Multidimensional Care II Exam 2 Study Guide 2021 PDF

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Multidimensional Care II Exam 2 Study Guide 2021 https://nurseslabs.com/arterial-blood-gas-abgs-nclex-quiz/ - nurse labs ABG practice https://nurseslabs.com/arterial-blood-gas-abgs-nclex-quiz/2/ -nurse labs ABG practice quiz 2 https://create.kahoot.it/share/mdc-2-exam-2/6981a25e-ae34-44aa-b50e-d841edc36a27 https://create.kahoot.it/share/mdc-2-exam-2/6981a25e-ae34-44aa-b50e-d841edc36a27

https://quizlet.com/_9heayd?x=1jqt&i=2z3d5j = another good quizlet i found for exam

Medical Surgical Success Book- found in the library- ch 10 GI

good luck homies *The exam questions are not limited to only what is listed on this guide, please refer to your chapter readings and module materials

Chapter 12 – Assessment and Care of Patients with Problems of Acid-Base Balance ● ABG ranges and analysis o Normal Ranges: ▪ pH: 7.35-7.45 7.35-7.4= acidosis 7.4-7.45= alkalosis ▪ PaCO2: 35-45 ▪ HCO3: 22-26 ▪ PaO2: 80-100 o Abnormal Ranges: ▪ Acidosis ● pH: ↓ 7.35 ● PaCO2: ↑ 45 ● HCO3: ↓ 22 ▪ Alkalosis ● pH: ↑ 7.45 ● PaCO2: ↓ 35 ● HCO3: ↑ 26 ▪ PaO2 is abnormal when it is ↓ 80 o How to solve ABG imbalances: ▪ First, look at pH- determine if it is acidic, alkaline, or normal ● If in normal range - determine if the pH is more acidic (7.35-7.4), or alkaline (7.4-7.45)- this will help us determine compensation ▪ Next, look at PaCO2- determine if it is below 35 (or more alkaline), in normal range, or above 45 (or more acidic). ▪ Then, look at the HCO3- determine if it is below 22 (or acidic), in normal range, or above 26 (or alkaline). ▪ Once all readings have been determined, use the ROME method to determine the ABG imbalance. ● Respiratory Opposite- the pH and CO2 levels will be in opposite directions, Metabolic Equal- the Ph and HCO3 levels will be in the same or equal direction.

▪ Next look at the PaO2. In our respiratory clients, we must look at this to determine if there is enough oxygen getting into the lungs or not. If it is lower than 80, then we know there is not enough perfusion of oxygen within the arterial blood and that there is breathing difficulty somewhere. ▪ Then we must determine if the patient is fully compensated, partially compensated, or uncompensated. ● Fully Compensated vs. Partially Compensated vs. Uncompensated o

Compensation occurs when there is an acid base imbalance and the body attempts to correct an abnormality within the other body system. ▪ First the pH will be affected due to being a buffer. Must look to see if it is normal, abnormal, acidic, alkaline. ▪ Then we will look at PaCO2 and HCO3. Whichever value is abnormal, that is your compensation.

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Fully Compensated: The body has placed the pH back to normal. However, there will be other systems with abnormal ranges. The abnormal value is the body systems that are compensating. pH normal and HCO3 and PaCO2 are both abnormal. 7.37, 60, 18

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Partially Compensated: The body is compensating for the pH and for both the PaCO2 and HCO3. This places all 3 levels abnormal. This shows that the respiratory and kidneys are compensating to get the pH back to normal. 7.3, 50, 18

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Uncompensated: The body is not in a state of compensation yet, so there is an abnormality of the pH and either the PaCO2 or HCO3, but not both. 7.3, 60, 24

● Buffers o

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Chemical (bicarbonate and intracellular fluid) and protein buffers (albumin and globulins) ▪ First line of defense ● Either bind or release hydrogen ions as needed ● Respond quickly to changes in pH Respiratory buffers ▪ Second line of defense ● Control the level of hydrogen ions (within minutes) in the blood through the control of CO2 levels ● When a chemoreceptor senses a change in the level of CO2, a signal is sent to the brain to alter the rate and depth of respirations. o Hyperventilation: Decrease in hydrogen ions (helps to blow off excess hydrogen ions), decreased PaCO2. Central chemoreceptors inhibited. o Hypoventilation: Increase in hydrogen ions, increased PaCO2. Central chemoreceptors stimulated. Kidney buffers ▪ Kidneys are the third line of defense. ● This buffering system is much slower to respond (24-48 hours), but it is the most effective buffering system with the longest duration. (kidney movement of bicarbonate, formation of acids [HPO4 -1 +

H+ → H2PO4 2-], and formation of ammonium [NH3+ + H+ → NH4+]) ● Kidneys control the movement of bicarbonate in the urine. Bicarbonate can be reabsorbed into the bloodstream or excreted in the urine in response to blood levels of hydrogen. ● Kidneys can also produce more bicarbonate when needed. o High hydrogen ions: Bicarbonate reabsorption and production o Low hydrogen ions: Bicarbonate excretion ● pH Regulation o

The pH is the expression of the balance between carbon dioxide (CO2), which is regulated by the lungs, and bicarbonate (HCO 3-), a base regulated by the kidneys. The greater the concentration of hydrogen, the more acidic the body fluids and the lower the pH. The lower the concentration of hydrogen, the more alkaline the body fluids and the higher the pH.

