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Ch 13 Imbalances
Med Surg 1
| Term | Definition |
|---|---|
| [Hydrogen Ion] | Acidity/Alkalinity depends on this |
| Acidity(osis) | Increase H+, Low pH, <7.35 |
| Alkalinity(osis) | Decrease H+, High pH >7.45 |
| 7.35-7.45 | Normal Blood pH range |
| Base | Bicarbonate |
| Acid | CO2 |
| Base:Acid Ratio | 20:1 |
| pH alteration causes | Reduced hormones and enzyme function, fluid & electrolyte imbalance, changes in excitable membranes |
| 3 Ways body maintains pH | Buffer system, Respiratory System, Renal System |
| Buffer System | Immediate, primary regulator, works by moving H in/out cell |
| Respiratory System | Within minutes. works by changing rate and depth of respirations |
| 35-45 mmHg | Normal partial pressure exerted by CO2 |
| Lungs | Blow off CO2 with increased respiration or retains CO2 with decreased respirations |
| Renal System | 2-3 days, works by kindeys reabsorbing and conserving bicarb |
| 22-26 | Normal Bicarb range (HCO3) |
| Alkaline/Base | HCO3 |
| Kidneys | Generate additional bicarb & excretes excess H to compensate for acidosis |
| 6.0 | Normally acidic urine |
| 4-8 | Urine pH range |
| Respiratory Acidosis | Hypoventilation, increase carbonic acid, decrease pH |
| Respiratory Alkalosis | Hyperventilation, decrease CO2, increase pH |
| Respiratory Acidosis Compensation | Kidneys produce and conserve bicarb and excrete H |
| Respiratory Alkalosis Compensation | Kidneys excrete bicarb |
| Metabolic Acidosis | Acid accumulates and bicarb lost |
| Metabolic Alkalosis | Loss of acid and gain of bicarb |
| Metabolic Acidosis Compensation | Lungs increase respiratory rate and depth (Kussmaul respirations) |
| Metabolic Alkalosis Compensation | Lungs decrease respiratory rate and depth |
| Respiratory Acidosis R/t | Smoking, COPD, Narcotic OD, Ambien @night |
| Metabolic Acidosis R/t | Anorexia, kidney failure, type I diabetic |
| Respiratory Acidosis Tx | Improve ventilation: bronchodilators, antibiotics, pulmonary hygiene, adequate fluids, and supplement oxygen |
| Metabolic Acidosis Tx | Correct imbalance: give bicarb, dialysis if renal failure, insulin for diabetes, diarrhea |
| Respiratory Alkalosis R/t | Running, anxiety, high altitudes |
| Respiratory Alkalosis Tx | If anxiety - breathing OR sedative |
| Metabolic Alkalosis R/t | Lasix or baking soda use |
| Metabolic Alkalosis Tx | Volume depletion from GI (I&O) |
| pH 7.31 CO2 68 HCO3 23 | UC Resp. Acidosis |
| Vomiting | Lose acid (increase CO2) |
| Diarrhea | Lose base (decrease CO2) |
| pH 7.3 CO2 41 HCO3 17 | UC Metabolic Acidosis |
| pH 7.5 CO2 29 HCO3 25 | UC Resp Alkalosis |
| pH 7.533 CO2 37 HCO3 37 | UC Metabolic Alkalosis |
| pH 7.5 CO2 30 HCO3 13 | C Resp Alk. |
| pH 7.51 CO2 60 HCO3 34 | C Metabolic Alk. |
| pH 7.3 CO2 64 HCO3 | C Resp Acidosis |
| Metabolic Acidosis S/S | Ketoacids, Severe diarrhea, impaired kidney function, shock |
| Metabolic Alkalosis S/S | Prolonged vomiting, Nasogastric suctioning, steroid use, diuretics |
| Respiratory Acidosis S/S | Resp. muscle paralysis, Immobility, emphysema, brainstem trauma |
| Respiratory Alkalosis S/S | Over sedation, hyperventilation with anxiety, vent settings too high or low, high altitudes |
| Cation | Positive ion |
| Anion | Negative ion |
| Serum levels | Indicate ECF |
| 2/3 Located Here | Intracellular |
| 1/3 Located Here | Extracellular |
| Intravascular | Plasma |
| Interstitial | Between cells |
| Transcellular | Digestive juices, bladder, intraocular, cerebrospinal fluid |
| Third space fluid | Not available for exchange with remaining ECF |
| Adult Male | 60% total body H20 |
| Adult Female | 50% total body H20 |
