NP2 2011: Fluid & Electrolyte Prof.Kamhoot
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| What percent of the body is extracellular fluid? | show 🗑
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| What percent of the body is intracellular fluid? | show 🗑
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| Extracellular fluid is... | show 🗑
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| show | Transport nutrients to and from the cells Manintains blood volume Acts as a lubricant for tissues Aides in maintance of acid-base balance Assists in heat regulation via evaporation
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| show | 2500 mL
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| show | Food: 1000 mL
Oxidation: 300 mL
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| Average Insensiable output of skin, sweat, feces, and lungs is... | show 🗑
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| S/S of fluid volume deficit/Hypovolemia... | show 🗑
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| show | -Decrease in systolic pressure > 20mm Hg
-Decrease in diastolic pressure 10mm Hg
-10-20% increase in HR
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| Nursing Interventions for fluid volume deficit/hypovolemia are | show 🗑
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| show | -Excessive intake of fluids -Abnormal retention of fluids -Interstitial to plasma shift
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| show | -Increase HR/BP -Tachypnea/dyspnea -Distended veins -Edema -Weight gain -I&O -Crackles in lungs -Pulmonary edema
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| Treatment of fluid volume excess/hypervolumia is... | show 🗑
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| show | -Asses for cause
-Daily weights
-I&O
-Asses VS
-Skin assessment/care
-Assess/monitor respiratory rate
-Restrict Na and fluid intake
-Administer meds as ordered
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| show | replacement of lean muscles to fat, kidneys are less able to concentrate urine, decrease in mobility decreases thirst, incontinent, over salt food, mild disorientation, orthostatic hypotension, constipation
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| show | 125 mL, 180L
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| show | 30mL/hr
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| 1 L of fluid = | show 🗑
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| Substances entering the body begin their journey in the ____________ fluid. | show 🗑
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| show | Diffusion
Osmosis
Filteration
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| show | energy
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| Solute | show 🗑
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| Solvent | show 🗑
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| show | used to describe fluids outside the body
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| Osmolality (mOsm/kg) (serum) | show 🗑
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| Diffusion... | show 🗑
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| Osmosis... | show 🗑
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| Hypertonic solution... | show 🗑
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| Isotonic solution... | show 🗑
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| Hypotonic solution... | show 🗑
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| show | D5 1/2NS: 5% dextrose in 0.45% sodium
chloride
D5NS: 5% dextrose in 0.9% sodium chloride
D5LR: 5% dextrose in lactated ringers
D10W: 10% dextrose
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| show | NS: 0.9% sodium chloride
LR: lactated ringers
D5W: 5% dextrose in water
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| show | 1/2NS: 0.45% sodium chloride
D2.5W: 2.5% dextrose
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| Osmotic pressure.... | show 🗑
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| Hydrostatic pressure... | show 🗑
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| Oncotic pressure... | show 🗑
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| Facillitated diffusion involves _______ ______ and requires _____ energy. | show 🗑
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| Filtration | show 🗑
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| show | synthesized, secreted, inhibited
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| Aldosterone is adrenal gland hormone that has an ________ effect on water. Released and inhibited in a feedback loop as part of the _____-__________ system. | show 🗑
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| show | adrenal gland, promotes
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| Atrial natriuretic peptide (ANP) cardiac hormone that is released when the atria is ________ from ______ _______ ______ or _____ ___. | show 🗑
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| show | causing vasodilation, decreasing aldosterone, decreasing ADH release, increasing GFR
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| show | cardiac
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| Brain natriuretic peptide (BNP) decreases blood volume and pressure by... | show 🗑
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| show | requires, the chemical adenosine triphosphate
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| show | the movement of molecules into cells without regard for their positive or negative charge and against concentration factors, moves fluids from an area of low concentration to an area of high concentration
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| Substances that require active transport are... | show 🗑
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| During dehydration, the serum osmolality ________; during overhydration the serum osmolality _________. | show 🗑
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| show | Hypothalmus
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| The pituitary store/releases ______ | show 🗑
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| show | increased osmolality, stress, nauses, nicotine, morphine
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| Diabetes insipidus affects the pituitary by... | show 🗑
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| show | Osmoreceptors in hypothalmus stimulate posterior pituitary to screte ADH->ADH increases tubule permeability -> increase reabsorption of H20 into blood -> Unrine output decreases which causes serum/blood osmolality decreese as the water dilutes fluids
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| show | ADH is suppressed-> ADH causes distal tubules to become less permable to water
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| show | increasing serum glucose,and has an antiinflammatory effect
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| Mineralcorticoids such as aldosterone help regulate BOTH water adn electrolytes by... | show 🗑
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| show | 1.010-1.025
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| show | dilute urine. may be caused by excess fluid intake, inability to concentrate unrine
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| show | concentrated urine. may be dehydration, excess solutes in urine
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| show | excess, renin, aldosterone and ADH
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| show | sodium and water, thrist
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| Normal serum sodium(Na+) levels are... | show 🗑
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| show | regulate ECF volume and distribution, maintaining blood volume, transmitting nerve impulses and contraction muscles.
