Fluid & Electrolytes PDF

I. Water a. Functions: i. Transportation of \_\_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_\_ ii. Medium for chemical reactions iii. Lubricant iv. Maintenance of acid-base balance v. Heat regulation through evaporation b. Factors Affecting Water Needs...

I. Water a. Functions: i. Transportation of \_\_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_\_ ii. Medium for chemical reactions iii. Lubricant iv. Maintenance of acid-base balance v. Heat regulation through evaporation b. Factors Affecting Water Needs vi. Temperature vii. Activity level viii. Functional losses---vomiting, diarrhea ix. Metabolic needs---need \_\_\_\_\_\_\_\_\_ per 1000 kcal x. Fat content 1. Fat has \_\_\_\_\_\_\_\_\_ water 2. \_\_\_\_\_\_\_\_\_ attracts water xi. Gender 3. Women have more fat & fat contains relatively little water 4. Men have more muscle than fat, therefore, men have more total body water xii. Age 5. Infants---70-80% water (over half is extracellular); need proportionately more 6. Adults---50-60% water; men need \_\_\_\_\_\_\_\_ than women 7. Older adults---45-55% water; more prone to \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_; water amount is low for actual body size xiii. Gains 8. Food 9. Liquids 10. By product of metabolism xiv. Losses 11. \_\_\_\_\_\_\_\_ a. Lungs b. Sweat c. Stool 12. Sensible d. \_\_\_\_\_\_\_\_\_ c. Characteristics xv. Constantly shifts between fluid compartments 13. 66% in intracellular fluid compartment 14. Extracellular fluid compartment e. Interstitial 27% f. Intravascular 7% II. Fluid Compartments d. Intracellular xvi. Fluid \_\_\_\_\_\_\_\_\_ the cells (ICF) xvii. Largest of the 2 compartments xviii. In adults---most \_\_\_\_\_\_\_\_\_is intracellular e. Extracellular xix. Fluid\_\_\_\_\_\_\_\_ the cells (ECF) xx. Substances entering the body start here then move to ICF to act on the body xxi. In Infants---most water is \_\_\_\_\_\_\_\_\_ xxii. Subdivided: 15. Intravascular g. Plasma \_\_\_\_\_\_\_\_\_vessels 16. Interstitial h. \_\_\_\_\_\_\_\_\_ cells or in tissue i. Ex.: lymph, CSF, GI secretions III. Regulation of fluid balance f. Thirst mechanism---controlled by \_\_\_\_\_\_\_\_\_ g. Kidneys---filters out excess water & electrolytes xxiii. Glomerular Filtration Rate (GFR) 17. Nephrons filter blood at a rate of 125 mL/min or 180 L/day = \_\_\_\_\_\_\_\_\_ urine/day 18. Must excrete minimum of \_\_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_ of urine to eliminate waste xxiv. Secrete Renin h. Lungs- Regulate CO2 levels, H2O vapors i. Skin- Regulate fluid losses (sweat) j. Hormonal xxv. ADH (antidiuretic hormone) 19. posterior pituitary gland 20. secreted when water levels \_\_\_\_\_\_\_\_\_\_, blood pressure drops or sodium increased 21. stimulates kidneys to\_\_\_\_\_\_\_\_\_ water xxvi. Renin 22. enzyme secreted by\_\_\_\_\_\_\_\_\_ 23. triggers the release of aldosterone j. Aldosterone - secreted by adrenal cortex - target organ is \_\_\_\_\_\_\_\_ 1. decreases the excretion of \_\_\_\_\_\_\_\_\_, thereby conserves water IV. transport k. Passive- doesn't require energy xxvii. Diffusion\--particles move [\_\_\_\_\_\_\_\_\_]area of [higher concentration to] area of [\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_] resulting in equal distribution xxviii. Filtration---F/E move [from] area of [higher\_\_\_\_\_\_\_\_\_\_ to] area of [lower pressure]; pumping force of heart provides the hydrostatic pressure needed (pressure against the vessel wall) xxix. Osmosis\--[\_\_\_\_\_\_\_\_\_\_]moves [from] an area of [lesser concentration to] area of [higher concentration] resulting in equal distribution l. Active- requires cellular energy xxx. Requires \_\_\_\_\_\_\_\_\_\--moves [from] area of [low concentration to] area of [higher concentration] regardless of positive or negative charges xxxi. Examples: sodium, potassium, calcium, iron, hydrogen, amino acids, glucose V. Intake & output m. Instruct xxxii. All intake 24. Ex.: Enteral/Parenteral xxxiii. All output 25. Ex.: Urine, diarrhea, vomitus, NG suction, chest tube drainage, wound drains 26. Insensible losses: lung vapor, \_\_\_\_\_\_\_\_\_, water in the stool xxxiv. Daily water 1/o is approximately 2500 ml (fluid leaves via kidneys, lungs, skin, GI) n. Daily Weights xxxv. 1 L of fluid = 2.2 lb; 500 mL = \_\_\_\_\_\_\_\_\_ o. End of shift measurement p. Document xxxvi. Flow sheets xxxvii. Nurse's notes xxxviii. Report VI. Fluid Volume Deficit/hypovolemia/dehydration q. Causes xxxix. Diarrhea, vomiting, sweating, high fever, increased urine output (diuretics), tachypnea, insufficient IV replacement r. S/S (clinical manifestations) xl. Decreased urination and \_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_ weight loss, dry mucous membranes, thirst, cool hands & feet, decreased pulse pressure, depressed fontanelles in infants xli. Late signs: hypotension with tachycardia, tachypnea s. Key Points xlii. Infants and elderly at greater risk t. Interventions for fluid volume deficit xliii. Find and correct cause 27. Diarrhea---antidiarrheals 28. Vomiting---antiemetics xliv. \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ if not contraindicated xlv. IV fluids if oral fluids are contraindicated xlvi. Weigh daily xlvii. I & O at least every shift xlviii. Monitor skin turgor, oral mucous membranes, and characteristics of urine (urine specific gravity- shows concentration/dilution of urine), fontanelles in infants under 18 months (with dehydration, would expect to be sunken) xlix. Protect perianal skin if client has diarrhea l. Provide oral hygiene for vomiting li. When replacing fluids, be sure to monitor for fluid volume excess (also known as fluid overload) VII. Fluid Volume Excess/hypervolemia/fluid volume overload u. Causes lii. CHF, excess fluid intake (usually associated with psych disorders, but can occur when replacing fluids with plain water); excessive sodium intake; compromised regulatory system, excessive IV fluids, decreased kidney function, cirrhosis v. S/S (clinical manifestations) liii. \_\_\_\_\_\_\_\_\_\_weight gain; leg or ankle edema (pitting or non-pitting), wheeze/dry cough, periorbital edema, headache, crackles, \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ (cramping, weakness, hypotension) liv. Late signs: HTN (hypertension); pulmonary edema (rales); wet cough, frothy sputum, increased ICP (intra cranial pressure), breathlessness, tachypnea; tachycardia;\_\_\_\_\_\_\_\_\_\_ (jugular vein distention) w. Interventions for Fluid Volume Excess lv. Monitor sodium intake lvi. I & O at least every shift lvii. Monitor for \_\_\_\_\_\_\_\_\_\_ and skin turgor 29. Peripheral 30. Pulmonary---\_\_\_\_\_\_\_\_\_ breath sounds lviii. Weigh daily lix. \_\_\_\_\_\_\_\_\_ lx. Monitor for fluid volume deficit---can occur, especially when diuretics are given lxi. Monitor characteristics of urine (urine specific gravity) lxii. Monitor lab values 31. \_\_\_\_\_\_\_\_\_(will decrease) 32. Potassium (K+) and sodium (Na+) will decrease (\_\_\_\_\_\_\_\_\_\_effect) lxiii. Monitor fontanelles in those under 18 months---would expect to bulge VIII. Electrolytes x. Functions: lxiv. Promote neuromuscular irritability lxv. Maintain fluid volume lxvi. Regulate acid base balance y. Sodium lxvii. Key Points 33. Recommended daily amount (RDA): \_\_\_\_\_\_\_\_\_\_ 34. Major cation in extracellular fluid compartment 35. Often bound with Chloride to maintain H2O distribution lxviii. Functions 36. Water balance, muscle contraction, heart contraction, transmission of nerve impulses & mandatory kidney urine concentration, most important electrolyte in maintaining the volume of body fluids lxix. Sources 37. Table salt---but is found everywhere lxx. Regulation 38. Aldosterone lxxi. Deficiency 39. \_\_\_\_\_\_\_\_\_ k. Causes: sodium loss or water excess; excess sweating, urination, or