CC2 exam 4
ABG interpretation *** pH: 7.35-7.45 (acidosis-alkalosis)
PaCO2: 35-45 (alkalosis-acidosis) respiratory
HCO3: 21-28 (acidosis-alkalosis) metabolic
metabolic acidosis *** - DKA w respiratory compensation (kussmaul respirations)
- Salicylate OD
- Pancreatitis, kidney/liver failure
- Starvation
- Burns
s/sx: dysrhythmias, bradycardia, tachypnea, Kussmaul respirations, warm/dry/pink skin
respiratory acidosis *** Caused by: hypoventilation - retaining CO2:
- Respiratory depression: opioids
- Brain tumors, stroke, neuro diseases
- Muscle weakness, pneumo/hemothorax, flail chest
- PE, thrombus, ARDS, chest trauma
- Inadequate mechanical ventilation
s/sx: initial tachycardia & HTN, bradycardia & hypotension, pale skin, shallow rapid breathing, END OF
LIFE
metabolic alkalosis *** losing acids
- Loss of gastric secretions: prolonged vomiting, NG suction
- Diuretics, laxative overuse, Cushing's, hyperaldosteronism
- s/sx: tachycardia, tetany, muscle weakness, confusion
,respiratory alkalosis *** Caused by: hyperventilation - lose too much CO2:
- fear, anxiety, intracerebral trauma, excessive mechanical ventilation, hypoxemia, shock, asthma,
pneumonia
- s/sx: rapid & deep breaths, can't concentrate, tinnitus, tingling, tachycardia, tachypnea
Endocrine system overview *** - Hand-in-hand with the neurological system
- Metabolic homeostasis
- Negative-feedback system (responds and adjusts according to internal environment)
- Whole body and cellular growth, reproduction
- Patient with brain injury might also have injury to endocrine system
diabetic ketoacidosis *** an acute, life-threatening condition characterized by uncontrolled
hyperglycemia (greater than 300 mg/dl), metabolic acidosis and an accumulation of ketones in the blood
and urine
- mainly seen in T1DM
- patho: insulin binds to receptors on cell walls, open cell wall, glucose enters cell, when pancreas isnt
working right/not producing insulin, cells arent able to function without energy. this leads to breakdown
of muscle cell, body is SOS. when body breaks down fat cell, leads to ketone production. ketones are
super acidic, when left untreated body goes into acidosis
dka manifestations *** - Polyuria
- Polydipsia
- Polyphagia
- Weight loss
- GI Effects
- Blurred vision, HA, vision changes
- Orthostatic Hypotension
, - Mental Status Changes
- Fruity odor of breath (Ketones)
- Kussmaul respirations (Blow off co2 to stabilize acidic nature, ketones)
- Metabolic acidosis (ketones)
dka interventions *** - Treat underlying cause
- ABCs: Kussamal respirations/not ventilating appropriately, mental status declined/wont be able to
protect airway, dehydration
- Fluid Resuscitation: rapid isotonic fluids 0.9% NaCl for first 1-3 hr
- Insulin Therapy*: Before insulin make sure not dehydrated and potassium level is good. Monitor
frequent glucose checks, once BG gets to 250 switch from isotonic fluids (LR, NS) to D5 ½ NS (Prevents
hypoglycemia and cerebral edema)
- Electrolyte Replacement
- monitor potassium, cardiac monitor
- Resolve acidosis, Severe may need bicarb
- once glucose is stabilized place on sliding scale SQ insulin
dka diagnostics *** - Glucose- > 300 mg/dl
- Na- low, normal, or high
- K- depends on duration of condition, decreases with treatment, Doesn't take long for acidosis to kill a
patient, depending on duration/dehydration it will be high due to hemoconcentration.
