acid base & fluid & electrolytes[1]

8/8/2019 Acid Base & Fluid & Electrolytes[1]

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ACID BASEACID BASEFLUID & ELECTROLYTESFLUID & ELECTROLYTES


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Fluid and ElectrolytesFluid and Electrolytes

45%45% -- 80% body weight is fluid80% body weight is fluid

Body fluid is divided into two majorBody fluid is divided into two majorcompartmentscompartments

1. Intracellular the fluid located within the1. Intracellular the fluid located within thecellscells

2. extracellular the fluid outside the cells2. extracellular the fluid outside the cells


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ELECTROLYTESELECTROLYTES

These are chemical compounds that partially dissociateThese are chemical compounds that partially dissociatein solution in separate particles.in solution in separate particles.

These particles carry electrical charges and are known asThese particles carry electrical charges and are known asionsions

Positive charges are referred to as cationsPositive charges are referred to as cations

Examples are +K, Ca++Examples are +K, Ca++

Negative charges are referred to as anionsNegative charges are referred to as anions

Examples are SO4Examples are SO4-- sulfate HCO3sulfate HCO3-- BicarbonateBicarbonate


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Electrolyte BalanceElectrolyte Balance

Maintaining electrolyte balance refers to keeping theMaintaining electrolyte balance refers to keeping theconcentration of each electrolyte within normal limitsconcentration of each electrolyte within normal limits

These are usually measured in mEq/LThese are usually measured in mEq/L


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SODIUMSODIUM

Most abundant cation in the ECFMost abundant cation in the ECF

Normal is 135Normal is 135 145 mEq/L145 mEq/L

Regulated by the reninRegulated by the renin--angiotensionangiotension--aldosteronealdosterone

systemsystem SOURCES of SODIUMSOURCES of SODIUM

Table salt, dairy products, meat, eggs and certainTable salt, dairy products, meat, eggs and certainvegetables; food process tends to add salt in thevegetables; food process tends to add salt in the

preserving process.preserving process.


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Signs andsymptomsofSigns andsymptomsof

HyponatremiaHyponatremia Causes areCauses are

Increase in water intakeIncrease in water intake

Abnormal secretion of ADHAbnormal secretion of ADH Decreased urinary output of waterDecreased urinary output of water

Sodium level less than 135mEq/LSodium level less than 135mEq/L

*major impact is on central nervous*major impact is on central nervoussystem as the cells swell inside the rigidsystem as the cells swell inside the rigidskullskull


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Signs and SymptomsofSigns and Symptomsof

HyponatremiaHyponatremia

Will be primarily neurologicalWill be primarily neurological

Lethargy, irritability, confusion, personalityLethargy, irritability, confusion, personality

changes, seizures, coma and eventuallychanges, seizures, coma and eventuallydeathdeath

Anorexia, nausea, vomiting, weakness,Anorexia, nausea, vomiting, weakness,and crampsand cramps


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HypernatremiaHypernatremia

Caused by a water deficitCaused by a water deficit

Decrease in water intake or increase inDecrease in water intake or increase in

water loss in the urinewater loss in the urine Excess intake of salt ( near drowning inExcess intake of salt ( near drowning in

salt water)salt water)

Serum sodium is greater than 145 mEq/LSerum sodium is greater than 145 mEq/L *Cellular shrinking occurs*Cellular shrinking occurs


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Signs and SymptomsofSigns and Symptomsof

hypernatremiahypernatremia Fluid is pulled from the brain cellsFluid is pulled from the brain cells

Confusion, agitation, convulsions,Confusion, agitation, convulsions,decreased urine output with and increasedecreased urine output with and increasein urine concentration, thrist and dryin urine concentration, thrist and drymucous membranesmucous membranes


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PotassiumPotassium

Normal range 3.5Normal range 3.5 5.0 mEq/L5.0 mEq/L

Essential for normal cardiac function andEssential for normal cardiac function andcontractility of all musclescontractility of all muscles

Necessary for protein and glycogenNecessary for protein and glycogensynthesissynthesis

Controlled by insulin and aldosterone.Controlled by insulin and aldosterone.


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PotassiumPotassium

Insulin promotes the transfer of K+ fromInsulin promotes the transfer of K+ fromthe ECF into skeletal muscle and liverthe ECF into skeletal muscle and livercells.cells.

Aldosterone enhances renal excretion ofAldosterone enhances renal excretion ofpotassiumpotassium

An increase in serum K+ stimulates theAn increase in serum K+ stimulates therelease of insulin and aldosterone to lowerrelease of insulin and aldosterone to lowerthe concentration of the ion.the concentration of the ion.