| Newborn | 80% total body H20 |
| Fluid | Major control of fluid intake |
| Kidney | Major organ of controlling fluid output |
| Higher Osmolarity | More concentrated, less fluid |
| Hypervolemia | Excess fluid volume; inhibits ADH&Aldosterone release; increased urination and decreased thirst |
| Hypovolemia | Decreased fluid volume; stimulates ADH&Aldosterone release; decreased urination and increased thirst |
| Hydrostatic Filtering force example | BP |
| Hydrostatic pressure | Push |
| Colloid pressure | pull |
| Edema | Results from Hydrostatic pressure difference changes |
| Insensible water loss | Can’t really measure; respiratory or sweating |
| Dehydration | Increased HR, R, lab values, P & decreased BP, urine output, saliva |
| Normal urine output | 30mL/h or 400-600mL/day |
| SIADH | |
| Diabetes Insipidus | |
| Third Spacing | |
| Orthostatic hypotension | P increases & BP decreases @least 15mmHg w/ change in position |
| Fluid Overload | R/t renal failure, HF, steroids, liver disease |
| Fluid overload s/s | Increased HR, BP, crackles |
| Drug Therapy for Fluid Overload | Furosemide (Lasix), Thiazide (HCTz), Spironalctone Diuretic |
| Furosemide (Lasix) | Diuretic for HTN and HF (decreases K) |
| Spironalactone Diurectic | Blocks aldosterone (increases K) |
| Normal Na | 135-145 mmol/L |
| Na level | Vital for skeletal muscle contraction, cardiac contraction, nerve impulse transmission, and normal osmolality and ECF volume |
| Hyponatremia | Na below 136 mEq/L |
| Hyponatremia Caused By | Diuretics, dilutional hyponatremia, SIADH |
| Diuretic Effect | Decreased H2O and Na |
| Effect of dilutional hyponatremia | Increased H20, Decreased NA (cirrhosis, kidney failure, psychogenic polydipsia) |
| SIADH Effect | Normal H20 and Decreased Na |
| Hypernatremia | Serum Na over 145 |
| Furosemide, K supplement, Digoxin (Lanoxin) | 3 medicines commonly given together |
| Hypernatremia | @high risk for; older adults, coma, tube feedings, fever, near drowning, hypertonic IV |
| Normal K level | 3.5- 5.0mEq/L |
| Hypokalemia | Serum K below 3.5; every body system threatening |
| Hyperkalemia | Serum K above 5.0 |
| Hyperkalemia Drug Therapy | Kayexalate, insulin |
| Normal Ca Level | 9.0-10.5mg/dL |
| Hypocalcemia | Serum below 9.0 |
| Hypercalcemia | Serum above 10.5; affects all systems |
| Hypercalcemia Drug Therapy | IV 0.9% NaCl, Furosemide, Ca chelators, Phosphorus, prostaglandin inhibitors, dialysis |
| Hyponatremia Drug Therapy | 3% Saline IV |
| Hypotonic IV Fluid | More H2O than Electrolyes (0.45 saline or D5W) |
| Hypotonic Fluids | Causes water to move into cells |
| Isotonic IV Fluid | Expands plasma volume (LR or 0.9 NaCl) given to hypernatremic pts |
| Potassium Drug Therapy | No more than 20mEq/h; irritating to GI tract so give with 6-8oz juice |
| Hypertonic IV Fluid | Tx of dangerously low Na levels (3% Saline) |
| High K foods | Oranges, bananas, apricots, potatoes, tomatoes |
| Metabolic Acidosis | Hyperkalemia |
| Metabolic Alkalosis | Hypokalemia |
| Check Ca levels | Thyroid Surgery |
| Hypocalcemia Risk factors | Cultures that don't consume dairy: Asians, African Americans, Native Americans, Native Alaskans |
| Hypocalcemia Drug Therapy | Ca gluconate |
| Chvostek's Sign | Testing for muscle tetany - facial muscle will twitch (w/ hypocalcemia) |
| Traousseau's sign | Blood pressure cuff - hand will turn in on itself when pump 20mmHg above normal systolic (hypocalcemia) |
| Hypocalcemia Tx | Green leafy veggies |
| CUS | Concerned, Uncomfortable, not Safe |
| Thyrocalcitonin and parathyroid | Regulate calcium (r/t hypocalcemia) |
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