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AC MED SURG MODULE 1
| Question | Answer |
|---|---|
| An indicator of Hydrogen ion (H+)concentration in plasma... | Plasma PH |
| Plasma PH normal range is... | 7.35-7.45 |
| Homeostatic mechanisms to keep PH balanced... | Buffer system, lungs, kidneys |
| Lower PH is... | Acidic |
| Higher PH is... | Alkaline |
| PH level of plasma compatible with life is... | 6.8-7.8 |
| Body's major extracellular buffer system... | Bicarbonate (HCO3-)-carbonic acid (H2CO3) buffer system |
| Bicarbonate (HCO3-) to carbonic acid (H2CO3) ratio | 20:1 |
| Kidneys control extracellular fluid PH by ... | Regulating bicarbonate levels |
| Kidneys regenerate and reabsorb bicarbonate ions in the ... | Renal tubular cells |
| Kidneys excrete hydrogen ions and conserve bicarbonate ions to restore balance in what conditions? | Respiratory acidosis and metabolic acidosis |
| Kidneys retain hydrogen ions and excrete bicarbonate ions to restore balance in what conditions? | Respiratory alkalosis ans metabolic alkalosis |
| CO2 is controlled by... | The lungs |
| Extracellular fluid carbonic acid content is controlled by... | CO2 levels |
| PaCO2 | Partial Pressure of CO2 |
| PaO2 | Partial pressure of oxygen |
| CO2 levels in the blood regulate... | respiration rate |
| What happens to RR in metabolic acidosis? | RR increases |
| Increased respirations eliminate what? | CO2, reducing the acid load |
| Decreased respirations cause what? | Retention of CO2, increasing the acid load |
| Respiratory buffer systems controls... | carbonic acid |
| Renal Buffer System controls... | bicarbonate |
| How long does it take the respiratory buffer system to activate? | several minutes |
| How long does it take the renal buffer system to activate? | Up to 2 days |
| PaCO2b level | 35-45 mm Hg |
| HCO3 | 22-26 mEq/L |
| Causes of respiratory acidosis | COPD, Pulmonary edema, airway obstruction, drug overdose |
| Respiratory acidosis is an excess of... | carbonic acid |
| S/S of Respiratory acidosis | SOB, H/A, drowsiness, restlessness, fatigue, confusion, lethargy, coma |
| Treatment of respiratory acidosis | Correct underlying condition, brochdilator, supplemental O2 |
| Respiratory alkalosis is a deficit of... | carbonic acid |
| Primary cause of respiratory alkalosis | Hyperventilation |
| S/S of respiratory alkalosis | Dizziness, lightheadedness, agitation, tingling around mouth, fingers, and hands, tetany, convulsion, coma |
| Treatment of respiratory alkalosis | Correct the underlying problem, slow deep breaths, breath in a paper bag |
| Meatbolic acidosis is a deficit of... | bicarbonate |
| Bicarbonate in the systems functions to... | neutralize the effects of acid |
| Causes of metabolic acidosis... | Diarrhea, vomiting, starvation, drug overdose, diabetic ketoacidosis, renal failure |
| S/S of metabolic acidosis | H/A, lack of energy, sleepiness, dehydration, fruity breath, diarrhea, disorientation, stupor, coma |
| Treatment of metabolic acidosis | Correct the underlying problem, administer fluids, administer insulin, control, N/V |
| Metabolic alkalosis is an excess of | Bicarbonate |
| Causes of metabolic alkalosis | loss of stomach acid through suctioning or vomiting, diarrhea, overuse of antacids or laxatives |
| S/S of metabolic alkalosis | decreased respiratory rate, apnea, cyanosis, diarrhea, N/V, convulsions, coma |
| Treatment of metabolic alkalosis | Correct the imbalance, administer fluids |
| Respiratory acidosis pH levels... | lower than 7.35 |
| Respiratory acidosis CO2 levels... | greater than 29 mmol/L |
| Respiratory acidosis HCO3 levels... | |
| PACU discharge criteria | stable V/S, orientation x4, uncompromised pulmonary function, adequate 02 levels, urine output of at least 30ml/hr, N/V under control, minimal pain |
| Pacu complication hypotension and shock.. | Mainly treated with volume replacement |