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PotassiumPotassium

A person loses approximately 30mEq ofA person loses approximately 30mEq ofK+ a day while a typical Western dietK+ a day while a typical Western diet

contains50contains50--100 mEq/d100 mEq/d


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HyperkalemiaHyperkalemia

Causes areCauses are

Kidney failureKidney failure

Increased cellular damage (burns)Increased cellular damage (burns)

Insulin deficiencyInsulin deficiency

Aldosterone deficiencyAldosterone deficiency

Rapid IV infusion of potassiumRapid IV infusion of potassium

Increased oral intake of potassium medicallyIncreased oral intake of potassium medicallyprescribedprescribed

Excessive use of salt substitutesExcessive use of salt substitutes


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Hyperkalemia Signs andHyperkalemia Signs and

SymptomsSymptoms Skeletal smooth and cardiac muscleSkeletal smooth and cardiac muscle

activity: irritability, anxiety, irritabilityactivity: irritability, anxiety, irritability

Gastrointestinal hyperactivity (diarrhea,Gastrointestinal hyperactivity (diarrhea,intestinal crampingintestinal cramping

EKG changes with cardiac dysrhythmiasEKG changes with cardiac dysrhythmias

Cardiac arrestCardiac arrest


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HyperkalemiaHyperkalemia

TREATMENTTREATMENTVery high levelsVery high levels

Administer calcium gluconateAdminister calcium gluconate

Infuse glucose and insulin to moveInfuse glucose and insulin to movepotassium into the cellpotassium into the cell

DialysisDialysis

Administer KayexalateAdminister Kayexalate


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Hyperkalemia TREATMENTHyperkalemia TREATMENT

Moderately elevatedModerately elevated

Administer diureticsAdminister diuretics

Identify and treat the underlying causeIdentify and treat the underlying cause


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HYPOKALEMIAHYPOKALEMIA

CausesCausesabnormal levels of potassiumabnormal levels of potassium

Inadequate replacementInadequate replacement Increased movement of potassium intoIncreased movement of potassium into

the cells (when insulin is given)the cells (when insulin is given)


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HypokalemiaHypokalemia

Symptoms begin in lower extremities and moveSymptoms begin in lower extremities and moveupward to the trunk and to upper extremitiesupward to the trunk and to upper extremities

Fatigue, impaired respiratory muscle function,Fatigue, impaired respiratory muscle function,abdominal distention, nausea, vomiting,abdominal distention, nausea, vomiting,constipation, and paralytic ileus from decreasedconstipation, and paralytic ileus from decreasedGI responsiveness; increased urination andGI responsiveness; increased urination and

thirst, dysrhythmias and characteristic EKGthirst, dysrhythmias and characteristic EKGchanges, elevated blood glucose because ofchanges, elevated blood glucose because ofsuppression of insulin releasesuppression of insulin release


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HYPOKALEMIAHYPOKALEMIA

TREATMENTTREATMENT Increase intake of potassiumIncrease intake of potassium

Give K+ enriched foodsGive K+ enriched foods

Administer oral K+ supplementsAdminister oral K+ supplements Use K+ sparing diureticsUse K+ sparing diuretics

Administer IV K+Administer IV K+

Identify and treat underlying causeIdentify and treat underlying cause Implement Preventive teachingImplement Preventive teaching


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CALCIUMCALCIUM

Normal range is 8.9Normal range is 8.9--10.110.1

99% of the bodys calcium is found in the bones99% of the bodys calcium is found in the bonesand teethand teeth

Large portions of calcium is bound to albumin soLarge portions of calcium is bound to albumin sowhen looking at labs always look at the calciumwhen looking at labs always look at the calciumlevel then look at the albumin levels!level then look at the albumin levels!

Normally if serum albumin levels are decreased,Normally if serum albumin levels are decreased,the calcium levels are also decreased.the calcium levels are also decreased.


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HYPERCALCEMIA SIGNS ANDHYPERCALCEMIA SIGNS AND

SYMPTOMSSYMPTOMS

Muscles weaknessMuscles weakness

Lack of coordination, confusion, lethargyLack of coordination, confusion, lethargy

Decreased neuromuscular excitabilityDecreased neuromuscular excitability Impaired memory, nausea, vomiting,Impaired memory, nausea, vomiting,

constipation, pruritus, kidney stones, boneconstipation, pruritus, kidney stones, bone

painpain


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HYPOCALCEMIAHYPOCALCEMIA

TREATMENTTREATMENT

Depends on underlying causeDepends on underlying cause

Administer IV normal saline andAdminister IV normal saline and

DiureticsDiuretics


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HYPERCALCIUMHYPERCALCIUM

Causes areCauses are

CancerCancer

Excessive intake of vitamin DExcessive intake of vitamin D Excessive intake of milk or alkalineExcessive intake of milk or alkaline

antacidsantacids

HyperparathyroidismHyperparathyroidism

ImmobilizationImmobilization

Reduced renal functionReduced renal function


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CausesCauses

Parathyroid deficiencyParathyroid deficiency

Vitamin deficiencyVitamin deficiency Renal deficiencyRenal deficiency

Some malignanciesSome malignancies

PancreatitisPancreatitis

Massive blood transfusionsMassive blood transfusions

Enemas or laxative abuseEnemas or laxative abuse


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TREATMENTTREATMENT

Depends on serum levelsDepends on serum levels

If mildIf mild

Administer oral calcium supplementsAdminister oral calcium supplements


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Signs and SymptomsSigns and Symptoms

