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