| PACU complication Hemorrhage... | treated with blood or blood product transfusion and determining source of hemorrhage |
| PACU complications hypertension and dysrhythmias... | Treat underlying causes:electrolyte imbalance, altered respirations, pain, hypothermia, stress, anesthasia |
| PACU complication pain and anxiety... | opioid analgesics are administered |
| PACU complications N/V | Intervene at the nausea stage, give meds |
| Aldrete Score... | PACU pts scores on activity, respirations, circulation, consciousness, 02 sat |
| PACU nurse primary objective... | maintain airway |
| Characteristics of type 1 diabetes... | Onset before 30 y/o, wt loss, ketoacidosis, hyperglycemia, islet cell antibodies, insulin antibodies, no endogenous insulin, insulin dependent |
| Charateristics of type 2 diabetes... | onset over 30 y/o, obesity, decreased edogenous insulin or increased insulin resistance, may be controlled with wt loss and exercise, oral antidiabetics |
| S/S of hyperglycemic diabetes mellitus... | the 3 P's, polyuria, polydipsia, poyphagia |
| Diagnostic findings for diabetes mellitus | Fasting glucose greater than 120, random glucose greater than 200, |
| Diabetes mangement components... | Diet, exercise, monitoring, medication, education |
| Type 2 diabetes nutritional goal... | reversal of hyperglycemia |
| Type 2 diabetes exercise goal... | wt loss |
| Conventional insulin regimen | One or more injections of a mixture of short and intermediate acting insulins per day. |
| Intensive insulin regimen... | three or four injections of insulin per day |
| S/S of hypoglycemia | sweating, tachycardia, palpitaions, nervousness, hunger, inability to concentrate, combativeness, double vision, numbness of lips and tongue, slurred speech, drowsiness |
| Management of hypoglycemia | 15g of fast acting carbs such a s glucose tablets, juice or soda, hard candies, sugar or honey |
| S/S of diabetic ketoacidosis | Hyperglycemia, dehydration and electrolyte loss, acidosis |
| Management of DKA | Reverse hperglycemia, rehydrate, restore electrolytes |
| HHNS | Hyperglycemic hyperosmolar nonketotic syndrome |
| S/S of HHNS | Hypotesion, dehydration, tachycardia, change in neurological signs |
| Management of HHNS | fluid replacement, restore electrolytes, insulin administration |
| Diabetic macrovascular manifestations | MI, CAD, cerebrovascular disease, PVD |
| Diabetic Macrovascular complication management | weight management, hypertension control, hyperlipidemai control |
| Diabetic microvascular complications | diabetic retinopathy, nephropathy |
| Management of diabetic nephropathy... | control hypertension, prevent UTI, avoid nephrotoxic substances, adjust medications, low sodium low protein diet |
| Tunneled central venous catheters | Long term use (years), Hickman, groshong, permacath, Surgically inserted |
| Nontunneled Central catheters | Short term use (less than 6 weeks), vas cath, arrow, hohn |
| Implanted ports | Port a cath, mediport, Hickman port, PAS Port, use Huber tipped needles |
| PICC Line | Peripherall inserted central catheters |
| Care of CVC | sterile dressing change, change caps weekly, observe for redness, swelling, drainage, clamp line when not in use, maintain sterility when changin fluids |
| Complications of CVC | air embolism, arfteial laceration, catheter embolism, malposition, pneumo or hemo thorax, infection, sepsis, thrombosis, migration or dislodgement |
| Vein selection | soft, full, long distal veins first, proximal to bruising, avoid flexion areas |
| Replace peripheral IV tubing how often? | 72-96 hours |
| Why is the order of a blood draw important? | to avoid inaccurate and inconsistent results caused by contamination of the sample additives in different types og tubes. |
| Blood draw order... | stop, red light, stay put, green light, goSTERILE, RED, LIGHT BLUE, SST, PST, GREEN, LAVENDER, GRAY |
Created by:
janelloyd
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