NUR2392 Multidimensional Care II Exam 2 2023 with complete solution

Uncompensated pH and one other value is abnormal Partial compensation pH, CO2, and HCO3 are all off Full compensation pH is normal Acidosis reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle. Alkalosis increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation ABG considerations - Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia) - Assess neuro status - Fall precautions Bicarb HC03 kidney compensation (slow and powerful) Respiratory PaC02 Respiratory compensation (fast but limited) Metabolic acidosis causes DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol intoxication Metabolic acidosis signs and symptoms bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin. Metabolic acidosis treatment hydration and medication to treat underlying problems (DKA - give insulin). Metabolic alkalosis causes antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics. Metabolic Alkalosis s/s anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort (muscle weakness). metabolic alkalosis treatment restore fluid/electrolyte imbalances Respiratory acidosis cause Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block. Respiratory acidosis s/s bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin. Respiratory acidosis treatment (Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation. Respiratory alkalosis cause Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage acute pulmonary issues. respiratory alkalosis s/s anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, hyperventilation respiratory alkalosis treatment restore fluid/electrolyte imbalances How do acid/base imbalances affect electrolytes - Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during buffering. - Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when kidney compensation is present - Alkalosis = hypocalcemia and hypokalemia - Acidosis = HYPERkalemia alkalosis hypocalcemia and hypokalemia