Med Surge Exam 4: Acid-Base Balance

pH and Acid-Base Balance

• pH ranges: 7.35-7.45
• pH lower than 7.35: Acidosis
• pH higher than 7.45: Alkalosis
• Pco2 ranges: 35-45
• If PCO2 is going in an opposite direction than pH, it indicates a 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

• HCO3 ranges: 22-26
• If HCO3 is going in the same direction as pH, it indicates a 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 manifestations: 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 manifestations: Hypertension, Rapid peripheral pulses, Respiratory symptoms, Crackles in lungs
• Hypervolemia medical management: Fluid restriction
• Hypervolemia complications: Weight gain of 2lbs in 3 days
• Hypervolemia nursing interventions: Monitoring weight, Calculating/monitoring strict I & Os, Fall precaution

Electrolyte Imbalance

• Hypokalemia: Serum potassium level < 5.0
• Hyperkalemia manifestations: 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 level: < 1.6
• Hypomagnesemia cause: Diarrhea
• Hypomagnesemia nursing management: Referral to alcohol abstinence programs
• Calcium normal values: 8.2-10.2
• Calcium and potassium are heart sensitive

Calcium Imbalance

• Hypocalcemia manifestations: Smooth muscle spasms/twitching, Positive Trousseau and Chvostek sign
• Hypercalcemia manifestations: Decreased deep tendon reflexes
• Hypercalcemia medical management: IV biphosphates, Calcitonin

Sodium Imbalance

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

Chloride Imbalance

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

Metabolic Acidosis

• Metabolic acidosis treatment: Treat underlying cause, Antidiarrheals
• Metabolic acidosis nursing management: Decreased cardiac output related to severe metabolic state
• Metabolic acidosis nursing interventions: Monitor hemodynamic status

Urinary Tract Infections

• UTI manifestations: Dysuria (painful urination and burning), Dark foul-smelling urine
• UTI nursing intervention: Increased fluid intake 2-3 liters per day

Urinary Incontinence

• Urinary incontinence: Involuntary or uncontrolled loss of urine in any amount

Cancer and Reproductive Health

• Bladder cancer risk factor: Smoking
• Dysmenorrhea treatment: Combined oral contraceptive (Progesterone & estrogen)
• Black cohosh: Menopause
• Cervical cancer diagnosis: Routine screening (pap smear)
• Cervical cancer treatment: Colposcopy with biopsy
• 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 are 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
• Urolithiasis (kidney stone) and UTI complication: Pyelonephritis
• Turp procedure: Surgical procedure that involved cutting away a section of the prostate BPH
• Cervical dysplasia: Abnormal growth of cells on the surface of the cervix (caused by HPV)
• Condylomata Acuminate: Anogenital warts caused by HPV
• Syphilis medication: Penicillin