NUR 260 Study Guide - Health and Illness PDF

**HEALTH AND ILLNESS** - Health -- a state of complete physical, mental, and social well-being and not merely the absence of disease. - Disease -- medical term, meaning there is a pathologic change in the structure or function of the body or mind. - Illness -- the response of the pe...

**HEALTH AND ILLNESS** - Health -- a state of complete physical, mental, and social well-being and not merely the absence of disease. - Disease -- medical term, meaning there is a pathologic change in the structure or function of the body or mind. - Illness -- the response of the person to a real or perceived disease; it is an abnormal process in which the person's level of functioning is changed. - All parts and subparts of individual are in harmony with whole system - ***Wellness --*** the condition in which an individual functions at optimal levels; all parts and subparts of individual are in harmony with whole system. - Factors affecting health: - Human dimensions: - Physical, emotional (individuals have physiological needs for security, self esteem, and a sense of belonging), intellectual (consists of cognitive functions such as judgment, the ability to take in and process information, orientation, and memory) dimensions - Environmental dimension - Sociocultural dimension -- as social creatures, we rely on others to some extent. - Empowerment -- process of enabling others to do for themselves and consists of encouraging the client to be an active participant in care - Spiritual dimension -- refers to one's relationship with self, others, and a higher power or divine source. - Can enhance self esteem and help with stress - Health status can have an impact on spirituality and spirituality can have an impact on health status - Basic human needs: - Physiological needs: focuses on achievement of the basic needs (oxygen, nutrition, circulation, sleep, and elimination) - Safety and security needs - Love and belonging needs - Self-esteem needs - Self-actualization needs - Acute illness: an illness that has a rapid onset of symptoms and lasts only a relatively short time. - Behaviors -- stage 1 (experiencing symptoms) stage 2 (assuming the sick role) stage 3 (assuming the dependent role) stage 4 (achieving recovery and rehabilitation) - Chronic illness: permanent change. It causes or is caused by irreversible alterations in normal anatomy and physiology. It requires special patient education for rehabilitation and requires a long period for care or support. - Health promotion: Trying to move individuals, families, and communities to a **higher level of wellness.** **ASESPSIS** - Medical asepsis or clean techniques: practices that reduce/limit the number, growth, and direct or indirect transfer of disease producing microorganisms. - Surgical asepsis/sterile techniques: Measures that render and maintain objects free from ALL microorganisms, including spores. - Top Nosocomial Infections 1. UTI 2. Surgical wound infection 3. Nosocomial Pneumonia 4. Bacterial anemia 5. Burn wound 6. Enteric infection (from food/water) - For an infection to occur an interaction between a susceptible host and an infectious agent is required. - Six links in chain of infection 1. Microorganism/ infectious agent a. Any microorganism is potentially pathogenic (potential to cause disease in susceptible host) - Normal flora -- microorganisms that normally inhabit a body site. Ex: E. coli is present in bowels, but causes infection if it gets in the urinary bladder. - Breaking the chain between the infectious agent and reservoir by sterilization, antibiotics, and handwashing 2. Reservoir: source of infectious agent b. Any habitat of the organism -- place where it can grow and reproduce - Breaking the chain between reservoir and portal of exit by personal hygiene, dressing changes, disposal of fluid canisters, changing soiled linens 3. Portal of exit: way infectious agent leaves the reservoir c. Nose, and mouth (respiratory) Mouth, anus, and drainage (GI tract) Urethral meatus, urinary diversion, ostomy (urinary tract) Vagina and Penis (reproductive tract) Open wound, needle puncture site, drainage (blood) Breaks in the skin, body orifice/natural or through surgical intervention (integument) - Breaking the chain from portal of exit to transmission by dry intact dressings, covering mouth and nose when sneezing, hand washing, wearing gloves when in contact with body fluids 4. Mode of transmission: route by which infectious agent is transmitted d. Contact, Vehicle transmission, Airborne, Vector-borne - Breaking the chain between transmission and portal of entry by hand washing, refrigeration, wearing gloves, masks, gowns, and goggles, proper disposal of contaminated objects. 