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| ____ is the most abundant cation in ECF. | show 🗑
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| show | potassium, sodium and magnesium phosphate, bicarbonate, protein, chloride and sulfate
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| Extracellular fluid (ECF) is 1/3 of bodys water and consists of cations mostly ______, some __________, ________, and magnesium. Also, anions of mostly _______, some ________, sulfate, and _________. | show 🗑
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| Cations are postitively charged and include.... | show 🗑
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| show | Sodium bicarbonate (HCO3-) Chloride (Cl-) Phosphate (PO4-3)
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| show | irritability, apprehension, confusion, postural hypertention, tachycarida, rapid thready pulse, jugular venous filling, nausea, dry mucous membranes, wt.loss, tremor, seizures, coma
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| show | GI losses Renal losses: SIADH, diuretic, adrenal insufficiency, Na+ wasting, renal disease Skin loss: burns, wound drainage, excessive sweating
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| Hyponatremia caused by gain of water (Na+ dilution) can be caused by... | show 🗑
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| show | h/a, fatigue, apathy, weakness, confusion, nausea, vomiting, wt.gain, postural hypotenstion, muscle spasms, seizure, coma
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| show | insensible water loss (diarrhea) and perspiration, diabetes insipidus, osmotic diuresis, water deprivation
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| show | intense thirst, dry swollen tongue, restlessness, agitation, twitching, confusion, seizure, coma, weakness, postural hypotension, wt.loss, low urinary output
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| Hypernatremia (serum sodium > 145 mEq/L) caused by sodium gain (increase ECF) s/s include... | show 🗑
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| Hypernatremia (serum sodium > 145 mEq/L) caused by sodium gain (increase ECF) can be caused by... | show 🗑
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| show | treat cause dietary adjustment treat fluid loss/gain
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| show | transmission & conduction of nerve impulses, maintance of normal cardiac rhythm, skeletal & smooth muscle contraction, major intracellular cation, regulates intracellular osmolaltity, promotes cellular growth, leaves cells during tissue breakdown
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| Normal serum potassium levels are | show 🗑
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| show | dark yellow and orange fruits, avocados, dark green leafy vegetables, sweet potatoes, meat, nuts and pb, cola drinks, instant tea and coffee
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| Hypokalemia (serum potassium < 3.5 mEq/L) caused by abnormal fluid loss can be caused by | show 🗑
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| S/S of hypokalemia (serum potassium < 3.5 mEq/L) | show 🗑
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| Treatment's of hypokalemia | show 🗑
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| show | renal failure(usually),,assive cell damage, rapid transfusion of blood products, catabolism, metabolic acidosis, adrenal insufficiency
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| S/S of hyperkalemia (>5.0 mEq/L) | show 🗑
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| Treatment for hyperkalemia (> 5.0 mEq/L) | show 🗑
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| show | 95-108 mEq/L
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| show | regulate acid base balance, functions with sodium, major component of gastric juice as hydrochloric acid (HCL), acts as buffer in the exchange of O2 and CO2 in RBC's
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| show | increased muscle excitablility, tetany,decreased respirations
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| show | stupor, rapid deep breathing, muscle weakness
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| Sources of chloride (Cl-) | show 🗑
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| Normal calcium total serum includes bound and unbound calcium and is | show 🗑
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| Calcium functions | show 🗑
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| What percent of calcium is in bones/teeth? | show 🗑
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| where is the 1% of calcium in the body located? | show 🗑
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| Calcium sources | show 🗑
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| show | lethargy, depressed reflexes, decreased memory confusion, personality changes, psychosis, anorexia, vomiting, bone pain, fractures, polyuria, dehydration, stupor, coma, muscle tremors, parathesias, ventricular arrhythmias, increased digitalis effect
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| show | 4.0-5.0 mEq/L
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| Causes of increased total calcium (hypercalcemia >10.5 mg/dL) | show 🗑
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| Causes of increased ionized calcium (hypercalcemia >5.0 mEq/L) | show 🗑
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| S/S of hypocalcemia (< 4.0 mEq/L or < 8.5 mg/dL) | show 🗑
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| Causes of hypocalcemia (< 4.0 mEq/L or < 8.5 mg/dL) | show 🗑
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| Phosphorus is chiefly an __________ anion. | show 🗑
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| Normal phosphorus serum level | show 🗑
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| Phosphorus and ________ have an inverse relationship in the body; an increase in one causes a decrease in the other. | show 🗑
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| show | phosphorus
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| show | essential to function of muscles, RBC's, and nervous system
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| An adequate intake of Vitamin ____ is necessary for the absorption of both calcium and phosphorus | show 🗑
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| show | diabetic ketoacidosis, dietary insufficiency, impaired kidney function, or misdistribution of phosphate
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| Hypophosphatemia (< 2.8 mg/dL) S/S | show 🗑
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| Treatment for hypophosphatemia (<2.8 mg/dL) | show 🗑
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| Hyperphosphatemia (> 8.5 mg/dL) may be caused from | show 🗑
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| show | tetany, numbness & tingling around the mouth, and muscle spasms