Tingling in hands, fingers, feet or around theTingling in hands, fingers, feet or around themouthmouth

Tetany, grimacing, muscle twitchingTetany, grimacing, muscle twitching

Cramping, hyperactive reflexes, and severeCramping, hyperactive reflexes, and severeflexion of the wrist and ankle jointsflexion of the wrist and ankle joints

Laryngospasm, seizures, cardiac arrest andLaryngospasm, seizures, cardiac arrest anddeath if untreateddeath if untreated

*Bradycardia and respiratory failure with*Bradycardia and respiratory failure withdepressed reflexes and paralysis in depression ofdepressed reflexes and paralysis in depression ofmuscular irritabilitymuscular irritability


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TREATMENTTREATMENT

If severeIf severe Give IV CALCIUM slowlyGive IV CALCIUM slowly


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CALCIUMCALCIUM

Essential ForEssential For

blood clottingblood clotting

Wound healingWound healing Muscle contractilityMuscle contractility

Bone and teeth formation synapticBone and teeth formation synaptic

transmission in the nervous tissuetransmission in the nervous tissue Membrane excitabilityMembrane excitability


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CALCIUMCALCIUM

Regulated byRegulated by

Parathyroid hormone (PTH)Parathyroid hormone (PTH)

Along with vitamin D and calcitoninAlong with vitamin D and calcitonin

PTH causes serum calcium levels to increase byPTH causes serum calcium levels to increase byincreasing intestinal and renal reabsorption ofincreasing intestinal and renal reabsorption ofcalcium and releasing calcium from the bonecalcium and releasing calcium from the bone

PTH increase calcium levels and decreasesPTH increase calcium levels and decreasesserum phosphate levelsserum phosphate levels


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CALCIUMCALCIUM

DIETARY SOURCESDIETARY SOURCES

MilkMilk

CheeseCheeseYogurtYogurt

Sardines, whole grainsSardines, whole grains

Leafy green vegetablesLeafy green vegetables


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MagnesiumMagnesium

Normal levels ranges from 1.5Normal levels ranges from 1.5--1.9 mEq/L1.9 mEq/L

5

05

0--60%

is found in the bone60%

is found in the bone

The rest is found in soft tissue and in bodyThe rest is found in soft tissue and in bodyfluidsfluids

It is primarily an intracellular ionIt is primarily an intracellular ion


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MagnesiumMagnesium

Regulates neuromuscular function and cardiacRegulates neuromuscular function and cardiacactivityactivity

Changes in potassium and calcium will causeChanges in potassium and calcium will causechanges in magnesium levels, with similar signschanges in magnesium levels, with similar signsand symptoms.and symptoms.

Dietary sources are green leafy vegetables,Dietary sources are green leafy vegetables,legumes, citrus fruit, peanut butter andlegumes, citrus fruit, peanut butter andchocolatechocolate


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HYPERMAGNESEMIAHYPERMAGNESEMIA

CAUSESCAUSES

RENAL FAILURERENAL FAILURE

Diabetic ketoacidosisDiabetic ketoacidosis Magnesium sulfate therapyMagnesium sulfate therapy

Magnesium based laxative useMagnesium based laxative use


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Depression of muscular irritabilityDepression of muscular irritability

HypotensionHypotension

WeaknessWeakness

Depressed reflexesDepressed reflexes

ParalysisParalysis

BradycardiaBradycardia

Respiratory failureRespiratory failure

Cardiac arrestCardiac arrest


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TREATMENTTREATMENT

Depends on underlying causeDepends on underlying cause Give IV calcium or prepare for removal byGive IV calcium or prepare for removal by

peritoneal dialysis or hemodialysisperitoneal dialysis or hemodialysis


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HYPOMAGNESEMIAHYPOMAGNESEMIA

CAUSESCAUSES

Impaired intakeImpaired intake

Impaired intestinal absorptionImpaired intestinal absorption Excessive urinary excretion secondary toExcessive urinary excretion secondary to

alcoholism or diureticsalcoholism or diuretics


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HYPOMAGNESEMIAHYPOMAGNESEMIA

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

Neuromuscular irritabilityNeuromuscular irritability TremorsTremors

CrampsCramps

Difficulty swallowingDifficulty swallowing Cardiovascular changesCardiovascular changes

h hh h


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PhosphorusPhosphorus

Normal serum phosphorus levels in adults range fromNormal serum phosphorus levels in adults range from2.52.5--4.5 mg/dL. Serum levels are higher in children and4.5 mg/dL. Serum levels are higher in children andeven higher in infantseven higher in infants

85% of it is found in the bones85% of it is found in the bones

14% is intracellular and14% is intracellular and

1% is extracellular1% is extracellular

Renal regulation under the influence of of vitamin D andRenal regulation under the influence of of vitamin D andthe parathyroid hormonethe parathyroid hormone


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PhosphorusPhosphorus

Dietary sources are diary products, meats,Dietary sources are diary products, meats,vegetables, fruits and cerealsvegetables, fruits and cereals


