dietary sources of sodium
table salt NaCl-also good source of iodine
| soy sauce, cured pork, canned foods, processed foods, salty seasonings, processed cheeses
155
drink every fluid they can find, even toilet water and bird baths
psychogenic polydipsia
156
sodium less than 135 mEq/L
hyponatremia
157
common causes of hyponatremia
diuretics, GI fluid losses, hormonal disturbance
158
anorexia, nausea, vomiting
weakness, lethargy, confusion
muscle cramps, muscle twitching, seizures
signs and symptoms of hyponatremia
159
increase oral sodium intake
| if severe, IV saline infusion
treatment for hyponatremia
160
sodium greater than 145 mEq/L
hypernatremia
161
excessive sodium intake, water deprivation, increased water loss through sweating, heat stroke
causes of hypernatremia
162
thirst, elevated temp, dry mouth, sticky mucous membranes
signs and symptoms of hypernatremia
163
hallucinations, irritability, lethargy, seizures
severe hypernatremia
164
sodium restriction, increase water intake
treatment for hypernatremia
165
found in ECF
| functions with sodium to regulate serum osmolality and blood volume
chloride
166
normal level is 95-108 mEq/L
chloride
167
found in gastric juice
involved in regulating acid/base balance
buffer in gas exchange in RBCs
found in the same foods as sodium
chloride
168
chloride greater than 108 mEq/L
hyperchloremia
169
chloride less than 95 mEq/L
hypochloremia
170
usually associated with hyponatremia
| hypokalemia, or metabolic alkalosis
chloride problem
171
major cation of ICF
potassium
172
normal levels are 3.5-5.0 mEq/L
potassium
173
key electrolyte in cellular metabolism
potassium
174
regulates conduction of cardiac rhythm
potassium
175
excreted and absorbed through kidneys
| losses through vomiting and diarrhea, potassium wasting diuretics
potassium
176
dietary recommendation of at least 4.7 grams/day
potassium
177
potassium restriction in
chronic kidney disease
178
common food sources of potassium:
bananas, oranges, apricots, dates, tomatoes, spinach, dairy products, and meats
179
chief regulator of all electrolytes
potassium
180
common causes of hypokalemia
potassium wasting diuretics, GI losses,steroids, anorexia, or bulemia
181
fatigue, anorexia, N/V, dysrhythmias, parasthesias
signs and symptoms of hypokalemia
182
numbness/tingling
parasthesias
183
potassium supplementation-diet, medications
| IV potassium must be DILUTED
treatment for hypokalemia
184
potassium less than 3.5 mEq/L
hypokalemia
185
potassium greater than 5.0 mEq/L
hyperkalemia
186
common cause of hyperkalemia
potassium sparing diuretics and renal failure
187
signs and symptoms of hyperkalemia
muscle weakness, dysrhythmia
188
Kayexalate
binds potassium in gut to treat hyperkalemia
189
Insulin
drives potassium back into cells to treat hyperkalemia
190
glucose
encourage potassium back in cells to treat hyperkalemia
191
treatment for hyperkalemia
meds such as kayexalate, insulin, and glucose if severe, dialysis
dietary measures-caution against intake
192
treatment of hypokalemia
order EKG to check heart function and rhythm
193
```
M.U.R.D.E.R.