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| show | underlying cause, restrict foods with phosphorus, phosphate binding agents such as Basajel, Amphogel, Aluminet
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| Magnesium (Mg+)function | show 🗑
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| Normal serum level of magnesium | show 🗑
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| show | magnesium
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| Causes of hypermagnesiumia (> 2.5 mEq/L) | show 🗑
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| show | lethargy,drowsiness, n/v, reflexes impaired, somnolence, EKG changes, hypotension,bradycardis, respiratory, cardiac arrest can occur
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| show | prevention/indentify and eliminate cause, EKG monitor, IV CaCl or calcium gluconate, fluids, neuro assessment, discontinue medications that contribute
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| Causes of hypomagnesiumia (< 1.5 mEq/L) | show 🗑
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| show | hyperactive deep tendon reflexes, tremors, seizures, cardiac arrthymias, confusion
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| Treatment of hypomagnesiumia (< 1.5 mEq/L) | show 🗑
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| Plasma proteins, particularly albumin, are significant determinants of _______ volume | show 🗑
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| show | (rare) anorexia, malnutrition, starvation, fad dieting, poorly balanced vegetarian diets
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| show | edema, slow healing, anorexia, fatigue, anemia, muscle loss, ascites
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| Nursing interventions for hypoprotienemia | show 🗑
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| show | extracellular
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| Normal serum level of bicarbonate | show 🗑
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| Bicarbonate is the main anion of the _______ fluid | show 🗑
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| show | the regulation of the acid-base balance
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| show | homeostasis, hydrogen
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| show | carbonic, bicarbonate
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| The symbol used to indicate hydrogen ion balance is _____ | show 🗑
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| show | acidic, neutral
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| show | acidic
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| show | alkaline (base)
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| show | PH, PaCO2, HCO3, PaO2, SaO2
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| Normal PH of ABG is | show 🗑
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| show | 35-45 mm Hg
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| show | 22-26 mEq/L
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| show | 80-100 mm Hg
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| Normal Sa02 of ABG is | show 🗑
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| show | blood buffers, lungs, kidneys
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| Blood buffers work to keep the PH in the range of normal by | show 🗑
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| Blood buffers act immediately, are present in _______ & ________, and take up or releases extra ______ ions | show 🗑
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| The lungs work to keep the PH in the range of normal by | show 🗑
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| The kidneys work to keep the PH in the range of normal by | show 🗑
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| show | any condition that impairs normal ventilation, perfusion, or diffusion
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| show | a retention of carbon dioxide occurs with a resultant increase of carbonic acid in blood; PH < 7.35; PaCO2 > 45mg; HCO3 normal early on then it increases
Compensation: kidneys retain HCO3
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| Respirtory Acidosis causes | show 🗑
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| Clinical S/S of respiratory acidosis | show 🗑
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| show | improve ventilation, use bronchodilators, administer oxygen, administer fluids, meds-possible anti infectives
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| show | an increase in respratory rate, depth, or both that results in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood.
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| show | PH > 7.45
PaCo2 < 35 mmHg
HCO3 Normal
Compensation: kidneys excrete HCO3
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| show | hyperventilation, anxiety, fear, head injuries, ASA overdose, pneumonia, disorders of the CNS, hypoxia, high fever, pulmonary emboli
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| Clinical S/S of respiratory alkalosis | show 🗑
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| show | treat source of anxiety, breathe slowly into a paper bag, administer sedatives
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| Metabolic Acidosis is | show 🗑
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| ABG results of metabolic acidosis | show 🗑
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| show | starvation, dehydration, diabetic ketoacidosis, renal failure, shock, diarrhea, drugs (ASA), acid indigestion, fistules, severe infection, excessive GI loss
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| show | nausea & vomiting, Kussmaul's breathing ( fast, shallow), h/a, drowsiness, increased breathing, diarrhe, lethargy, decrease LOC, cardiac arrhythmias
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| show | reverse underlying cause, administer Na HCO3, insulin
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| show | when a significant amount of acid is lost from the body or an increase in the bicarbonate level
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| show | PH > 7.45 HCO3 > 24mEq/L PaCo2 Normal Compensation: lungs retain CO2
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| show | excessive vomiting, prolong NG suctioning, electrolyte disturbance (hypokalemia), cushings disease, drugs (steriods, NaHCO3, diuretics & antiacids), hyperaldosteronism
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| show | h/a, lethargy, irritability, decrease LOC, tachycardia, slow, shallow respirations, bradycardia, n/v, numbness & tingling in extremities, tetany
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| show | reverse underlying cause, thiazide diuretics discontinued, NG suctioning discontinued, administer antimetic, restore normal fluid volume
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| show | Respiratory acidosis
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