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Example:

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When excess carbon dioxide is produced, the equation shifts to the right, causing an increase in hydrogen ions (and a decrease in pH). ▪ Whenever the CO2 level changes, the pH changes to the same degree, in the opposite direction ▪ When the CO2 level of a liquid increases, the pH drops, indicating more free hydrogen ions (more acidic) ▪ When the CO2 level of a liquid decreases, the pH rises, indicating fewer free hydrogen ions (more alkaline).

● Causes of imbalances and treatment o Respiratory Acidosis ▪ What is it: ● pH lower than 7.35 ● PaCO2 greater than 45 ● HCO3 normal range (unless partially compensated) ● PaO2 less than 80 ● The patient may have CO2 retention, increase H+ ions, causing the pH and CO2 levels to be more acidic. CO2 is an acid in the body ▪ Causes ● Hypoventilation ● COPD ● Asthma ● Pneumonia ● Under Elimination of H ions o Respiratory depression: ▪ Anesthetics, ▪ Drugs (especially opioids), poisons

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▪ Electrolyte imbalance (fluid overload) ▪ brain tumors ▪ cerebral aneurysm/ edema (increased intracranial pressure) ▪ stroke o Inadequate chest expansion: ▪ Muscle weakness ▪ Airway obstruction ▪ Alveolar-capillary block (pneumonia, pneumonitis, tuberculosis, emphysema, acute respiratory distress syndrome, chest trauma, pulmonary emboli, pulmonary edema, and drowning) ▪ Mechanical ventilation ● May be seen in those who also have sleep apnea and obesity. ▪ S/S: ● Vital signs: Initial tachycardia and hypertension; bradycardia and hypotension develop as acidosis worsens. bounding pulse ● Dysrhythmias: Ventricular fibrillation can be the first indication in a client receiving anesthesia. ● CV: Delayed electrical conduction,Ranges from bradycardia to heart block ,Tall and peaked T waves, Widened QRS complex, Prolonged PR interval ● Neuro: Initial anxiety, irritability, and confusion; lethargy and possibly coma develop as acidosis worsens ● Respiratory: Ineffective, weak, shallow, rapid breathing. Variable respirations (generally ineffective in respiratory acidosis) ● Skin: Pale or cyanotic and dry ▪ Treatment ● Improve gas exchange (use Incentive spirometer) ● Drugs: Bronchodilators, Anti-inflammatories, Mucolytics ● Oxygen therapy o Remember to never hyperoxygenate the patient! Especially if they have COPD! Their lungs do not have enough compliance to handle large amounts of oxygen. ● Pulmonary hygiene ● Ventilation support ● Prevention of complications Respiratory Alkalosis ▪ What is it ● pH: above 7.45 ● PaCO2: less than 35 ● HCO3: normal range (unless partially compensated) ● PaO2: between 80-100 ● Caused by an excessive loss of CO2 ▪ Causes ● Hyperventilation ● Fear/ Anxiety ● Mechanical Ventilation ● Aspirin toxicity ● High altitudes

● Shock ● Early stage acute pulmonary problems ● Diarrhea ▪ S/S

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● Vital signs: Tachypnea ● Neurologic: Inability to concentrate, numbness, tingling, tinnitus, and possible loss of consciousness ● Cardiovascular: Tachycardia, ventricular, and atrial dysrhythmias ● Respiratory: Rapid, deep respirations ▪ Treatment ● If possible: instruct the patient to breathe into a paper bag to help place CO2 back into the body. ● Oxygen therapy ● Anxiety reduction interventions ● Rebreathing techniques ● Drugs: antianxiety agents Metabolic Acidosis ▪ What is it ● pH: less than 7.35 ● PaCO2: normal range (unless partially compensated) ● HCO3: less than 22 ● There is an overproduction of hydrogen ions, underelimnateon, underproduction or over elimination of bicarbonate ions. ▪ Causes ● Excessive oxidation of fatty acids: o Diabetic ketoacidosis o Starvation ● Hypermetabolism: o Heavy exercise o Seizure activity o Fever o Hypoxia, ischemia ● Excessive ingestion of acids: o Ethanol or methanol intoxication o Aspirin toxicity ● Kidney failure ● Pancreatitis ● Liver failure ● Dehydration ● Diarrhea ▪ S/S ● Hyperkalemia- potassium is an acid and will increase in the body. ● Vasodilation ● CV: o Dysrhythmias ▪ Delayed electrical conduction ▪ Ranges from bradycardia to heart block ▪ Tall and peaked T waves ▪ Widened QRS complex

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▪ Prolonged PR interval o Hypotension o Thready, peripheral pulses ● Vital signs: Bradycardia, weak peripheral pulses, hypotension, tachypnea ● Neurologic: Headache, drowsiness, confusion ● Respiratory: rapid, deep respirations- Kussmal respirations ● Skin: Warm, flushed, dry, pink ● Blood sugar may be high ● CNS: Depressed activity (lethargy, confusion, stupor, coma) ● Neuromuscular: Hyporeflexia, Skeletal muscle weakness,Flaccid paralysis ▪ Treatment ● Hydration ● Strict I&O ● Seizure precaution ● Drugs: Insulin to treat DKA, Antidiarrheals, Bicarbonate (only with low serum levels pH...