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HYPERPHOSPHATEMIAHYPERPHOSPHATEMIA

CausesCauses

Renal failureRenal failure

Tumor lysisTumor lysis Excess phosphate intakeExcess phosphate intake


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HYPERPHOSPHATEMIAHYPERPHOSPHATEMIA

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

USUALLY THE SIGNS AND SYMPTOMS OFUSUALLY THE SIGNS AND SYMPTOMS OFHYPOCALCEMIA WHICH ACCOMPANIES ITHYPOCALCEMIA WHICH ACCOMPANIES IT


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HYPOPHOSPHATEMIAHYPOPHOSPHATEMIA

TREATMENTTREATMENT

Identify and treat the underlying casueIdentify and treat the underlying casue

Possibly restrict phosphate intake if renalPossibly restrict phosphate intake if renalfailure presentfailure present

Administer IV normal saline if renal failureAdminister IV normal saline if renal failureis absentis absent


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CAUSESCAUSES

Increased carbohydrate calories andIncreased carbohydrate calories and

respiratory alkalosisrespiratory alkalosis

Depletion due to alcoholismDepletion due to alcoholism

Uncontrolled diabetes mellitusUncontrolled diabetes mellitus Renal phosphate wastingRenal phosphate wasting


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HYPOPHOSPHATEMAIHYPOPHOSPHATEMAI

Neuromuscular dysfunction:Neuromuscular dysfunction:

Weakness or respiratory musclesWeakness or respiratory muscles

FatigueFatigue Myocardial depressionMyocardial depression Ventricular dysrhythmiasVentricular dysrhythmias Confusion, coma decreased oxygen delivery toConfusion, coma decreased oxygen delivery to

tissuestissues Renal loss of bicarb, calcium, magnesium andRenal loss of bicarb, calcium, magnesium and

glucoseglucose


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TREATMENTTREATMENT

Identify and treat the underlying causeIdentify and treat the underlying cause

Encourage foods high in phosphorusEncourage foods high in phosphorus

Administer oral phosphate replacement ifAdminister oral phosphate replacement ifindicatedindicated

P f Fl id d El t l tP f Fl id d El t l t


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ProcessofFluid and ElectrolyteProcessofFluid and Electrolyte

MovementMovement

Diffusion. Movement of a solvent from anDiffusion. Movement of a solvent from anarea of higher solvent concentration to aarea of higher solvent concentration to aregion of lower solvent concentrationregion of lower solvent concentration

Important in balancing electrical charge toImportant in balancing electrical charge tothat the cations will = the anionsthat the cations will = the anions

identically.identically.


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OsmosisOsmosis

The movement of a fluid through a semipermeable membranesThe movement of a fluid through a semipermeable membraneswhich allows some substances through and not others.which allows some substances through and not others.

In this case the semi permeable membrane is separating two fluidIn this case the semi permeable membrane is separating two fluidcompartments one compartment is hyperosmolar and the othercompartments one compartment is hyperosmolar and the other

compartment is hypoosmolarcompartment is hypoosmolar

REMEMBER: water moves down its concentration gradient fromREMEMBER: water moves down its concentration gradient fromareas wehre there is more water to areas wehre there is less waterareas wehre there is more water to areas wehre there is less water

REMEMBER: capillary vessel walls and cell walls are semipermeableREMEMBER: capillary vessel walls and cell walls are semipermeable

membranesmembranes


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ACTIVE TRANSPORTACTIVE TRANSPORT

The process by which ions and other moleculesThe process by which ions and other moleculesmove across membranes from an area of lessermove across membranes from an area of lesserconcentration to an area of greaterconcentration to an area of greaterconcentrationconcentration

This movement is facilitated by energy calledThis movement is facilitated by energy calledenzymes (ATPase)enzymes (ATPase)

This process is what causes sodium to move toThis process is what causes sodium to move tothe outside of the cell and potassium to move tothe outside of the cell and potassium to move tothe inside of the cellthe inside of the cell


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FiltrationFiltration

Involves the transfer of water and dissolvedInvolves the transfer of water and dissolvedsubstances through a permeable membranesubstances through a permeable membranefrom a region of high pressure to a region of lowfrom a region of high pressure to a region of lowpressurepressure

Fluid against the walls of the capillariesFluid against the walls of the capillariespromotes the flow of the fluid out of thepromotes the flow of the fluid out of thecapillariescapillaries

EXAMPLE:: Filtration occurs within the kidneysEXAMPLE:: Filtration occurs within the kidneysglomerular capillaries and in blood capillariesglomerular capillaries and in blood capillaries


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ASSESSMENT OFFLUIDASSESSMENT OFFLUID

VOLUMEVOLUME

INTAKE AND OUTPUTINTAKE AND OUTPUT

Intake should = output within a 24 hourIntake should = output within a 24 hour

periodperiod

Be certain that the record is correctBe certain that the record is correct

Insensible fluid loss if fluid loss that weInsensible fluid loss if fluid loss that wecannot see.cannot see.


