Complex 2 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/sxx: rapid & deep breaths, can't concentrate, tinnitus, tingling, tachycardia, tachypnea
DKA clinical manifestations *** ONLY occurs in Type 1 DM - FAST ONSET
- Uncontrolled hyperglycemia = > 300
- 3 Ps: Polyuria, polydipsia, polyphagia
- Metabolic acidosis: dehydration & accumulation of ketones in blood and urine
- Mental status changes, blurred vision, HA
- Orthostatic hypotension, weakness
- Fruity breath d/t ketones
- Kussmaul respirations
DKA nursing interventions *** - ABC FIRST AWALYS!!!
- IVF: monitor for hypovolemic shock.. FLUIDS!!!
* Rapid isotonic fluids 0.9% NaCl for first 1-3 hr
* When blood sugar APPROACHES 250 add regular insulin 0.1 unit/kg/hr as an IV bolus (continuous IV
maintenance)
* Change to D5 ½ NS when blood sugar IS at 250
- Monitor BG q 1 hr and VS Q15 min until stable, then Q4
- Admin sodium bicarb slow by IV infusion for severe acidosis & give potassium
- Monitor potassium: cardiac monitor for hypo/hyperkalemia
- Once glucose is stabilized: place on sliding scale insulin with SQ insulin
, DKA 8 dx *** - Blood gluocose/sugar: > 300
- Sodium: low, normal, or high
- Potassium depends on duration of condition: decreases with
tx
- BUN: > 30 (kidneys are stressed)
- Cr: > 1.5 (kidneys are stressed)
- Ketones: present in serum & urine
- Serum osmolarity: high
- Serum pH: metabolic acidosis with respiratory compensation (Kussmaul respirations)
DKA complications *** · Prolonged metabolic acidosis --> coma
· High osmolarity = neurovascular changes
· Hypoglycemia with tx
· Hypokalemia with tx
· Severe dehydration
· Cerebral edema d/t fluid shift
Hyperosmolar hyperglycemic syndrome (HHS) 6 risk factors *** - Undiagnosed DM
- Inadequate fluid intake or poor kidney function
- Most common in older adults ages 50-70: bc more prone to dehydration
- Infection or stress
- Medical conditions such as MI, CVA, sepsis
- Meds
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/sxx: rapid & deep breaths, can't concentrate, tinnitus, tingling, tachycardia, tachypnea
DKA clinical manifestations *** ONLY occurs in Type 1 DM - FAST ONSET
- Uncontrolled hyperglycemia = > 300
- 3 Ps: Polyuria, polydipsia, polyphagia
- Metabolic acidosis: dehydration & accumulation of ketones in blood and urine
- Mental status changes, blurred vision, HA
- Orthostatic hypotension, weakness
- Fruity breath d/t ketones
- Kussmaul respirations
DKA nursing interventions *** - ABC FIRST AWALYS!!!
- IVF: monitor for hypovolemic shock.. FLUIDS!!!
* Rapid isotonic fluids 0.9% NaCl for first 1-3 hr
* When blood sugar APPROACHES 250 add regular insulin 0.1 unit/kg/hr as an IV bolus (continuous IV
maintenance)
* Change to D5 ½ NS when blood sugar IS at 250
- Monitor BG q 1 hr and VS Q15 min until stable, then Q4
- Admin sodium bicarb slow by IV infusion for severe acidosis & give potassium
- Monitor potassium: cardiac monitor for hypo/hyperkalemia
- Once glucose is stabilized: place on sliding scale insulin with SQ insulin
, DKA 8 dx *** - Blood gluocose/sugar: > 300
- Sodium: low, normal, or high
- Potassium depends on duration of condition: decreases with
tx
- BUN: > 30 (kidneys are stressed)
- Cr: > 1.5 (kidneys are stressed)
- Ketones: present in serum & urine
- Serum osmolarity: high
- Serum pH: metabolic acidosis with respiratory compensation (Kussmaul respirations)
DKA complications *** · Prolonged metabolic acidosis --> coma
· High osmolarity = neurovascular changes
· Hypoglycemia with tx
· Hypokalemia with tx
· Severe dehydration
· Cerebral edema d/t fluid shift
Hyperosmolar hyperglycemic syndrome (HHS) 6 risk factors *** - Undiagnosed DM
- Inadequate fluid intake or poor kidney function
- Most common in older adults ages 50-70: bc more prone to dehydration
- Infection or stress
- Medical conditions such as MI, CVA, sepsis
- Meds
