Exam 1

7.35-7.45

22-26mEq/L (kidneys/metabolic)

Alkaline

35-45Hg or Torr (lungs/respiratory)


acidic

80-100mm Hg or Torr (lungs/respiratory)

acidic

If metabolic imbalance; kidneys cannot compensate; Carbonic Acid is broken down into carbon dioxide/CO2 and H2O through fluid buffering, then released by lungs during experation.

Occurs within minutes but less effective over time.

If respiratory imbalance and lungs cannot compensate; Kidneys excrete(during alkalosis) or retain(during acidosis) bicarb ion in the loop of Henle.

Response in hrs or day

EX. If high pH/alkaline kidneys excrete more bicarb and retain more hydrogen

low pH + high CO2

Causes: COPD, Hypoventilation

high pH + low CO2

Causes: hyperventilation, ICU venilation rate set too high

high pH + high HCO3

Cause: diuretics...

low pH + low HCO3

Causes: diabetic, OD on aspirin

Total/complete - pH restored to norm

Partial - pH moves toward normal, but never gets within normal range

Absent/uncompensated - pH remains abnormal; carbon dioxide/bicarb may not increase or decrease as needed

found in cells

essential for normal cell function

outside cells

further classified by location

blood, plasma

lower concentration to higher concentration

• more ions than normally found in body; loose H2O and shrink
• more than 295 mOsm/L
• ex. 3%NS saline

• just like body, neither gain or loose H2O
• Between 275-295 mOsm/L
• ex. Lactate Ringers, 0.5% NS

• absorb H2O and may burst
• less than 275 mOsm/L
• ex.

Cause: internal bleeding; a lot of diuretics; a lot of sweating; vomiting/diahrrea

Effects: excess skin tugor; low BP; High HR/tachycardia

Action: rehydration; teach prevention (drink H2O)

Cause: heart failure; kidney/renal failure

Effects: edema; full bounding pulse/tachycardia; hypertension; ascites; low O2 Sat; high urine output

Action:

sodium less than 135 mEq/L

cause: diuretics

effect: muscle cramps, weakness, fatique; low sodium = more neurological effects.

Action: IV slowly (given too high rate = brain swelling)

sodium greater then 145 mEq/L

cause: sodium gained in excess of H2O

action: give diuretics

potassium less than 3.5

cause: duiretics

effects: nausea, leg cramps, weakness, low bowel sounds and cardiac output, dsyrhythmias

action: monitor hrt rate, check for low level before admin diuretics, give by IV no more than 10 me bag through IV (too fast= cardiac arrest)

potassium more than 5.0 mEq/L

• Causes: renal failure, meds, adrenal insufficiency
• Effects: dysrhythmia
• Action: diuretics, Kayexalate (sodium potassium exchange through stool), insulin

• Normal Range: 8.5-10.5
• calcium below 8.5

tests: chvostek- muscle twitching when tap portion of cheek in front of ear; and Truso- fingers twitch when pump up cuff on BP.

• Normal Range: 1.5-2.5
• Tests for hypomagnesium: Chvostek and Truso
• hypo = irritability; give mag tablet or IV
• hyper = flacid; give calcium

Foods: dark green leafy veggies, chocolate, nuts

Normal Range: 2.5-4.5

hypophosphatemia = weakness

hyperphophatemia = acute renal failure

Normal Range: 96-106

does not need nursing care; quick recovery time.

Ex.- cataract removal, hernia, tubal ligation...

Advantages: low cost, low interruption to life, lower chance of hospital related infection.

begins when decision for surgery is made until go to surgery.

Get good history; Labs (CBC, type and cross match, electrolytes, glucose); EKG; chest xray; NPO after midnight, no meds day of surgery except for hypertensive; signed consent form; no dentures, jewelry, bobby pins, polish (note in chart where things were placed).

During surgery

sterile environment

admittance to recovery room to go to floor to complete recovery.

Monitoring stats and BP every few minutes for Aldrete scale (cant leave PACU until at least an 8 out of 10)

Local

Regional

Concious sedation: bersaid, perpoball, versaid

Dantrolene

romazican

Narcan

part of the lung collapses and fluid builds

common in post op patients

intestine spilling out of opened wound

cover with saline soaked sterile gauze and call Dr.

opened wound with nothing coming out

cover with saline soaked sterile gauze and call Dr.

Jackson pratt: connected to compressed small plastic bulb to create suction; soft tube placed in operative site to drain blood and inflammatory fluid post surgery. Has smaller capacity

Hemovac: wound suction device compressed to provide gentle suction post surgery. Has a larger capacity and can collect blood to give back to patient.

Penrose Drain: Drains off fluids and blood post surgery

sutured and stapled laceration

unsutured laceration; ragged edge

absess or contaminated wound more likely; tissue regenerated by the granulation process; larger scar

135-145

3.5-5.0

1.5-2.5

8.9-10.1

2.5-4.5

96-106

High Phosphorus

Low Magnesium

Low Calcium

Local

General

Twilight

Dantrolene

Narcan

Romazicon

Higher concentration to lower concentration