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ASSESSMENTASSESSMENT

Body WeightBody Weight

Compare daily body weights . This is the bestCompare daily body weights . This is the best

way to confirm apparent discrepancies in intakeway to confirm apparent discrepancies in intakeand output. Consider at least the last48 hours,and output. Consider at least the last48 hours,if chronic condition is suspected.if chronic condition is suspected.

Look for a pattern of imbalance between intakeLook for a pattern of imbalance between intakeand output that correlate with the increase orand output that correlate with the increase ordecrease in weight.decrease in weight.


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MENTAL STATUSMENTAL STATUS

Changes in mental status or LOCChanges in mental status or LOC

Client may simply report feeling fatigued,Client may simply report feeling fatigued,restless or apprehensiverestless or apprehensive

Nurse may note confusion and lethargyNurse may note confusion and lethargy


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VITAL SIGNSVITAL SIGNS

Respiratory rate and depthRespiratory rate and depth

Deep labored respirations may occur toDeep labored respirations may occur tocompensate for metabolic acidosiscompensate for metabolic acidosis

Shallow respirations may be present in alkalosisShallow respirations may be present in alkalosis

Fluid can accumulate in the lungsFluid can accumulate in the lungs

Crackles, and subtle signs of fluid excess beforeCrackles, and subtle signs of fluid excess beforeobservable dyspneaobservable dyspnea

4949


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Postural Pulse Rate and Blood PressurePostural Pulse Rate and Blood Pressure Increase in pulse rate and a decrease in bloodIncrease in pulse rate and a decrease in blood

pressure in ECFpressure in ECF Measure pulse and blood pressure in all threeMeasure pulse and blood pressure in all three

positions.positions.

*In volume deficit the client may become faint*In volume deficit the client may become faintwhen they standwhen they stand

In volume deficit the client may have elevatedIn volume deficit the client may have elevatedpulse rate of more than 20 beats / minpulse rate of more than 20 beats / min


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ACID BASE INTERPRETATIONACID BASE INTERPRETATION

# 1# 1 Example 1Example 1 ABG ValueABG Value

Which step?Which step?

RationaleRationale pHpH

7.397.39

Step 1Step 1

Normal pHNormal pH PaCO2PaCO2

4040

Step 2Step 2

NormalNormalPaCO2PaCO2 InterpretationInterpretation

Normal ABGNormal ABG (acid base(acid baseis balanced; there are nois balanced; there are nopH changes, so if thepH changes, so if the

respiratory acid is normal,respiratory acid is normal,the metabolic basethe metabolic basecannot be causingcannot be causingchanges either.)changes either.)


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ABGsABGs

Arterial Blood GassesArterial Blood Gasses

pHpH Normal arterial blood has a pH ofNormal arterial blood has a pH of7.357.35--7.45.7.45.

How does the body achieve this pH value?How does the body achieve this pH value?As long as there is a 1:20 ratio of carbonicAs long as there is a 1:20 ratio of carbonicacid to bicarbonate, pH will remain withinacid to bicarbonate, pH will remain withinnormal limits.normal limits.


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EssentialFactsEssentialFacts

H2CO3 = Carbonic acidH2CO3 = Carbonic acid

Carbonic acid can change into carbon dioxideCarbonic acid can change into carbon dioxideand water and back to carbonic acid.and water and back to carbonic acid.

HCO3 = BicarbonateHCO3 = Bicarbonate

Too much carbonic acid = acidosisToo much carbonic acid = acidosis

Too little bicarbonate = acidosisToo little bicarbonate = acidosis

Too much bicarbonate = alkalosisToo much bicarbonate = alkalosis Too little carbonic acid = alkalosisToo little carbonic acid = alkalosis


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EssentialFactscont.EssentialFactscont.

In all cases, once the pH goes OVER 7.45,In all cases, once the pH goes OVER 7.45,it is called alkalosis and once the pH goesit is called alkalosis and once the pH goesBELOW7.35, it is called acidosis.BELOW7.35, it is called acidosis.


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Howdoesthe bodymaintain thisHowdoesthe bodymaintain this

delicate balance?delicate balance?

Two body organs accomplish the balanceTwo body organs accomplish the balancebetween carbonic acid and bicarbonatebetween carbonic acid and bicarbonate

The LUNGS control the carbonic acid side ofThe LUNGS control the carbonic acid side ofthe ratio by controlling the bodys level ofthe ratio by controlling the bodys level ofcarbon dioxide.carbon dioxide.

The KIDNEYS control the bicarbonateThe KIDNEYS control the bicarbonate

concentrations by various chemical reactionsconcentrations by various chemical reactionsin the kidney tubules.in the kidney tubules.


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Whatinformation isindicatedin anWhatinformation isindicatedin an

ABG report?ABG report?

An ABG report will have at least theAn ABG report will have at least thefollowing information:following information:

pH: How acid or alkaline the arterial blood ispH: How acid or alkaline the arterial blood is

CO2: The gaseous state of carbonic acid.CO2: The gaseous state of carbonic acid.

