Nursing Stuff to Memorize

• Couch homeostasis:
• pH 7.35-7.45
• CO2 = 35-45mm Hg
• HCO3 = 22-26 mmol/L

• pulmonary disease causes respiratory acidosis - i.e.
• copd
• pulmonary edema
• pna
• asthma
• respiratory failure

• You want to decrease CO2.  You can do this through:
• 1.  Medication (bronchodilator/steroid)
• 2.  bipap
• 3.  ventilator - increase respiratory rate / tidal volume.

hyperventilation

• You wanna try to get pt to stop hyperventilating:
• 1. have them breathe into a paper bag
• 2. if pt is on ventilator decrease tidal volume or respiratory rate
• 3. address anxiety
• 4. look at metabolic system to see if it is compensating (is bicarb going down)?

• renal failure
• aspirin overdose
• antifreeze overdose
• diarrhea
• DKA

• You gotta treat the cause:
• i.e. consider renal failure (dialysis!)
• aspirin/antifreeze overdose (?pump stomach?)
• you can also give sodium bicarbonate IV
• and, look at the opposite system (respiratory) to see if it is compensating.

caused by LOSS OF ACID FROM STOMACH!  Results in too much bicarbonate. - this'll happen if pt throwing up lots or if they are in constant NG suction.  if you lose too much acid it'll throw the body into metabolic alkalosis.

• 1. address underlying cause.
• 2. see if IV fluids are needed (to replace volume lost)
• 3. look at opposite system (respiratory) to see if it is compensating.

270-300 mOsm/L

• This is used to increase
• circulating volume (does not carry oxygen):
• Watch for fluid overload and hypokalemia/hypernatremia.
• Contains Na - be careful with renal disease, glucocorticoids!

shock, dka, blood transfusion, metabolic ketoacidosis, hypercalcemia

as a fluid and electrolyte replenisher

• liver converts lactate to bicarbonate.
• patients with liver disease cannot metabolize lactate well.
• if patient has alkalosis, lactate will make it worse (i.e. bicarbonate).

• 1. Left circumflex occlusion (lateral or posterior MI)
• 2. Left anterior descending occlusion (anterior wall damage - highest mortality - "widow maker")
• 3. Right coronary artery occlusion - inferior wall damage

• subendocardial infarction (NSTEMI)
• intramural infarction (NSTEMI)
• transmural infarction (STEMI)
• subepicardial infarcton (NSTEMI)

• In ischemia, minimal ST depression
• In NSTEMI, large ST depression

localized area of necrotic dead tissue caused by occlusion of a coronary artery that cuts off supply of oxygenated blood to the heart.

whether there has been damage to tissue

• Troponin I or T
• High-sensitivity troponin
• Creatinine Kinase (CK) and CK-MB
• Myoglobin

• rises in 3-6 hours
• peaks 24-48 hours
• back to baseline 5-14 days

• approved by FDA in 2017
• more sensitive, positive results appear sooner
• may also be present in stable angina or no symptoms, indicate increased risk of future heart attack

It's a measure of enzymes released by myocardial cells when they are damaged.  Released within 30-60 minutes.

CK-MB

• CK-MBspecific to myocardial damage in absence of skeletal damage
• rises in 4-8 hours
• peaks 18-24 hours
• back to. normal in 3 days

CK-MB must be > 5% total CK for definitive diagnosis of MI

• ABG
• CMP/BMP
• Electrolytes
• CBC

• in chronic stable angina, atherosclerotic plaques, not thrombus, are present in the vessel.  this will lead to chest pain when the heart works harder and needs more oxygen (ie exercise).  
• unstable angina, on the other hand, is associated with thrombus.

• new onset exertional symptoms
• symptoms when client is at rest

if the angina increases in intensity/duration OR occurs at rest, then this may signal increasing occlusion and the potential for infarction.

• lasts 5-30 minutes
• caused by vasospasm, contraction of the vessel
• occurs at rest or during sleep[
• it's not a medical emergency, can be managed at home

• this type of angina occurs during exercise, activity or stress
• usu subsides with rest or medication (nitroglycern)
• not a medical emergency

beta blockers block the effect of epinephrine -> this causes the heart to beat more slowly and with less force.  this, in turn, reduces the amount of oxygen needed by the heart - and can prevent mi / death.

• unstable angina is a medical emergency.  treatment consists of:
• 1. anti-ischemic therapy:  nitroglycerin, beta blocker, oxygen, ace inhibiter, ARBs
• 2. anti-platelet therapy: i.e. aspirin
• 3. anti-coagulant therapy: LMW heparin, direct thrombin inhibitors, unfractionated heparin
• 4. consider thrombolytic after diagnosis and only after contraindications are ruled out.

The partial pressure of oxygen in the blood.

The fraction of inspired oxygen.

.21-1.0 (or, 21% - 100%)

21%

• Acute respiratory distress syndrome - characterized by:
• 1. Severe hypoxemia
• 2. Bilateral infiltrates on chest radiograph - note infiltrates do not exchange Oxygen and Co2 well.
• 3. Reduced pulmonary compliance - cant get air in well, alveoli is jacked up

As a result PaO2/FiO2 is low.

• First category - respiratory problems happen within first week of a known clinical insult (pna, injury, trauma).  Plus you gotta rule out the following:
• 1. make sure the bilateral opacities on the xray is not due to effusion, lung collapse or nodule;
• 2. respiratory failure isn't due to cardiac failure or fluid overload; and,
• 3. you'll need an objective assessment to exclude hydrostatic edema if no risk factors are present (ie via echocardiography)

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SECOND Category - impaired oxygenation

1. Mild:  PaO2/FiO2 200-300 w/ vent setting for PEEP or CPAP >= 5 cm H2O

2. Moderate:  PaO2/FiO2 100-200 w/ PEEP >= 5 cm H2O

3. Severe:  PaO2/FiO2 < 100 w/ PEEP >= 5 cm H2O