M-muscle weakness
U- urine, oliguria, anuria
R- respiratory distress
D-decreased cardiac contractility
E- ECG changes
R- reflexes, hyperreflexia or areflexia (flaccid)
```
signs and symptoms of increased potassium levels
194
```
M- Medications- Ace inhibitors, NSAIDs
A- Acidosis- metabolic and respiratory
C- Cellular destruction - burns, traumatic injury
H- Hypoaldosteronism, hemolysis
I- Intake - excessive
N- Nephrons, renal failure
E- Excretion - impaired
```
causes of increased potassium
195
responsible for bone health, neuromuscular, and cardiac function
calcium
196
Normal level is 8.5-10.5 mg/dL
calcium
197
essential factor in blood clotting
calcium
198
99% located in bone and teeth, 1% in circulating blood
calcium
199
serum losses lead to bone losses
calcium
200
adults and adolescents need dietary intake of calcium of
1200-1500 mg/day
201
dietary sources of calcium
milk, milk products, daily green leafy vegetables, salmon
202
sign of hypocalcemia
If you inflate BP cuff on arm above normal systolic BP, patient's hand will flex
Chvostek's sign- tap face below zygoma and you will see unilateral twitch if positive sign
203
calcium less than 8.5 mg/dL
hypocalcemia
204
common causes of hypocalcemia
malabsorption, hypoparathyroidism
205
signs and symptoms of hypocalcemia
diarrhea, numbness and tingling in extremities, muscle cramps,tetany, convulsions (seizures), positive trousseau's sign and chvostek's sign
206
treatment for hypocalcemia
encourage increased calcium intake
if severe, monitor airway and place on seizure precautions
parenteral calcium infusion
207
common causes of hypercalcemia
malignant bone disease
| hyperparathyroidism
208
calcium level of 10.5 mg/dL or more
hypercalcemia
209
muscle weakness, polyuria, polydipsia, bizarre behavior
signs and symptoms of hypercalcemia
210
treatment for hypercalcemia
eliminate calcium supplements
limit calcium rich foods
dialysis
211
normal phosphorus level
2.5-4.5 mg/dL
212
found in ICF, bone, skeletal muscle, nerve tissue
phosphorus
213
helps metabolize proteins, fats, and carbs
phosphorus
214
essential for functioning of muscles, nerves, and RBCs
phosphorus
215
can be associated with elevated calcium levels
complication of refeeding after severe malnourishment
administering TPN without adequate phosphorus
prolonged use of aluminum and magnesium based antacids
severe vomiting and diarrhea
prolonged gastric suction
increased calcium, low phosphate
hypophophatemia
216
phosphate less than 2.6 mg/dL
hypophosphatemia
217
phosphate greater than 4.5 mg/dL
hyperphosphatemia
218
```
hypocalcemia
excessive intake
vitamin D excess
massive blood transfusions
large milk intake
rhabdomyolysis (break down of striated/skeletal muscle)
```
hyperphosphatemia symptoms
219
rhabdomyolysis happens in
people who do extreme physical exercise. Patients in one position for too long.
220
used in more than 300 chemical reactions
magnesium
221
normal levels 1.5-2.5 mEq/L
magnesium
222
necessary for protein and DNA synthesis
magnesium
223
only 1% found in circulating blood, 99% in ICF and bone
magnesium
224
deficiency is rare- occurs mostly in alcoholics and those with absorption disorders (pancreatitis, burns)
magnesium
225
dietary recommendation of 18-30 mEq/day
magnesium
226
dietary sources of magnesium
most foods
| green vegetables, cereal grains, nuts
227
common causes of hypomagnesemia
chronic alcoholism
| excessive loss of fluids from GI tract (NG suction)
228
Symptoms of hypomagnesemia
tremors, increased reflexes, positive Chvostek's and Trousseau's signs
229
treatment of hypomagnesemia
carefully administer magnesium salts as ordered
place patient on seizure precautions
encourage patient to eat magnesium rich foods
230
magnesium of less than 1.5 mEq/L
hypomagnesemia
231
common causes of hypermagnesemia
renal failure
adrenal insufficiency
excessive intake of magnesium-containing antacids
232
signs and symptoms of hypermagnesemia
vasodilation and flushing
nausea and vomiting
depressed DTR's
233
treatment for hypermagnesemia
notify PCP
| dialysis
234
the amount of acid or base in a solution
pH
235
substance containing hydrogen ions that an be liberated or released
acid
236
substance that can trap hydrogen ions
base
237
normal arterial blood and body tissue pH is
735-7.45
238
the lower the pH the ________ the acid
stronger
239
the higher the pH the __________ the base
stronger
240
pH below __________ or above _____ is usually FATAL
6.9 or 7.8
241
pH requires
TIGHT control
242
homeostatic regulators of hydrogen ions
respiratory mechanisms and renal mechanisms
243
work rapidly to restore homeostasis. regulate acid-base balance by either eliminating or retaining carbon dioxide
respiratory mechanisms
244
if pH is low respirations
increase (rapid and deep) causes a drop in carbon dioxide
245
If hyperventilating you get
alkalotic; respiratory alkalosis
246
any clinical condition that increases respiratory rate and depth can cause lungs to eliminate CO2 and cause decreased PACO2 and increased pH causing
RESPIRATORY ALKALOSIS
247
pH increases respirations decrease, body retains CO2, increased carbonic acid level retention, increased acid leads to
respiratory acidosis
248
if pH is high respirations _________________ causing body to retain carbon dioxide which increases the carbonic acid level