HCO3: The amount of bicarbonate dissolvedHCO3: The amount of bicarbonate dissolvedin the arterial bloodin the arterial blood

O2: The pressure exerted by the oxygen thatO2: The pressure exerted by the oxygen thatis dissolved in the arterial bloodis dissolved in the arterial blood

SaO2: Oxygen saturation.SaO2: Oxygen saturation.


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What arethe normalvaluesforWhat arethe normalvaluesfor

ABGs?ABGs? pH: 7.35pH: 7.35 7.457.45

O2: 80O2: 80--100 mm Hg100 mm Hg

SaO2: 95SaO2: 95--100A%100A%

CO2: 35CO2: 35--45 mm Hg45 mm Hg

HCO3: 24HCO3: 24--28 mEq/L28 mEq/L Remember that CO2 and HCO3 determine the arterial pH.Remember that CO2 and HCO3 determine the arterial pH.


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LungsorKidneys?LungsorKidneys?

How do I know if an abnormal pH is due to theHow do I know if an abnormal pH is due to thelungs (respiratory) or to the kidneyslungs (respiratory) or to the kidneys(metabolic)?(metabolic)?

1. Check the pH value. Where is it in comparison to1. Check the pH value. Where is it in comparison tonormal? Alkaline or acid?normal? Alkaline or acid?

2. Check the CO2 value. High CO2 means more of the2. Check the CO2 value. High CO2 means more of thegas is available for conversion to carbonic acid. Lowgas is available for conversion to carbonic acid. Low

CO2 indicates less carbon dioxide is available forCO2 indicates less carbon dioxide is available forconversion to carbonic acid. The CO2 represents theconversion to carbonic acid. The CO2 represents thelungs side of the balance or RESPIRATORY CONTROL.lungs side of the balance or RESPIRATORY CONTROL.


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LungsorKidneyscont.LungsorKidneyscont.

3. Check the HCO3 value. A high value3. Check the HCO3 value. A high valuemeans a large amount of bicarbonatemeans a large amount of bicarbonatebuild up, while a low value indicatesbuild up, while a low value indicates

bicarbonate loss. The HCO3 representsbicarbonate loss. The HCO3 representsthe kidneys side of the balance, metabolicthe kidneys side of the balance, metaboliccontrol.control.

Determine which value (CO2 or HCO3) canDetermine which value (CO2 or HCO3) cancreate the patients pH.create the patients pH.


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ExamplesExamples

Example 1:Example 1:

pH = 7.31 (less than 7.35, so it ispH = 7.31 (less than 7.35, so it isacidosis)acidosis)

CO2 = 50 mm Hg (above 45 mm Hg)CO2 = 50 mm Hg (above 45 mm Hg)

HCO3 = 24 mEq/L (normal)HCO3 = 24 mEq/L (normal)

Conclusion: This is an example ofConclusion: This is an example ofrespiratory acidosis. (Note: a pH of7.31respiratory acidosis. (Note: a pH of7.31could not be caused by a WNL bicarb)could not be caused by a WNL bicarb)


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Example 2Example 2

pH = 7.31 (less that7.35 so acidosis)pH = 7.31 (less that7.35 so acidosis)

CO2 = 44 mm Hg (nl. 35CO2 = 44 mm Hg (nl. 35--45)45)

HCO3 = 20 mEq/L (less than nl of 24HCO3 = 20 mEq/L (less than nl of 24--28)28)

This is an example of metabolic acidosis.This is an example of metabolic acidosis.

(Note: this is the same pH as the first(Note: this is the same pH as the firstexample, but it is due to too littleexample, but it is due to too littlebicarbonate).bicarbonate).


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Example 3Example 3

pH = 7.48 (more than 7.45 so it ispH = 7.48 (more than 7.45 so it isalkalosis)alkalosis)

CO2 = 33 mm Hg (below 35)CO2 = 33 mm Hg (below 35)

HCO3 = 24 mEq/L (normal)HCO3 = 24 mEq/L (normal)

Conclusion: Respiratory alkalosis. (Note: aConclusion: Respiratory alkalosis. (Note: apH of7.45 could not be caused by a WNLpH of7.45 could not be caused by a WNLbicarb).bicarb).


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Example 4Example 4

pH = 7.48 (more than 7.45, alkalosis)pH = 7.48 (more than 7.45, alkalosis)

CO2 = 43 mm Hg (nl 35CO2 = 43 mm Hg (nl 35--45)45)

HCO3 = 33mEq/L (nl is 24HCO3 = 33mEq/L (nl is 24--28)28)

Conclusion: Metabolic alkalosis. (Note: thisConclusion: Metabolic alkalosis. (Note: this

is the same pH as the third example, but itis the same pH as the third example, but itis due to too much bicarb.)is due to too much bicarb.)


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CompensationCompensation

Can I tell by looking at an ABG report ifCan I tell by looking at an ABG report ifthe body is attempting to get the pH backthe body is attempting to get the pH backinto balance?into balance?

