Med Surge Exam 4: Acid-Base Balance

Acid-Base Balance

• Normal pH range: 7.35-7.45; acidosis occurs below 7.35 and alkalosis above 7.45.
• PCO2 normal range: 35-45 mmHg; changes indicating respiratory disorders when opposite to pH.
• Respiratory acidosis: pH < 7.35, PCO2 > 45 mmHg.
• Respiratory alkalosis: pH > 7.45, PCO2 < 35 mmHg.
• HCO3 normal range: 22-26 mEq/L; indicates metabolic disorders when in the same direction as pH.

Metabolic Acidosis & Alkalosis

• Metabolic acidosis: Decreased pH, PCO2, and HCO3.
• Metabolic alkalosis: Increased pH, PCO2, and HCO3.

Fluid Balance Disorders

• Hypovolemia:

  • Manifestations: tachycardia, tachypnea, dehydration, low blood pressure, orthostatic hypotension.
  • Management: IV isotonic solution (0.9% normal saline).
  • Nursing interventions: fall precautions, assist with ambulation, monitor weight, skin turgor assessment.

• Hypervolemia:

  • Manifestations: hypertension, rapid peripheral pulses, respiratory symptoms, pulmonary crackles.
  • Management: fluid restriction.
  • Complication: weight gain of 2 lbs in 3 days.
  • Nursing interventions: monitor weight, strict intake/output monitoring, fall precautions.

Electrolyte Imbalances

• Hypokalemia:

  • Serum potassium level: < 3.5 mEq/L.

• Hyperkalemia:

  • Manifestations: ECG changes (tall peaked T waves), abdominal cramps, muscle weakness, diarrhea, arrhythmias.
  • Interventions: calcium gluconate IV, calcium administration, IV dextrose with insulin.
  • Causes: inhibited aldosterone secretion leading to cardiac dysrhythmias.

• Hypomagnesemia:

  • Level < 1.6 mEq/L; common cause is diarrhea.
  • Nursing management includes referral to alcohol abstinence programs.

• Calcium Levels:

  • Normal range: 8.2-10.2 mg/dL; affects heart sensitivity.

• Hypocalcemia:

  • Manifestations: smooth muscle spasms, positive Trousseau's and Chvostek's signs.

• Hypercalcemia:

  • Manifestations: decreased deep tendon reflexes.
  • Management: IV bisphosphonates and calcitonin.

• Hyponatremia:

  • Causes: diuretics; manifestations include seizure potential.
  • Nursing interventions focus on seizure precautions.

• Hypernatremia:

  • Management: limit sodium intake and monitor daily weight.

• Hypochloremia:

  • Manifestations include irritability, hypotension, and tetany.

Metabolic Acidosis Management

• Treatment focuses on addressing underlying causes and using antidiarrheals.
• Nursing interventions: monitor hemodynamic status, especially cardiac output.

Urinary Disorders

• UTI:

  • Manifestations: dysuria and dark, foul-smelling urine.
  • Nursing intervention: increase fluid intake to 2-3 liters daily.

• Urinary Incontinence:

  • Characterized by involuntary or uncontrolled loss of urine.

Reproductive Health

• Bladder Cancer: Major risk factor is smoking.

• Dysmenorrhea: Treated with combined oral contraceptives (estrogen and progesterone).

• Cervical Cancer: Diagnosed through routine pap smears; treatment typically involves colposcopy and biopsy.

• BPH:

  • Manifestations: weak urine stream, decreased force.
  • Diagnosis: digital rectal exam and urinalysis.
  • Medications: anticholinergics.

• Prostate Cancer: Risk increases with age; teaching includes signs of infection.

• Testicular Cancer: Normal finding includes darker testicles.

• HPV: Associated with increased risk of cervical cancer and diagnosed via pap tests and colposcopy. Teaching emphasizes vaccination for prevention.

STI Treatment

• Genital Herpes: Manifestations include fever and headache; avoid medication during pregnancy.
• Chlamydia: Can be asymptomatic but may lead to dysuria.
• Gonorrhea: Risk factors include low socioeconomic status and history of STIs.

Miscellaneous

• Menopause: Classified after 12 months without vaginal bleeding.
• Urolithiasis Complication: Kidney stones may lead to pyelonephritis.
• TURP Procedure: Surgery to remove part of the prostate due to BPH.
• Cervical Dysplasia: Abnormal cervical cell growth typically linked to HPV.
• Condylomata Acuminata: Anogenital warts caused by HPV.
• Syphilis Treatment: Managed with penicillin.