MDC2 Exam 2

MDC2 Exam 2 Acidosis The acid base balance of the blood and other ECF is upset by an excess of hydrogen. Arterial blood pH below 7.35 Causes of metabolic •Diabetic Ketoacidosis •Renal failure •Starvation •Diarrhea •Ileostomy •Hyperthyroidism •Pancreatitis •Liver failure •Dehydration •Seizure activity •Ethanol intoxication •Aspirin toxicity metabolic acidosis too much acid Hydrogen irons of metabolic acidosis are? Over Produced Under eliminated Bicarbonate irons of metabolic acidosis are? Under producted Over eliminated S/S of Metabolic Acidosis •Kussmaul's breathing •20bpm •weak •Confused •Hypotension •Cardiac changes (due to Hyperkalemia) •Nausea •Vomiting Interventions for Metabolic Acidosis •Hydration •Antidiarrheal medications •Monitor Electrolytes (potassium) •Renal Failure •Neuro status •DKA •Bicarbonate •Watch for Respiratory distress Lab assessment for metabolic acidosis SERUM POTASSIUM HIGH Respiratory Acidosis Respiratory function is impaired, causing problems with O2 and CO2 too much Co2 retained Respiratory Acidosis causes •COPD •SEVERE ASTHMA Acidosis Interprofessional collaborative care: •CNS changes Lethargy, confusion, stupor,coma Acidosis Interprofessional collaborative care: Neuromuscular changes ↓ Muscle tone, deep tendon reflexes, facial paralysis, skeletal muscle weakness Acidosis Interprofessional collaborative care: Respiratory changes Kussmaul's breathing Acidosis Interprofessional collaborative care: Skin changes Warm, dry, and pink (vasodilation) Acidosis Interprofessional collaborative care: Cardiovascular changes •Early: ↑ Heart rate, cardiac output changes Worsening: •Hyperkalemia; ↓ heart rate; T wave peaked and QRS widened; weak peripheral pulses; hypotension Priority problem for patient with respiratory acidosis Reduce GAS EXCHANGE resulting from underlying pulmonary disease. Interventions for Respiratory Acidosis •Focus on improving gas exchange •Administer Oxygen •If severe the patient may need to be put on a ventilator •Drug Therapies •Encourage breathing techniques Alkalosis a decrease in the free hydrogen ion level of the blood, arterial blood pH above 7.45. Metabolic Alkalosis Excessive intake of bicarbonates, carbonates, acetates, too much base Respiratory changes of metabolic alkalosis S/S •Increased rate and depth of ventilation (RA) •Decreased respiratory effort associated with skeletal muscle weakness (MA) Neuro changes of metabolic alkalosis S/S Hyperreflexia, muscle cramping, twitching, skeletal muscle weakness. Cardiovascular changes of metabolic alkalosis S/S Increased HR, normal or low blood pressure, increased digitalis toxicity. CNS changes of metabolic alkalosis Increased activity, Anxiety, Positive Chvostek's and Trousseau's sign, Paresthesias Interventions for Metabolic Alkalosis Treat the cause.... •Watch for respiratory distress •If Vomiting administer anti emetics (Zofran, phenergan) •Stop NG suctioning •Stop or alter dose of Diuretic •May administer Diamox (watch for hypokalemia) Hernia teaching POSToperative for patients getting LNF procedure • Soft diet for a week avoid carbonated beverages, tough foods, and raw vegetables that are difficult to swallow. • Take anti-reflux med for a month • No driving a week after surgery; do not drive if taking opioid pain medication. • walk, but no straining