Med Surge Exam 4: Acid-Base Balance

pH Ranges and Acid-Base Imbalance

• pH range: 7.35-7.45
• pH lower than 7.35: Acidosis
• pH higher than 7.45: Alkalosis

PCO2 Ranges and Respiratory Disorders

• PCO2 range: 35-45
• PCO2 opposite direction to pH: Respiratory disorder (Respiratory acidosis)
• Respiratory acidosis: pH less than 7.35 and PCO2 higher than 45
• Respiratory alkalosis: pH greater than 7.45 and PCO2 less than 35

HCO3 Ranges and Metabolic Problems

• HCO3 range: 22-26
• HCO3 same direction as pH: Metabolic problem
• Metabolic acidosis: Decreased pH, PCO2, HCO3
• Metabolic alkalosis: Increased pH, PCO2, HCO3

Fluid and Electrolyte Balance

• Diffusion: Fluids move from extracellular to intracellular
• Hypovolemia: Tachycardia, Tachypnea, dehydration, Low BP, Orthostatic hypotension
• Hypovolemia medical management: IV isotonic solution (9% NS)
• Hypovolemia nursing interventions: Fall precaution, Assist with ambulation, Monitor weight, Skin turgor assessment
• Hypervolemia: Hypertension, Rapid peripheral pulses, Respiratory symptoms, Crackles in lungs
• Hypervolemia medical management: Fluid restriction
• Hypervolemia nursing interventions: Monitoring weight, Calculating/monitoring strict I&Os, Fall precaution

Electrolyte Imbalance

• Hypokalemia: Serum potassium level < 5.0
• Hyperkalemia: ECG changes, Tall peaked T waves, Abdominal cramps, Muscle weakness, Diarrhea, Arrhythmia
• Hyperkalemia interventions: Calcium gluconate IVP, Calcium administration, IV dextrose and insulin administration
• Hypomagnesemia: Serum level < 1.6, Diarrhea
• Hypomagnesemia nursing management: Referral to alcohol abstinence programs
• Calcium normal values: 8.2-10.2
• Calcium and potassium are heart sensitive

Hyponatremia and Hypernatremia

• Hyponatremia: Diuretics and seizure
• Hyponatremia nursing interventions: Seizure precaution
• Hypernatremia medical management: Limit sodium intake, Monitor daily weight

Other Electrolyte Imbalance

• Hypochloremia: Irritability, Hypotension, Tetany (Charlie horse)

Metabolic Acidosis

• Treatment: Treat underlying cause, Antidiarrheals
• Nursing management: Decreased cardiac output related to severe metabolic state
• Nursing interventions: Monitor hemodynamic status

UTI and Incontinence

• UTI manifestations: Dysuria, Dark foul-smelling urine
• UTI nursing intervention: Increased fluid intake (2-3 liters per day)
• Urinary incontinence: Involuntary or uncontrolled loss of urine in any amount

Men's Health and Reproductive Health

• Black cohosh: Menopause
• Bladder cancer risk factor: Smoking
• BPH manifestation: Weak urine stream/decreased force
• BPH medications: Anticholinergic
• BPH diagnosis: Digital rectal exam, Urinalysis to detect infection or blood
• Prostate cancer risk factor: Prostate enlarges with age
• Prostate cancer teaching: Signs of infection/fever
• Testicular cancer normal finding: Testicles darker in skin color than the rest of the body
• HPV increases the risk of: Cervical Cancer
• HPV diagnosis: Pap test, Colposcopy
• HPV nursing intervention assessment: Presence of genital warts
• HPV teaching: Prevention vaccine recommended for age 15-26
• Genital herpes manifestations: Fever, Headache
• Genital herpes medication: Cannot be taken during pregnancy
• Chlamydia may be asymptomatic but may result in: Dysuria
• Gonorrhea risk factors: Low socioeconomic status, History of STI and PID, Multiple sex partners
• Menopause classification: 12 months of no vaginal bleeding