diarrhea; n/v; NGT suction, diuretics, adrenal insufficiency l. S/S (clinical manifestations): H/A, muscle cramps, weakness, low urine SG, n/v, abdominal cramps, confusion/disorientation, convulsions, coma, hypotension, oliguria m. Interventions: Monitor I/O; replace fluid loss with fluids containing sodium---do \_\_\_\_\_\_\_\_\_\_ use plain water; juices; bouillion n. Key Points: May cause\_\_\_\_\_\_\_\_\_\_ imbalance (D/T fluid moving into cells causing K+ to move out) lxxii. Toxicity 40. \_\_\_\_\_\_\_\_\_ o. Causes: sodium excess or water loss; profuse diarrhea; antacids with sodium p. S/S (clinical manifestations): Thirst, edema, HTN, dry/sticky mucous membranes & tongue, oliguria (decreased urine output), flushed appearance (d/t dehydration), fever, weakness q. Interventions: Monitor I & O; decrease sodium in diet; monitor water losses from fever, infection, increased respiratory rate; D5W-be careful when administering fluids to correct---can lead to fluid volume overload, 8-10 glass water/day r. High Na+ foods to avoid - Table salt, processed/cured meats (ham, sausage, hot dogs, pork), packaged foods, seafood (tuna), cheese, pickles, potato chips, canned foods, seasonings, soy sauce, soft drinks s. Key Points - Body attempts correction through \_\_\_\_\_\_\_\_\_\_\_ water via renal reabsorption - Causes fluid to shift \_\_\_\_\_\_\_\_\_of\_\_\_\_\_\_\_\_\_ resulting in cell dehydration z. Potassium lxxiii. Key Points 41. Major cation in\_\_\_\_\_\_\_\_\_\_ fluid compartment 42. RDA- 4700 mg/day lxxiv. Functions 43. Regulation of water & electrolyte content w/i the cell (main); acid base balance; nerve impulse transmission; regulate heartbeat; insulin release, protein synthesis, use & storage of glucose, maintenance of excitability of cellular membranes in the heart & nervous system, muscle contraction lxxv. Sources 44. \_\_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_\_ fruits & vege, tea, raisins, meat lxxvi. Excretion 45. \_\_\_\_\_\_\_\_\_ (80%-controls excretion), feces, perspiration lxxvii. Deficiency 46. \_\_\_\_\_\_\_\_\_ t. Causes: renal excretion without conservation when needed; excessive GI losses (suctioning or vomiting); diuretics w/o K+ supplements; steroids; Lanoxin (digoxin); loss from cells with burns/trauma u. S/S (clinical manifestations): Muscle weakness, cardiac arrhythmias, cardiac arrest, hyporeflexia (below normal reflexes-tested with reflex hammer) or areflexia (absent reflexes), paresthesia (numbness and tingling), paralytic ileus (: Obstruction of the intestine due to paralysis of the intestinal muscles. The paralysis does not need to be complete to cause ileus, but the intestinal muscles must be so inactive that it prevents the passage of food and leads to a functional blockage of the intestine. Also referred to as ileus), polyuria, fatigue, vertigo, ECG changes, anorexia, weak pulse, resp paralysis, lethargy, confusion v. Patients at Risk for K+ Deficit - \_\_\_\_\_\_\_\_\_ or thiazide diuretics - Unable to take anything by mouth - Severe anorexia (chemotherapy) - Unable to chew or swallow - Gastric \_\_\_\_\_\_\_\_\_\_\_\_ applied - Severe diarrhea - Stress\--activates \_\_\_\_\_\_\_\_\_ (saves Na+ and H2O and gets rid of K+) w. Key Points 2. If on Lanoxin (digoxin-usually requires a K+ supplement)\--hypokalemia may induce Lanoxin (digoxin) toxicity x. Treatment - Replacement---know patient's renal function 3. IV or oral K+ a. Always \_\_\_\_\_\_\_\_\_IV form and liquid po form b. \_\_\_\_\_\_\_\_\_ given IV push\--can cause cardiac arrest 4. Should not be given if urine output \< 30 ml/hr - Increase dietary intake of K+ 5. Fish, bananas, cantaloupe, raisins, carrots, potatoes, fruit juice, green leafy vege, asparagus, apricots - I & O every shift lxxviii. Toxicity 47. Hyperkalemia y. Causes: Renal disease or failure; severe tissue damage causes K+ to be released from the cell; foods high in potassium