5. Portal of entry: Method by which infectious agent enters the body (susceptible host) - Break the chain between entry and susceptible host by sterile techniques and proper disposal of sharps/needles 6. Susceptible host: person who is at risk for infection e. Persons with lower resistance, or compromised conditions. - Isolation precautions: - Isolation -- The separation of infected sources from others to prevent or limit direct or indirect transmission of the infectious agent. - Airborne precautions - Private room with negative air pressure (keep door closed), wear masks/respiratory protection, have the patient wear a mask when transporting them. - Used for TB, Varicella, Rubeola (measles), and possibly SARS. - Droplet precautions - Private room, wear mask when within 3 feet of patient, transport patient with mask. - Used for Rubella, Mumps, Diptheria, and Adenovirus - Contact precautions - Private room if available, wear gloves, may need a gown if contact with infectious agent is possible. - Used for microorganisms spread by direct or indirect contact, MRSA, VRE - Reverse precautions - Used when patient is extremely susceptible, during or after chemotherapy. - Infectious process stage: - Incubation -- time between entry and onset of symptoms - Prodromal -- time between nonspecific and specific s/s of infection - Full stage -- s/s specific to type of infection is manifested - Covalescence -- time acute s/s of infection disappear until return to client's normal state of health - Localized infection - Single area of body - Caused by inflammatory response - Localized swelling/edema, pain and tenderness, erythema - Systemic infection - Infection spreads to other body systems - S/S: fever, increased pulse and respirations, weakness, anorexia, tender lymph nodes - Septicemia: pathogens in circulating blood - Laboratory data for infection - Increased WBC, positive cultures (urine, blood, sputum, drainage, presence of pathogens) - Pain - An unpleasant sensory and emotional experience associated with actual or potential tissue damage. - Believe the patient - Sensory components: location, intensity, quality, pattern - Types of pain scales: - 10cm visual analog scale (VAS) - Wong-Baker faces pain rating scale - Nonverbal pain scale (no pain -- relaxed/guarded, slight or mild pain -- stressed, tense, expression, moderated pain -- guarded movement or grimacing, worst pain -- crying out or increased intensity of behaviors) - Edema - Fluid that accumulates in intercellular spaces; excess fluid. - Assess the location, and whether the area remains indented (pitted) when pressing with finger. - Edema scale: - 1+ -- barely detectable; slight indentation (2mm) - 2+ -- Indentation of less than 5mm - 3+ - Indentation of 5-10 mm; puffy, deeper pitting - 4+ - Indentation of more than 10mm; extreme deep pitting - Consciousness -- being aware of one's own existence, feelings and thoughts, and environment. - LOC: alert, lethargy, stupor, semi-comatose, comatose - Orientation -- awareness of the objective world in relation to the self -- in relation to person, place, and time. Ask open-ended questions. **RESPIRATORY** - Position is sitting upright, or recumbent if too ill. - Inspection, Palpation, Percussion, Auscultation - Begin with posterior and work top to bottom - With stethoscope listen to the patient's lungs as he breathes through his mouth more deeply than normal. - Listen to one full breath at each location on posterior, lateral, and anterior chest. - Breath Sounds: - Rales/Crackles: Sound produced by air entering a space that contains secretions (or blockings). During inspiration, discontinuous, short, bubbling noises - Alveolar rales: fine crackles, popping sounds - Rhonchi/Gurgles: continuous, but more pronounced during expiration, rumbling, low pitched, coarse, gurgling, sound produced by an airway obstruction with thick secretions, cleared by coughing. - Wheezes: continuous during inspiration and expiration, high or low pitched, squeaky, musical sounds. Sound produced by a high velocity flow of air through a narrowed airway. Can be unilateral or bilateral, usually not altered by coughing. - Friction rub: Loud, dry, grating sound. Not altered by coughing. Rub over pericardial area is suggestive of pericarditis. Rub over pleural area may be present in lung disease. - Decreased or absent breath sounds due to: - Obstruction from bronchial tree (mucous plug, foreign body) - Emphysema - Obstruction of sound transmission (fluid (pleural effusion) or air (pneumothorax)) - Hypercapnia -- an increase in carbon dioxide - Hypoxia -- Low O~2~ in cells. - Hypoxemia -- a decrease in oxygen, low O~2~ in blood. - Tachycardia (HR greater than 100) - Hypertension - Tachypnea (RR greater than 20) - SaO~2~ less than 90% - Normal thoracic cage: chest is symmetrical and oval. Anteroposterior/ transverse diameter is ratio of 1:2. Costal angle is less than 90 degrees. - Abnormal: - Barrel chest -- COPD - Pigeon chest -- sternum protrudes out - Funnel chest - Chest asymmetric -- one side is bigger than the other - Costal angle is greater than 90 degrees. - Spine deformities: - Kyphosis: hump back \-\-- can't take deep breaths - pneumonia - Lordosis: curve in spine \-\-- pregnant women - Scolosis: "S" or "C" shaped spine **OXYGENATION** - Pulse Ox: Determines the percentage of hg saturated by oxygen. Normal is 95% or above. Goal is to keep above 90% - Oxygen devices: - E Cylinders for transport: 2-6 L of oxygen. Lasts about 4-6 hours. - Low flow devices: - Nasal Cannula: 1-6 L of oxygen. Delivers about 24-44% of oxygen. - Simple Mask: 6-10 L of oxygen. Delivers approx. 35-60% of oxygen. - Partial Rebreather Mask: Runs 6-15 L of oxygen. Delivers approx. 70-90% oxygen. - Non-rebreather Mask: Runs 6-15 L of oxygen. Delivers approx. 60-100% of oxygen. - High flow devices: - Venturi Mask: delivers a specific FiO2 regardless of the patient's breathing pattern. Delivers specific concentrations of oxygen up to 55%. - Incentive Spirometry: used in presence of atelectasis. - Technique: draw in a slow deep breath to maximal inspiration, hold the breath, and let it out slow, repeat as ordered - Medication delivery devices: - Multi-Dose Inhaler -- more convenient, requires hand/mouth coordination, spacer is helpful. - Small volume nebulizer -- used in acute and long term care settings, more medication is lost to the atmosphere, re-infection is a concern. - Artificial airways - Oropharyngeal -- used to relieve upper airway obstruction, seizure patients, poorly tolerated in alert patients. - Nasopharyngeal -- used to relieve upper airway obstruction caused by tongue and/or soft palate, suctioning is less traumatic than nasal suctioning, better tolerated in alert patient, should be alternated every 24 hours to minimize complications. **NURSING PROCESS** - A process is a series of steps or acts to accomplish some goal or purpose. - Purpose of the nursing process is to identify a client's health status, actual or potential health care problems or needs, establish plans to meet identified needs, and to deliver specific nursing. - ADPIE - Assessment - Nurse collects client health data. - Diagnosis - Nurse analyzes the assessment data. - NANDA - "related to" "as evidence by" - Planning - Nurse identifies expected outcomes individualized by the client. - Nurse develops a plan that prescribes interventions to attain expected outcomes. - Determine interventions, based on goals, make care plan. - Short term/long term goals \-\-- be realistic when setting goals. Goals are specific, should be measurable (SMART criteria) - Implementing - Putting the plan into action. - Evaluation - Nurse evaluates the client's progress toward attainment of outcomes. - Nursing care plans -- written guidelines for client centered care. - Maslow's Hierarchy of Needs - Physiological needs (air, food, water, rest, exercise) - Safety needs (shelter, insurance, job security) - Love and Belonging (children, friends, partners) - Self Esteem (1) (fame, recognition, reputation, dignity) - Self Esteem (2) (confidence, achievements, freedom) **URINARY SYSTEM** - The functions of the kidneys are to remove waste products of metabolism from the blood through filtration and reabsorption, and regulate body fluid and electrolyte balance, and produce hormones. - Filtration: the average adult has 1200 mL of blood that passes through the kidneys every minute. - About 99% of the filtrate that passes through the kidneys is reabsorbed into the plasma. Only 1% is excreted as urine. - The normal adult urine output is 1200-2,000 mL/24 hours. - Output that is less than 30mL/hour may indicate renal alterations - Voiding happens if nerves (stretch receptors) that process this function are intact - Autonomic bladder: urination that occurs as a reflex because of paralysis or impaired brain function - Increased ADH decreases urine and decreased ADH increases urine - Medications affecting urination: - Cholinergics -- aid urinary elimination by stimulating the contraction of the detrusor muscle - Anticholinergics -- promote urinary retention - Opioids -- promote urinary retention - Diuretics -- increase