YES. As one system goes out of balance, theYES. As one system goes out of balance, theother system kicks in to restore and maintainother system kicks in to restore and maintainthe all important ratio of 1 part carbonic acidthe all important ratio of 1 part carbonic acidto 20 parts bicarbonate.to 20 parts bicarbonate.

The four examples that we just examined areThe four examples that we just examined areuncompensated situations.uncompensated situations.


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Compensation cont.Compensation cont.

The following is an example of aThe following is an example of acompensated situation:compensated situation:

pH = 7.4pH = 7.4

CO2 = 60 mm HgCO2 = 60 mm Hg

HCO3 = 37 mEq/LHCO3 = 37 mEq/L

Note that the carbon dioxide and bicarb values areNote that the carbon dioxide and bicarb values are

both abnormal, but the pH isW

NL. In this case,both abnormal, but the pH isW

NL. In this case,the kidneys are retaining bicarbonate to counterthe kidneys are retaining bicarbonate to counterthe lungs retention of carbon dioxide, this keepingthe lungs retention of carbon dioxide, this keepingthe 1:20 ratio and a pH that is WNL.the 1:20 ratio and a pH that is WNL.

ff


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When should I be alertforpossibleWhen should I be alertforpossible

acidacid--baseimbalance?baseimbalance?

When the pH has a metabolic etiology, the pHWhen the pH has a metabolic etiology, the pHvalues and the bicarbonate value go together;values and the bicarbonate value go together;thus, high pH plus high HCO3 in metabolicthus, high pH plus high HCO3 in metabolic

alkalosis and low pH plus low HCO3 in metabolicalkalosis and low pH plus low HCO3 in metabolicacidosis.acidosis.

When the imbalance has a respiratory etiology,When the imbalance has a respiratory etiology,the pH value and the carbon dioxide values arethe pH value and the carbon dioxide values are

opposite; thus, low pH and high CO2 inopposite; thus, low pH and high CO2 inrespiratory acidosis and high pH and low CO2 inrespiratory acidosis and high pH and low CO2 inrespiratory alkalosis.respiratory alkalosis.


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Memory Tip!Memory Tip!

MeTROMeTRO

MetabolicMetabolic

TogetherTogether RespiratoryRespiratory

OppositeOpposite


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FourAcid Base ImbalancesFourAcid Base Imbalances

1. Metabolic acidosis: pH less than 7.35,1. Metabolic acidosis: pH less than 7.35,HCO3 will be low.HCO3 will be low.

Common etiologies: Diabetic acidosis, shock,Common etiologies: Diabetic acidosis, shock,

renal failure, intestinal fistulas, lactic build uprenal failure, intestinal fistulas, lactic build upas in cardiac arrest.as in cardiac arrest.

Assessment findings: Apathy, disorientation,Assessment findings: Apathy, disorientation,

weakness, stupor, coma, Kussmaulsweakness, stupor, coma, Kussmaulsrespiration.respiration.


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FourAcid Base Imbalancescont.FourAcid Base Imbalancescont.

2. Metabolic alkalosis: pH more than 7.45,2. Metabolic alkalosis: pH more than 7.45,HCO3 will be elevated.HCO3 will be elevated.

Common etiologies: Nasogastric drainage,Common etiologies: Nasogastric drainage,

prolonged vomiting.prolonged vomiting.

Assessment findings: Shallow and slowAssessment findings: Shallow and slowrespirations, lethargy, irritability, tetany,respirations, lethargy, irritability, tetany,

convulsionsconvulsions


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FourAcid Base ImbalancescontFourAcid Base Imbalancescont

3. Respiratory acidosis: pH less than 7.35,3. Respiratory acidosis: pH less than 7.35,CO2 will be elevated.CO2 will be elevated.

Common etiologies: respiratory depressionCommon etiologies: respiratory depression

(drugs, CNS trauma, any condition leading to(drugs, CNS trauma, any condition leading tohypoventilation), COPD, pneumoniahypoventilation), COPD, pneumonia

Assessment findings: Dyspnea, disorientation,Assessment findings: Dyspnea, disorientation,

tachycardia, arrhythmiastachycardia, arrhythmias


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FourAcid Base ImbalancescontFourAcid Base Imbalancescont

4. Respiratory alkalosis: pH more than4. Respiratory alkalosis: pH more than7.45, CO2 will be low.7.45, CO2 will be low.

Common etiologies: any situation leading toCommon etiologies: any situation leading to

hyperventilation (emotions, pain, respiratorhyperventilation (emotions, pain, respiratoroverventilation).overventilation).

Assessment findings: Lightheadedness,Assessment findings: Lightheadedness,inability to concentrate, numbness andinability to concentrate, numbness andtingling, loss of consciousness.tingling, loss of consciousness.