in excess; salt subs; blood transfusion near expiration; metabolic acidosis; potassium sparing diuretics z. S/S (clinical manifestations): Muscle weakness (usually starts in \_\_\_\_\_\_\_\_\_\_extremities); changes in cardiac rhythm, even cardiac arrest; tall, tented T-Waves on EKG; confusion; diarrhea; tachycardia followed by bradycardia; muscle twitching; anuria (aka anuresis is non passage of urine); nausea; diarrhea; colic (spasm in a hollow organ); paresthesia (facial, tongue, extremities); flaccid paralysis a. Treatment - I & O every shift - Non-emergent: 6. Kayexalate\--orally, rectally, NGT (Most K+ is absorbed in the\_\_\_\_\_\_\_\_\_. Kayexalate \_\_\_\_\_\_\_\_ with K+ & prevents its absorption. The enema is repeated every 2-4 hours. Serum K+ may begin to lower in 1-4 hr. The response time for oral Kayexelate is longer than 6 hr) 7. Potassium wasting diuretics- Ex. Lasix (furosemide) - Emergent: 8. IV insulin with dextrose solution (D50) (Insulin, dextrose, glucose, & K+ are shifted into the cell where the K+ is metabolized. The response time is 15-60 min. If the pt is diabetic & has elevated blood sugar, then only insulin is given. The effect lasts for 2-6 hr) 9. IV sodium \_\_\_\_\_\_\_\_\_\_ (The effects are seen in 30 min to 1 hr & can last 1-2 hr) 10. Hemodialysis (4 hr tx removes 40-50%) (If the pt has poor renal fx & cannot eliminate enough K+, then dialysis is begun. An hr dialysis tx removes \_\_\_\_\_\_\_\_\_\_ of the serum K+. a. Chloride lxxix. Key Points 48. RDA- \_\_\_\_\_\_\_\_\_to Sodium 49. Major anion of extracellular fluid compartment 50. Chief anion in interstitial & intravascular fluid 51. Diffuses easily \_\_\_\_\_\_\_\_\_\_\_ ICF & ECF 52. Combines with sodium to form sodium chloride 53. Combines with potassium to form potassium chloride lxxx. Functions---fluid and acid-base balance; necessity for formation of hydrochloric acid in gastric juices, works with sodium to maintain osmotic pressure, maintenance of the respiratory system, BP, & acid base balance lxxxi. Sources---table salt; chlorinated water lxxxii. Excretion- \_\_\_\_\_\_\_\_\_ lxxxiii. Deficiencies 54. Hypochloremia b. Causes: Vomiting; prolonged NG suction or fistula drainage; can occur when sodium is lost because they are frequently paired c. Can cause growth retardation (rare) lxxxiv. Toxicities 55. Hyperchloremia d. Causes: Usually precipitated by \_\_\_\_\_\_\_\_\_\_; may occur when bicarbonate levels are low e. Rare b. Calcium lxxxv. Key Points 56. RDI 1000-1200 mg/day 57. 99% stored in bones/teeth 58. Most abundant mineral in the body 59. Need Vitamin D to absorb calcium from diet 60. Inverse relationship with \_\_\_\_\_\_\_\_\_\_\_\_ lxxxvi. Functions 61. Strong bones/teeth; clotting; regulates heart beat & BP; muscle contraction & relaxation; transmission of nerve impulses & normal contraction of skeletal & heart muscles, hormone secretion, maintenance of muscle tone lxxxvii. Sources 62. Milk/milk products; dark green leafy vegetables lxxxviii. Hormonal control 63. Parathormone---raises low \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ 64. Calcitonin---\_\_\_\_\_\_\_\_\_\_ high serum calcium lxxxix. Deficiencies 65. Hypocalcemia f. Causes: Infusion of excess amounts of citrated blood, diarrhea, inadequate intake, surgical removal/ hypoactive parathyroid, pancreatic disease, small bowel disease, excessive GI losses, massive SQ infection, burns, renal failure, lactose intolerance, immobility, thyroidectomy g. S/S (clinical manifestations): Rickets; osteoporosis, osteomalacia; \_\_\_\_\_\_\_\_\_\_Chvosteks sign; \_\_\_\_\_\_\_\_\_Trousseau\'s sign; poor clotting; neuromuscular excitability & tetany (tetany involves overly stimulated neuromuscular activity. These overly stimulated nerves cause involuntary muscle cramps and contractions, most often in the hands and feet. But these spasms can extend throughout the body, and even into the larynx, causing