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Ch 13 Imbalances

Med Surg 1

TermDefinition
[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)
Created by: TedMed