decrease (slow and shallow)
249
effective but slow if pH is high will excrete bicarb, this can take up to 3 days to normalize pH level
, renal mechanism/kidneys
250
disturbance alters the carbonic acid portion of the buffering system
respiratory
251
disturbance alters the bicarbonate portion of the buffering system
metabolic
252
normal PCO2 range is
35-45 mmHg
253
normal HCO3 level is
22-26 mEq/L
254
ROME
Respiratory opposite metabolic equal
255
occur when carbonic acid or bicarbonate levels become disproportionate
acid base imbalances
256
primary excess of carbonic acid in ECF (PCO2 greater than45 and pH less than 7.35)
respiratory acidosis
257
primary deficit of carbonic acid in ECF (PCO2 less than 35 and pH greater than 7.45)
respiratory alkalosis
258
proportionate deficit of bicarbonate in ECF (HCO3 less than 22 and pH less than 7.35)
metabolic acidosis
259
primary excess of bicarbonate in ECF (HCO3 greater than 26 and pH greater than 7.45
metabolic alkalosis
260
causes of respiratory acidosis
```
acute and chronic respiratory disease
CNS depression
neuromuscular disease
retention of PCO2
common in patients with chronic respiratory diseases
```
261
signs and symptoms of respiratory acidosis
acute: increased pulse and respirations, decreased LOC
chronic: weakness, HA
example pH 7.30 PCO2 47
262
Interventions for respiratory acidosis
O2, adequate hydration
263
causes of respiratory alkalosis
hyperventilation, extreme anxiety
| high fever, early sepsis
264
signs and symptoms of respiratory alkalosis
confusion, difficulty concentrating, lightheadedness, palpitations, sweating
265
interventions for respiratory alkalosis
encourage slow, deep breaths (paper bag)
sedatives
Morphine or Ativan may be given to decrease respiratory rate
266
causes of metabolic acidosis
uncontrolled DM
| excessive GI fluid losses
267
signs and symptoms of metabolic acidosis
N/V
| Increased respiratory rate, peripheral vasodilation, hyperkalemia
268
interventions for metabolic acidosis
correction of underlying problem
| bicarbonate IV
269
causes of metabolic alkalosis
excessive acid loss- vomiting or gastric suctioning
| hypokalemia
270
signs and symptoms of metabolic alkalosis
dizziness, tingling of extremities, hypertonic muscles
271
interventions for metabolic alkalosis
give salt p.o. or sodium rich foods
272
reduces transfusion reactions
typing and cross matching
273
A person with group A blood can donate blood to
A and AB
274
A person with group A blood can receive blood from
A & O
275
A person with group B blood can give blood to
B & AB
276
A person with group B blood can receive blood from
B & O
277
A person with group AB blood can donate blood to
AB only
278
A person with group AB blood can receive from
all: A, B, AB, and O
279
A person with type O blood can give blood to
all: A, B, AB, and O
280
A person with type O blood can receive blood from
O only
281
identifies major antigens
helps reduce risk of transfusion reactions
RBCs from donor blood is mixed with plasma from recipient, a reagent is added, observed for clumping and if no clumping should be safe to give blood
crossmatching
282
blood products include:
```
whole blood
RBCs or PRBCs
Plasma
WBCs
plasma derivatives- albumin
autologous transfusion-
```
283
helps with oxygen transport
PRBCs
284
patient can receive their own blood- prior to surgery donate and it is given back postop
autologous transfusion
285
given to neutropenic patients
WBCs
286
stay with patient for __________ of transfusion
first 5 minutes
287
when monitoring tranfusions:
```
verify doctor's orders
baseline vitals
inspect IV site
18 gauge preferred, no less than 20 gauge IV catheter
verify blood by 2 RN's
vitals q 15 min x 4 then 30 min until completed
flush with hanging saline after infusion
blood must infuse in 4 hours or less
```
288
the longer blood hangs the more likely
it is to grow bacteria
289
some patients may receive __________ between transfusions, especially if heart failure patient
diuretics
290
types of transfusion reactions:
Allergic, bacterial febrile, hemolytic, circulatory overload
291
flushing, itching, rash, urticaria, hives, anaphylaxis
Allergic reaction to transfusion
292
fever, increased BP, and chills
bacterial reaction to transfusion
293
fever, chills, and flushing
febrile reaction to transfusion
294
RBCs destruction, fever, chills, SOB, chest pain, back pain. caused by infusing incompatible blood
hemolytic transfusion reaction
295
One of the most serious types of transfusion reactions
hemolytic
296
hypervolemia, cough, crackles, increased BP
circulatory overload
297
transfusion reaction nursing interventions:
immediately stop the transfusion
disconnect the tubing from the patient
Infuse 0.9% NS
Vital signs, cardiac and respiratory assessment
Notify physician
Send the blood back to the blood bank, call the lab to come draw a blood sample and take a urine specimen (sometimes ordered) according to policy
298
IV insertion and maintenance
Choose the right site: site that meets patient's need for fluids, in hand or lower arm, In trauma or cardiac arrest use antecubital fossa (bend of arm), use nondominant limb if possible, avoid using veins that lie over joints, avoid veins in feet of patients with diabetes or circulatory problems, avoid limbs with injuries, loss of sensation.