- BUN- > 30 mg/dl
- Creatinine- > 1.5 mg/dl
- Ketones- Present in serum and urine
- Serum osmolarity- High
- Serum pH- Metabolic acidosis with respiratory compensation (Kussmaul respirations)
- pH < 7.3
ABG interpretation *** pH: 7.35-7.45 (acidosis-alkalosis)
PaCO2: 35-45 (alkalosis-acidosis) respiratory
HCO3: 21-28 (acidosis-alkalosis) metabolic
metabolic acidosis *** - DKA w respiratory compensation (kussmaul respirations)
- Salicylate OD
- Pancreatitis, kidney/liver failure
- Starvation
- Burns
s/sx: dysrhythmias, bradycardia, tachypnea, Kussmaul respirations, warm/dry/pink skin
respiratory acidosis *** Caused by: hypoventilation - retaining CO2:
- Respiratory depression: opioids
- Brain tumors, stroke, neuro diseases
- Muscle weakness, pneumo/hemothorax, flail chest
- PE, thrombus, ARDS, chest trauma
- Inadequate mechanical ventilation
s/sx: initial tachycardia & HTN, bradycardia & hypotension, pale skin, shallow rapid breathing, END OF
LIFE
metabolic alkalosis *** losing acids
- Loss of gastric secretions: prolonged vomiting, NG suction
- Diuretics, laxative overuse, Cushing's, hyperaldosteronism
- s/sx: tachycardia, tetany, muscle weakness, confusion
,respiratory alkalosis *** Caused by: hyperventilation - lose too much CO2:
- fear, anxiety, intracerebral trauma, excessive mechanical ventilation, hypoxemia, shock, asthma,
pneumonia
- s/sx: rapid & deep breaths, can't concentrate, tinnitus, tingling, tachycardia, tachypnea
Endocrine system overview *** - Hand-in-hand with the neurological system
- Metabolic homeostasis
- Negative-feedback system (responds and adjusts according to internal environment)
- Whole body and cellular growth, reproduction
- Patient with brain injury might also have injury to endocrine system
diabetic ketoacidosis *** an acute, life-threatening condition characterized by uncontrolled
hyperglycemia (greater than 300 mg/dl), metabolic acidosis and an accumulation of ketones in the blood
and urine
- mainly seen in T1DM
- patho: insulin binds to receptors on cell walls, open cell wall, glucose enters cell, when pancreas isnt
working right/not producing insulin, cells arent able to function without energy. this leads to breakdown
of muscle cell, body is SOS. when body breaks down fat cell, leads to ketone production. ketones are
super acidic, when left untreated body goes into acidosis
dka manifestations *** - Polyuria
- Polydipsia
- Polyphagia
- Weight loss
- GI Effects
- Blurred vision, HA, vision changes
- Orthostatic Hypotension
, - Mental Status Changes
- Fruity odor of breath (Ketones)
- Kussmaul respirations (Blow off co2 to stabilize acidic nature, ketones)
- Metabolic acidosis (ketones)
dka interventions *** - Treat underlying cause
- ABCs: Kussamal respirations/not ventilating appropriately, mental status declined/wont be able to
protect airway, dehydration
- Fluid Resuscitation: rapid isotonic fluids 0.9% NaCl for first 1-3 hr
- Insulin Therapy*: Before insulin make sure not dehydrated and potassium level is good. Monitor
frequent glucose checks, once BG gets to 250 switch from isotonic fluids (LR, NS) to D5 ½ NS (Prevents
hypoglycemia and cerebral edema)
- Electrolyte Replacement
- monitor potassium, cardiac monitor
- Resolve acidosis, Severe may need bicarb
- once glucose is stabilized place on sliding scale SQ insulin
dka diagnostics *** - Glucose- > 300 mg/dl
- Na- low, normal, or high
- K- depends on duration of condition, decreases with treatment, Doesn't take long for acidosis to kill a
patient, depending on duration/dehydration it will be high due to hemoconcentration.
- BUN- > 30 mg/dl
- Creatinine- > 1.5 mg/dl
- Ketones- Present in serum and urine
- Serum osmolarity- High
- Serum pH- Metabolic acidosis with respiratory compensation (Kussmaul respirations)
- pH < 7.3