breathing problems); diarrhea; ECG changes; tachycardia; anxiety, psychosis h. Treatments: - Replacement: 11. Calcium carbonate orally 12. Calcium gluconate IV for \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ deficit 13. Do not let IV calcium infiltrate (will slough) 14. Never give \_\_\_\_\_\_\_\_\_\_---precipitates into the muscles - Calcium rich foods with vitamin D supplements 15. Milk, yogurt, cheese, sardines, canned salmon, egg yolks, soybeans, green leafy veges - Monitor respiratory status - \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ at bedside for acute cases - I & O c. Phosphorus xc. Key Points 66. RDA- 700 mg/day 67. Chiefly an intracellular anion 68. 85% in \_\_\_\_\_\_\_\_\_&\_\_\_\_\_\_\_\_\_ 69. Inverse relationship with Calcium 70. Requires adequate\_\_\_\_\_\_\_\_\_for absorption xci. Functions 71. Health of bones and teeth; buffer in acid base balance; metabolism of CHO, protein, & fat; activation of B complex vitamins; formation/activation of ATP xcii. Sources 72. Milk/milk products 73. Meat 74. \_\_\_\_\_\_\_\_\_ portion of carbonated beverages xciii. Deficiencies 75. Hypophosphatemia i. Causes - Dietary insufficiency - Impaired renal function - Excess \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ antacids (bind with phosphorous in GI tract & eliminated in feces) - Diarrhea j. S/S (clinical manifestations) - Muscle weakness especially of the respiratory muscles; \_\_\_\_\_\_\_\_\_\_ fractures; pain of the long bones; disorientation k. Treatment - Mild- Oral supplements; Severe- IV Phosphorous - I/O; daily wt; VS q 4hr; assess resp & breath sounds; seizure precautions; drink 8 oz H2O each hour to prevent formation of \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ l. Toxicity - Hyperphosphatemia 16. Causes c. Renal insufficiency d. Increased dietary intake of phosphate or Vitamin D 17. S/S e. \_\_\_\_\_\_\_\_\_ f. Numbness and tingling around mouth (circumoral) g. Muscle spasms- sharp flexion of the wrist & external extension of the feet h. Nervousness/Irritability 18. Treatment i. Aluminum based antacids (bind with Phosphorous in the GI tract & eliminate it in the feces) j. Limit Phosphorous intake i. Milk, cheese, egg yolk, nuts d. Magnesium xciv. Key Points: 76. RDA: 310-420 mg/day 77. 2^nd^ most abundant cation in intracellular fluid xcv. Functions\--Regulate nerve and muscle function/contraction, especially the heart, activation of ATP, bone formation, activation of B Complex xcvi. Sources: \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ vegetables xcvii. Excretion: Kidneys xcviii. Deficiencies 78. Hypomagnesemia m. Key Points - Decreased level often parallels decreased \_\_\_\_\_\_\_\_\_\_ n. Causes: Increased excretion by kidneys; severe malnutrition; intestinal malabsorption; chronic alcoholism; prolonged IV therapy, diarrhea, GI suctioning; hypoparathyroidism; renal failure o. S/S (clinical manifestations): Leg cramps; paresthesia\'s; esophageal/ laryngeal spasm; tetany (neuromuscular excitability); convulsions; HTN; + Trousseau's sign; + Chvostek's sign p. Treatment: - Decrease \_\_\_\_\_\_\_\_\_\_\_(quiet/dark room) - Deep tendon reflexes & VS hourly - Oral/IV/IM supplements & Mg+ rich foods 19. Mg+ rich food: spinach, broccoli, squash, avocados, potatoes, whole grains, nuts seeds, tuna, beef, pork, chicken 20. IV given \_\_\_\_\_\_\_\_\_\_ to prevent arrest 21. Monitor for s/s toxicity- Resp \< 12, absent reflexes, drop in BP - Mg+ based antacids (Mylanta, Maalox) - \_\_\_\_\_\_\_\_\_ precautions - D/C diuretics that may pull Mg+ xcix. Toxicities 79. Hypermagnesemia q. Key Points: Severely restricts nerve & muscle activity r. Causes: \_\_\_\_\_\_\_\_\_\_with normal kidney function; renal insufficiency; excess administration of magnesium; diabetic ketoacidosis; severe dehydration s. S/S: NV; decreased deep tendon reflexes; flaccid paralysis; depressed respirations: respiratory