Know why IV is placed
A lot of facilities require physician's orders for IV placed in lower extremities
299
complications of IV therapy:
```
infiltration
infection
phlebitis, thrombophlebitis
extravasation
severed catheter
allergic reaction
air embolism
speed shock
fluid overload
```
300
fluid leaks into tissue outside of vein
infiltration
301
purulent drainage and redness
infection
302
red, inflammation of vein, red streak up arm
phlebitis
303
inflammation of vein
thrombophlebitis
304
similar to infiltration with tissue damage
| red, hot
extravasation
305
part of catheter shears off and causes an embolus
| requires calling PCP
severed catheter
306
itching at site, redness, anaphylaxis, laryngeal edema, runny nose
allergic reaction
307
obstruction of blood vessel caused by air bubble
air embolism
308
sudden physiologic reaction to IV med or fluids given too quickly
speed shock
309
LOC, cardiac arrest, dyspnea, SOB, crackles, tachypnea
fluid overload
310
the worst type of complication of IV therapy
extravasation
311
documentation of IV therapy
how patient tolerated
date, time, type of catheter
Label actual site with date, time, and gauge size, and your initials
# of attempts
insertion site and its appearance
the type and amount of fluid being infused and the rate
any patient teaching
312
```
There once was a tekkie named Chvos,
whose calcium was so low it was lost!
He'd tap on his face
on the facial nerve space
Till his face twitched and his eyes almost crossed.
```
Chvostek's sign
313
```
There once was a bride named Eve Snow,
Whose groom's parathyroid was low.
His calcium decked
And both arms were so flexed
that poor Eve carried her own trousseau.
```
Trousseau's sign
314
Normal thirst or may refuse some fluids
A moist mouth and tongue
Normal to slightly decreased urine output, normal specific gravity, and serum osmolality
less than 3% weight gain
normal HR, P, breathing, and warm extremities
cap refill less than 2 seconds
instant recoil on skin turgor test
eyes not sunken (and/or fontanel in baby)
this can be managed at home with oral hydration
mild dehydration
315
dry mouth and tongue
tired, restlessness, irritability, increased thirst
decreased urine output to slightly elevated urine specific gravity and serum osmolality
3-9% weight loss
normal to increased HR and P, normal to fast breathing, and cool extremities
cap refill greater than 2 seconds
recoil on skin turgor test in less than 2 seconds
slightly sunken eyes (and/of fontanel in baby)
may or may not be treatable at home, more aggressive approach may be needed
an IV bolus of fluid may or may not be given
marked or moderate dehydration
316
Poor drinking or may be unable to drink
lethargy, parched mouth and tongue
Minimal to no urine output, elevated urine specific gravity and serum osmolality
greater than 9% weight loss
increased HR, weak pulses, deep breathing, and cool mottled extremities
cap refill that is very prolonged or minimal
recoil on skin turgor test is more than 2 seconds
deeply sunken eyes (and/or fontanel in baby)
Considered MEDICAL EMERGENCY!!!
Patient is at risk for shock and death!!!
requires aggressive IV rehydration
severe dehydration