urine production - Anesthetics -- decrease urinary production or promote retention - Urgency -- feeling of need to void immediately - Hesitancy -- difficulty initiating urination - Frequency -- voiding in frequent intervals - Nocturnal enuresis -- involuntary voiding at night during sleep - Dribbling -- leakage of urine despite voluntary control of micturition (release of urine) - Residual urine -- volume of urine remaining in the bladder after voiding (only voiding half) - Neurogenic bladder -- dysfunctional urinary bladder resulting from impaired neurological innervation - Anuria -- voiding less than 100mL/day (4mL/hour). Urine is super concentrated (dark/amber) - Oliguria -- diminished urinary output (less than 500mL/day or 20mL/hour) - Polyuria -- voiding abnormally large amounts of urine (2500mL/day). There is a decreased ADH (ex: diabetes) - Nocturia -- voiding in frequent intervals at night - Dysuria -- painful, or difficult urination - Urinary incontinence: inability to control urination - Functional incontinence -- the state in which one experiences an involuntary, unpredictable passage of urine. - Inability to suppress detrusor muscle contractions until reaching an appropriate receptacle due to sensory, cognitive, or mobility deficits - Reflex incontinence -- the state in which one experiences an involuntary passage of urine occurring at somewhat predictable intervals when a specific bladder volume is reached. - Can happen from spinal cord injuries above the reflex voiding center; don't feel the urge. - Can still have continence if on a timed schedule. - Stress incontinence -- the state in which one experiences an involuntary passage of urine of less than 50mL occurring with increased intra-abdominal pressure. - Dribbling of urine with increased intra-abdominal pressure (ex: coughing, sneezing, bending over) - Urge incontinence -- the state in which one experiences involuntary passage of urine soon after a strong sense of urgency to void. The signal is too late. - Urinary retention: the state in which one experiences an incomplete emptying of the bladder - Urinary tract infection (UTI): state in which one has an infection of a structure in the urinary tract - Bacteria count is more than 100,000 (ecoli) per mL. - Pathogens enter the urinary tract, women are more susceptible than men because of the proximity to anus and short urethra - Urine specimen collections: - Routine urinalysis -- frequently done as routine, admission, diagnostic test/outpatient; emphasis is clean rather than sterile - Clean-catch and midstream -- emphasis is on sterile. Clean meatus prior to voiding, void about 30mL into toilet, collect urine specimen and stop collection before end of voiding. - Timed specimen collection -- collections from 1-2 hours to 24 hours. Major focus is timing. Note the time started, start with empty bladder, save all the urine, end the collection with an empty bladder, and collect specimen in large jug kept on ice in room. - Urine specimen from indwelling catheter -- obtained from catheter tubing not bag, cleanse port, clamp tubing, use syringe, and dispense urine in sterile container. Urine comes straight from bladder. **FLUIDS AND ELECTROLYTES** - Body fluid components: - Extracellular - Intravascular (Na^+^) vessels -- 3L - Interstitial (Na^+^) tissues -- 12L - Intracellular (K^+^) cells -- 25L - Spacing: - 1^st^ spacing = normal, in the right place - 2^nd^ spacing = interstitial fluid (edema in ankles or legs) - 3^rd^ spacing = fluid in a space where there is normally little/no fluid -- ascites (ex: fluid in abdomen because of liver failure) - Causes of edema: - Increased capillary permeability -- allows fluid to leave in order to heal. - Burns and trauma, allergic reactions, infections - Patient with extensive burns will have an increased capillary permeability swelling. - Increased capillary osmotic pressure -- force generated by the concentration of plasma solutes. Water follows solutes. - Problems: malnutrition, loss of protein, edema, kidney disease, liver disease - A malnourished old man will have swelling from increased osmotic pressure. - Increased hydrostatic pressure -- pressure builds up - Ex: hypertension, obstruction of liver, prolonged standing, salt water retention - A hypertensive woman will have swelling from increased hydrostatic pressure. - Lymphatic obstruction -- blockage of the lymph causing swelling - A woman post-op mastectomy will have a lymphatic obstruction swelling. - Amounts of fluids: - Approximately 60% water in the adult male. - Total body fluid = 40L - Intracellular -- 25L (40% total body weight) - Extracellular -- 15L (20% total body weight) - Intake and output - Types of measured intake: oral fluids, foods that become fluid at room temperature, tube feedings, iv fluids, irrigations - Types of measured output: urine, vomitus, liquid feces, drainage, suctioning - Electrolytes: chemical substances within body fluids that are vital to life - Extracellular: - Sodium (Na^+^) - 135-145mEq/L - Water balance and neuromuscular membrane excitability - Calcium (Ca^++^) - 9-10.5dl - Required for normal skeletal muscle, smooth muscle, and cardiac muscle contraction. Also needed for blood clotting. - Chloride - 98-110mEq/L - Maintains electroneurality with sodium - Intracellular: - Potassium (K^+^) - 3.5-5.0mEq/L - Critical for electrical conduction of nerve impulses -- particularly cardiac electrical conduction - Phosphorus (P^-^) - 2.4-4.7mg/dl - Needed for cellular energy formation and regulation - Magnesium (Mg^++^) - 1.3-2.1mEq/L - Needed to prevent over excitability of muscles - Movement of fluids and electrolytes: - Filtration: The movement of fluid and electrolytes through a permeable membrane from high pressure to lower pressure by force or by pressure between intravascular and interstitial spaces - Diffusion: molecules move across a semipermeable membrane from more concentrated to more dilute - Osmosis: water moves though a semipermeable membrane from a weaker solution to a more concentrated solution - Colloid osmotic pressure: the pulling force that occurs by plasma proteins that puts pressure on the permeable membranes, fluid follows proteins. - Active transport: molecules move against a concentration gradient across cell membranes (Na-K pump) - Hydrostatic pressure: the pushing force of water and solutes moving from a solution with higher hydrostatic pressure to a solution with lower hydrostatic pressure - Oncotic pressure (also known as colloidal osmotic pressure) - Pressure caused by colloids in solutions - Colloids are particles that are too large to pass though a semipermeable membrane. Ex: proteins - Osmolality: the measure of a solution's ability to create osmotic pressure and thus affecting the movement of water. Ratio of solutes to water. - Osmolarity: concentration of solutes; reflects the number of particles in a liter of solution. - Normal osmolarity = 275-295 mOsm/kg - Greater than 295 -- darker color - Less than 275 -- lighter color - Tonicity -- reflects osmolality - Hypotonic - Less than 275 - Osmolality is less than body fluids - Fluid moves in the direction of greater solute concentration (into the cells) - How to remember \-\-- Hypo -- Hippo (swelled) - Isotonic -- osmolality is the same as body fluids - 275-295 - No net transfer of fluid - Hypertonic - Greater than 295 - Osmolality is more than body fluids - Fluid moves in the direction of greater solute concentration (out of the cells) - Hypervolemia (fluid volume excess) - Isotonic Hypervolemia - Retention/excessive intake of fluids or saline -- equal gains of water and solutes - Signs and symptoms: - Edema, urine pale/colorless, firm tissue turgor, sudden weight gain, increased pulse (full and bounding), increased BP, distended neck veins, dyspnea (and moist breath sounds -- crackles), mental confusion, decreased hematocrit, Na^+^ 135-145 = normal - Interventions: - Monitor VS, weight, and lungs, restrict fluid intake, give diuretics per MD order - Hypotonic Hypervolemia - SIADH (increase in ADH), excessive tap water enema, irrigating NG with water, psychogenic polydipsia (excessive thirst and keep drinking water) - Signs and symptoms: - Changes in LOC, widened pulse pressure, Na^+^ is less than 125mEq/L, serum osmolality is less than 295mOsm/Kg - Interventions: - Assess risk, monitor VS and weight, I&O, restrict free water - Hypovolemia (fluid volume deficit) - Isotonic Hypovolemia - Body loses both water and electrolytes from ECF in similar portions; such as abnormal GI losses such as vomiting - Signs and symptoms: - Dry flaky skin, sunken eyes, oliguria (decrease in urine), dark amber urine, weight loss, decreased tissue turgor, weak and rapid pulse, decreased blood pressure (which may cause orthostatic hypotension -- feeling light headed from sitting up after laying down), salivation, dry mucous membranes - Hypertonic Hypovolemia - Dehydration and hypernatremia, more water is lost than Na^+^, or water intake is insufficient to replace losses, or more electrolytes are taken in; hyperglycemia -- increase glucose - ECF is hypertonic (cells become dehydrated) - Signs and symptoms: - Flushed skin, thirst, dry mucous membranes, increased body temperature, weight loss, decreased urinary