Summary Advance Med Surg Guide practice

1-Arterial Blood Gas (Page 1-4)




CONTENTS
2-Ekg Interpretation (Page 5-12)
3-Fluid & Electrolytes (Page 13-20)
4-Cardiac Study guide (Page 21-37)
5-Endocrine System Guide (Page 38-71)
6-Burns Nursing Guide (Page 72-82)
7-Cancer Study Guide (Page 83-96)
8-Hepatic Study Guide (Page 97-112)
9-Hematology Study Guide (Page 113-125)
10-Immunology Study Guide (Page 126-137)
11-Neurology Study Guide (Page 138-148) 12-
Respiratory Disorders (Page 149-159) 13-Renal
Study Guide (Pages 160-181) 14-Integumentary
System (Page 182-191) 15-Digestive System (Page 192-
197) 16-Respiratory System (Page 198-201) 17-
Musculoskeletal System (Page 202-213) 18-GI
Disorders Study Guide (Page 214-226) 19-Genetics &
Congenital Disorders (Page 227-235) 20-Tissue
Structure & Function (Page 236-237) 21-Central


270+
Nervous System CNS (Page 238-249) 22-Cell Injury


PAGES
Study Guide (Page 250-262) 23-Neoplasia Study
Guide (Page 263-268) 24-The Five Senses Guide (Page
269-276) 25_Pathophysiology Template (Page 277)




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, pH 7.35 - 7.45 Respiratory Acidosis pH low pCO2 high
Metabolic Acidosis pH low HCO3 low
PaCO2 PaO2 35 - 45 mm Hg
Respiratory Alkalosis pH high pCO2 low
SaO2 HCO3 70 - 100 mm Hg **
Metabolic Alkalosis pH high HCO3 high
%MetHb 93 - 98%

%COHb Base 2 2 - 26 mEq/L

excess < 2.0% < 3.0% -2.0
CaO2 to 2.0 mEq/L



16 - 22 ml O2
/dl
[HCO3 -]
pH = pK + log
03 [PaCO2]


B
A G
For teaching purposes, the H-H equation can be
shortened to its basic relationships:

HCO 3
pH ~
PaCO2



Arterial Blood Gas




pH [H+] in nanomoles/L
100
7.00
80
7.10
50
7.30
40
7.40
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, pH [H+] in nanomoles/L
7.52 30
7.70 20
8.00 10




Acidemia: blood pH < 7.35
Acidosis: a primary physiologic process that, occurring alone,
tends to cause acidemia. Examples: metabolic acidosis from
decreased perfusion (lactic acidosis); respiratory acidosis from
hypoventilation. If the patient also has an alkalosis at the same
time, the resulting blood pH may be low, normal, or high.

Alkalemia: blood pH > 7.45
Alkalosis: a primary physiologic process that, occurring alone,
tends to cause alkalemia. Examples: metabolic alkalosis from
excessive diuretic therapy; respiratory alkalosis from acute
hyperventilation. If the patient also has an acidosis at the
same time, the resulting blood pH may be high, normal, or low.




Respiratory alkalosis - A primary disorder where the first Respiratory acidosis - A primary disorder where the first
change is a lowering of PaCO2, resulting in an elevated pH. change is an elevation of PaCO2, resulting in decreased pH.
Compensation (bringing the pH back down toward normal) is a Compensation (bringing pH back up toward normal) is a
secondary lowering of bicarbonate (HCO3) by the kidneys; this secondary retention of bicarbonate by the kidneys; this
reduction in HCO3- elevation of HCO3-
is not metabolic acidosis, since it is not a is not metabolic alkalosis since it is not a
primary process. primary process.
Primary Event Compensatory Event Primary Event Compensatory Event

HCO 3 ↓HCO 3 HCO 3 ↑ HCO 3
↑ pH ~ ↑ pH ~ ↓ pH ~ ↓pH ~
↓PaCO2 ↓ PaCO2 ↑ PaCO2 ↑ PaCO2


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, Metabolic alkalosis - A primary acid-base
Metabolic acidosis - A primary acid-base disorder where the
disorder where the first
first change is a lowering of HCO3-
change is an elevation of HCO3-
, resulting in decreased pH.
, resulting in increased pH.
Compensation (bringing pH back up toward normal) is a
Compensation is a secondary hypoventilation
secondary hyperventilation; this lowering of PaCO2 is not
(increased PaCO2),
respiratory alkalosis since it is not a primary process.
which is not respiratory acidosis since it is not a
primary process.
Primary Event Compensatory Event
Compensation for metabolic alkalosis
↓HCO 3 ↓HCO 3 (attempting to bring pH back
↓ pH ~ ↓ pH ~ down toward normal) is less predictable than
PaCO2 ↓ PaCO2
for the other three acid base disorders.

↓ HCO 3 ↓ HCO 3
↓ pH ~ ↓ pH ~
PaCO2 ↓ PaCO 2



Arterial Blood Gas Interpretation


RISK FACTORS: RISK FACTORS:

>ingestion of acids or < production of • Hypovolemia
HCO3 • Excess aldosterone
• Etiology: lactic acidosis, ketoacidosis, uremic • Iatrogenic base administration
acidosis • Etiology:
• Acid loss or base gain
P A T HO:
• Renal excretion of HCO3 will fix the problem
• compensatory hyperventilation • Prolonged vomiting (loss of HCL) ?
– Hyperkalemia: shift of acid from plasma to ICF PATHO:
– <pH, <HCO3, PaCo2 normal or low if compensation is respiratory compensation is limited
occurring • Hypokalemia: K+ moves from ECF to ICF due to
– cardiac dysrhythmias & CNS dysfunction hydrogen ions moving out of the cell to ECF
– headache, diarrhea, tremors • Depleted body stores (K+):
– Loop diuretics? NGT?
• Signs and symptoms:
– cardiac dysrhythmias; seizures; confusion; muscle
twitching, agitation
– > pH; >HCO3; normal PaCo2 or elevated if
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