arrest; vasodilation: low blood pressure; coma; arrhythmias, bradycardia, cardiac arrest t. Treatment - Treat underlying cause - \_\_\_\_\_\_\_\_\_ - VS, reflexes, muscular movement , LOC hourly - Diuretics - Decrease food/medicines with Mg+ IX. acids & bases e. Acid base balance c. Acid base balance means homeostasis of the \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ in body fluids ci. The symbol that indicates \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_ balance is pH 80. Normal pH is 7.35-7.45 u. 7.4 is the only true norm v. \7.4 = alkalosis 81. The more hydrogen ions in a solution, the more \_\_\_\_\_\_\_\_\_ the solution; The fewer hydrogen ions in a solution, the more alkaline the solution. cii. Normal PCO2 (partial pressure of carbon dioxide) 35-45 mm/Hg ciii. Normal HCO3 (bicarbonate) 22-24 mEq/L f. Buffer systems (3 that work to maintain the body's ph) civ. Blood Buffers 82. \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ of acid base- most effective buffer 83. Circulating buffers react with acids or bases to prevent large changes in pH 84. Primary buffer is \_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\_ system x. HCL (hydrogen chloride) neutralized changed to carbonic acid and salt y. Carbonic acid then broken down to CO2 and H2O 85. Second buffer---phosphate buffer system works similarly cv. Pulmonary system 86. Controls amount of carbon dioxide excreted through respirations z. Slow resp---\_\_\_\_\_\_\_\_\_\_more CO2 a. \_\_\_\_\_\_\_\_\_ resp--- retain less CO2 cvi. Renal system 87. Selectively excretes or reabsorbs bicarbonate and excretes hydrogen ions as needed 88. Least effective of the systems g. Acid Base Alterations cvii. Metabolic disorders 89. If a pH imbalance is caused by something other than a \_\_\_\_\_\_\_\_\_\_of\_\_\_\_\_\_\_\_\_\_\_\_, it is called a metabolic acidosis or alkalosis. 90. Causes are from disease states that create excessive metabolism of fats in the absence of useable CHO leading to the accumulation of ketoacids. 91. The lungs compensate by \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ CO2 to raise the pH or compensate by retaining CO2 to lower the pH. 92. Metabolic Acidosis b. What - Loss of bicarbonate or \_\_\_\_\_\_\_\_\_of\_\_\_\_\_\_\_\_\_ by products c. Causes - Diabetes mellitus - Renal insufficiency - Shock - Fasting or starvation - Severe diarrhea; intestinal suction d. S/S - pH \< 7.35 - Low urine pH - Bicarb \< 22 mEq/l - Kussmaul's -- Lungs attempt to compensate by \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ (hyperventilation) - Disorientation, stupor, coma - \_\_\_\_\_\_\_\_\_\_\_breath - n/v/d - polyuria e. Treatment: - Treat underlying cause - \_\_\_\_\_\_\_\_\_\_ for those in renal failure - IV bicarb - Promote air exchange 22. Semi fowlers 23. TCDB 24. Incentive spiro - Monitor: 25. ABGs 26. LOC 27. Vital signs 28. I & O 29. K+ levels (shifts) 30. Quality of pulse - Oral hygiene - \_\_\_\_\_\_\_\_\_\_\_- freq BG (blood glucose) & urine glucose 93. Metabolic Alkalosis f. What - Loss of acid or \_\_\_\_\_\_\_\_\_of\_\_\_\_\_\_\_\_\_ g. Causes - Excessive vomiting (loss of Cl-/electrolyte shift) - Gastric suctioning - Potent \_\_\_\_\_\_\_\_\_\_\_\_ (esp K+ depleting) - Excessive ingestion of sodium bicarb or bicarb containing antacids h. S/S (clinical manifestations) - CNS depression - NVD - \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ - Irritability, confusion, convulsions, coma - Slow, shallow resp. (compensation) - Elevated pH, HCO3 - \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ - Restlessness then lethargy i. Treatment: - Treat underlying cause - Give acidifying solutions IV or orally - \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_ - Administer muscle relaxants - \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_ - Monitor: 31. I & O 32. K+ levels (supplements as needed) 33. Neurologic status 34. Vital signs cviii. Respiratory disorders 94. \_\_\_\_\_\_\_\_\_\_ changes indicate a resp prob. Metabolic changes take \_\_\_\_\_\_\_\_\_\_ to take place. 