output (less than 30mL/hour) - Interventions: - Increase oral intake or give IV fluids per MD order, take I&O, monitor daily weights and VS - Hypernatremia -- excess of sodium relative to body water (greater than 145mEq/L) - Caused by sodium gain - Excessive IV or oral Na^+^ intake, salt water drowning, hyperaldosteronism (ADH causes kidneys to retain salt), renal insufficiency, Cushing's syndrome (excessive amount of cortisol produced by adrenal glands, being on steroids for too long causing sodium retention, moon shaped face and striae on abdomen) - Caused by water loss - Brain injury causing a decrease in thirst, diabetes insipidus, osmotic diuresis - Hyponatremia -- deficiency of sodium in relation to body water (less than 135mEq/L) - Caused by sodium loss - Vomiting and diarrhea, NG suctioning/Gi loss, skin losses (burns, wound drainage), renal losses (adrenal insufficiency, diuretics), excessive diaphoresis - Caused by water gain - Excessive intake of electrolyte free fluids (IV and oral), renal, liver and heart failure, psychogenic polydipsia, SIADH (kidneys unable to excrete urine so they hold onto water) - - Hypercalcemia -- serum calcium is greater than 10.1mg/dl - Caused by: cancer excessive intake of vitamin D (not soluble), hyperparathyroidism, immobilization, reduced renal functions - S&S: muscle weakness, lack of coordination, confusion, N&V, pruritus, kidney stones, bone pain, cardiac arrest - Hypocalcemia -- serum calcium is less than 8.9mg/dl - Cause by: vitamin D deficiency, hypoparathyroidism, renal disease, cancer, pancreatitis, massive blood transfusions, enema or laxative abuse/GI losses - S&S: tingling in hands, feet, fingers, and around the mouth, tetany, cramps in muscles of extremities, laryngospasm, positive trousseau's sign (compress arm with BP cuff for 3 min to see if patient has finger spasms), or positive Chvostek's sign (facial nerve tapped and face will start twitching if patient has decrease calcium), seizures, cardiac arrest - Hyperkalemia -- serum potassium is greater than 5mEq/L - Caused by: kidney failure, cellular damage, insulin deficiency, adrenal deficiency (Addison's disease), high potassium intake - S&S: anxiety, irritability, neuromuscular weakness, GI hyperactivity (diarrhea, cramping), ECG changes, cardiac dysrhythmias, cardiac arrest/heart block - Hypokalemia -- serum potassium is less than 3.5mEq/L - Caused by: abnormal loss of potassium (diuretics, vomiting, diarrhea, NG suction ostomics), inadequate replacement of lost potassium, stress, Cushing's syndrome or steroid administration, hyperaldosteronism, antibiotics - S&S: muscle weakness (starting in lower extremities and moving up), impaired respiratory muscle function, abdominal distention, nausea and vomiting, constipation, increased urination and thirst, dysrhythmia and ECG changes, elevated blood glucose levels - Hypermagnesemia -- serum magnesium is greater than 2.5mEq/L - Caused by: renal failure, diabetic ketoacidosis, magnesium sulfate therapy, magnesium based laxative use - S&S: hypotension, weakness, depressed reflexes, paralysis, bradycardia, respiratory failure - Hypomagnesemia -- serum magnesium is less than 1.5mEq/L - Caused by: impaired intake, impaired intestinal absorption, excessive urinary excretion - S&S: tremors, cramps, difficulty swallowing, CV changes/tachycardia **Acid Base Balance** - pH is the concentration of hydrogen (H+) ions - The pH of blood indicates the net result of normal acid-base regulation, any acid-base imbalance, and the body's compensatory mechanisms - The human body must maintain a very narrow pH range **7.35-7.45** - Carbon dioxide is the "acid" (CO2) Normal: 35-45 mmHg - Bicarbonate is the "base" (HCO3) Normal: 22-26 mEq/L - Buffer systems - Prevent major changes in pH by removing or releasing a hydrogen (H+) ion - Act chemically to change strong acids into weaker acids or to bind acids to neutralize their effects - Kidneys - Regulate bicarbonate in the ECF - The kidneys will retain or excrete H+ ions or HCO3 ions as needed - Normally acidic urine - Lungs - Control CO2 - Adjust rate and depth of ventilation in response to amount of CO2 in the blood - Imbalances in PaCO2 are influenced by respiratory causes - Imbalances in HCO3 are influenced by metabolic processes - Metabolic Acidosis - Low pH (\ - Respiratory Acidosis - Low pH (\ - Interpreting Arterial Blood Gases - Determine if acidosis or alkalosis - \*use 7.40 as **normal** in this step - 2\. Determine the component that caused the abnormality in step 1 - 3\. Determine if the gas is compensated - If the pH is 7.35-7.45, it is compensated - If the pH is \