95. Resp that increase rate, depth, or both can result in loss of excessive amounts of carbon dioxide with lowering of carbonic acid level in blood. pH rises bc of decrease in \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ being blown off or rate of efficiency of resp decrease which permits retention of CO2 with resultant increase of carbonic acid; as the pH falls, the PCO2 increases; shallow resp bc of retained carbon dioxide. 96. The\_\_\_\_\_\_\_\_\_\_ compensate by retaining increased amounts of HCO3 to increase the pH. 97. Kidneys compensate by excreting increased amounts of HCO3 to lower pH. 98. Respiratory Alkalosis j. What - Carbonic acid deficit; rate of resp increases & CO2 is rapidly exhaled k. Causes - Hyperventilation (blowing off CO2) - \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ l. S/S - Serum pH \> 7.45 - Urine pH decreased - CO2 low - \_\_\_\_\_\_\_\_\_\_ - Dizziness, seizures, confusion - Paresthesia- circumoral/ fingertips - \_\_\_\_\_\_\_\_\_\_ serum K+ - Normal or decreased HCO3 - Hysteria - Hyperventilation m. Treatment: - Educate patient on breathing techniques - Breathe into a paper bag---helps retain CO2 - Emotional support - Reassurance - \_\_\_\_\_\_\_\_\_\_ 99. respiratory acidosis n. What - Carbonic acid excess o. Causes - Any condition that interferes with release of CO2 from lungs: pulmonary edema; pneumonia; sedatives; brain trauma; paralysis of resp muscles; upper airway obstruction; COPD; lung infection; - \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ can bring about a mild resp acidosis, which stimulates the medulla to initiate breathing again. p. S/S - pH \< 7.35 - \_\_\_\_\_\_\_\_\_\_ PCO2 - K+ elevated - Weakness, restlessness- 1^st^ s/s - Disorientation, confusion- 1^st^ s/s - H/A (seen 2^nd^), twitching, convulsions - Normal or increased HCO3 - \_\_\_\_\_\_\_\_\_\_ - Perspiration - Elevated cardiac output q. Treatment: - Improve ventilation---maybe mechanical ventilation 35. \_\_\_\_\_\_\_\_ as ordered 36. Suction 37. Maintain patent\_\_\_\_\_\_\_\_\_ 38. TCDB 39. Incentive Spirometer 40. Chest physiotherapy - Treat primary cause - Emotional support - \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ - Reorientation - Assess neurological status - Administer sodium bicarb - \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ (thin secretions) X. ABG (arterial blood gases) h. Determine \_\_\_\_\_\_\_\_\_or\_\_\_\_\_\_\_\_\_---look at pH cix. \< 7.35\-\--acidosis cx. 7.45---alkalosis i. Look at PCO2---if the [PCO2] level goes in [\_\_\_\_\_\_\_\_\_]direction of [pH], then we know that the [problem is \_\_\_\_\_\_\_\_\_] cxi. pH 7.30; CO2 50---respiratory acidosis (pH down, CO2 up) cxii. pH 7.56; CO2 30---respiratory alkalosis (pH up, CO2 down) j. If [PCO2 is normal or] goes in [\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ of pH], then [look at HCO3]---if this level goes in [same direction as pH]---then [problem is \_\_\_\_\_\_\_\_\_\_] cxiii. pH 7.48; HCO3 30---metabolic alkalosis (pH up, HCO3 up) cxiv. pH 7.26; HCO3 15---metabolic acidosis (pH down, HCO3 down) XI. ABG Assessment k. Compensation---this relates to one of the other systems kicking in and trying to correct the imbalance; [with respiratory problems], you will see a change in the [HCO3] levels that go [opposite the pH as a compensatory] measure cxv. pH 7.25; CO2 60; HCO3 32 (pH down, CO2 up, Bicarb up) cxvi. pH 7.60; CO2 25; HCO3 20 (pH up, CO2 down, Bicarb down) l. If the [problem is metabolic], what you will see is the [CO2 levels] going in the [same direction as the pH as a compensatory] measure cxvii. pH 7.30; CO2 28; HCO3 16 (pH down, CO2 down, Bicarb down) cxviii. pH 7.65; CO2 36; HCO3 32 (pH up, CO2 norm, \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_)