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# 2# 2 Example 2Example 2

ABG ValueABG Value


RationaleRationale

pHpH

7.27.2

Step 1Step 1

LowLow pHpH indicatesindicates

acidosisacidosis PaCO2PaCO2

5050

Step 2Step 2

HighHigh PaCO2PaCO2indicates respiratoryindicates respiratory

cause for acidosiscause for acidosis InterpretationInterpretation

respiratoryrespiratoryacidosisacidosis



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# 3# 3 ABG ValueABG Value


RationaleRationale

pHpH

7.497.49

Step 1Step 1

HighHigh pHpH indicatesindicatesalkalosisalkalosis

LowLow PaCO2PaCO2 indicatesindicatesrespiratory cause forrespiratory cause foralkalosis (lo respiratoryalkalosis (lo respiratoryacid is causing higher pH)acid is causing higher pH)

PaCO2PaCO2

3030

Step 2Step 2

LowLow PaCO2PaCO2 indicatesindicates

respiratory cause forrespiratory cause foralkalosis (lo respiratoryalkalosis (lo respiratoryacid is causing higher pH)acid is causing higher pH)

InterpretationInterpretation

respiratory alkalosisrespiratory alkalosis



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RationaleRationale

pHpH

7.237.23

Step 1Step 1

LowLow pHpH indicatesindicatesacidosisacidosis

PaCO2PaCO2

3131

Step 2Step 2

LowLow PaCO2PaCO2 rules outrules outrespiratory cause forrespiratory cause for

acidosis, thereforeacidosis, thereforemetabolic cause. Lowmetabolic cause. Lowrespiratory acid isrespiratory acid iscompensating for lowercompensating for lowerpH.pH.


metabolic acidosismetabolic acidosis



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RationaleRationale

pHpH 7.487.48

Step 1Step 1

HighHigh pHpH indicatesindicates

alkalosisalkalosis PaCO2PaCO2

4747

Step 2Step 2

HighHigh PaC02PaC02 and Highand HighpHpH indicates metabolicindicates metaboliccause of alkalosis.cause of alkalosis.

Respiratory acid isRespiratory acid iscompensating for highcompensating for highpH.pH.


Partially compensatedPartially compensatedmetabolic alkalosismetabolic alkalosis



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RationaleRationale

pHpH

7.437.43

Step 1Step 1

pHpH is normal but higheris normal but higherthan 7.4, thereforethan 7.4, therefore

compensated alkalosis.compensated alkalosis. PaCO2PaCO2

3333

Step 2Step 2

LowLow PaCO2PaCO2 causescausesalkalosisalkalosis


CompensatedCompensatedrespiratoryrespiratoryalkalosisalkalosis


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ACID BASE CASE STUDY # 1ACID BASE CASE STUDY # 1

Mrs. Puffer is a 35Mrs. Puffer is a 35--yearyear--old single mother, just getting off the nightold single mother, just getting off the nightshift. She reports to the ED in the early morning with shortness ofshift. She reports to the ED in the early morning with shortness ofbreath. She has cyanosis of the lips. She has had a productive coughbreath. She has cyanosis of the lips. She has had a productive coughfor 2 weeks. Her temperature is 102.2, blood pressure 110/76, heartfor 2 weeks. Her temperature is 102.2, blood pressure 110/76, heartrate 108, respirations 32, rapid and shallow. Breath sounds arerate 108, respirations 32, rapid and shallow. Breath sounds arediminished in both bases, with coarse rhonchi in the upper lobes.diminished in both bases, with coarse rhonchi in the upper lobes.

Chest XChest X--ray indicates bilateral pneumonia.ray indicates bilateral pneumonia. ABG results are:ABG results are:

pH= 7.44pH= 7.44

PaCO2= 28PaCO2= 28

HCO3= 24HCO3= 24

PaO2= 54PaO2= 54

Problems:Problems:

PaCO2 is low.PaCO2 is low.

pH is on the high side of normal, thereforepH is on the high side of normal, therefore compensated respiratorycompensated respiratoryalkalosis.alkalosis.

Also, PaO2 is low, probably due to mucous displacing air in the alveoliAlso, PaO2 is low, probably due to mucous displacing air in the alveoliaffected by the pneumoniaaffected by the pneumonia


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ACID BASEACID BASE

Solutions:Solutions: Mrs.Puffermostlikely has ARDS alongwith herpneumonia.Mrs.Puffermostlikely has ARDS alongwith herpneumonia.

The alkalosis need not betreateddirectly. Mrs.PufferisThe alkalosis need not betreateddirectly. Mrs.Pufferishyperventilatingtoincreaseoxygenation, which isincidentallyhyperventilatingtoincreaseoxygenation, which isincidentally

blowingoffCO2. ImproveP

aO2 and a normalrespiratoryrateblowingoffCO2. ImproveP

aO2 and a normalrespiratoryrateshould normalizethepH.should normalizethepH.

High FiO2 can help, butifshe hasinterstitiallungfluid, shemayHigh FiO2 can help, butifshe hasinterstitiallungfluid, shemayneedintubation andPEEP, ora BiPAPtoraise herPaO2.needintubation andPEEP, ora BiPAPtoraise herPaO2.

Expectordersforantibiotics, andpossiblysteroidal antiExpectordersforantibiotics, andpossiblysteroidal anti--inflammatory agents.inflammatory agents.

Chestphysiotherapy andvigorouscoughingorsuctioningwill helpChestphysiotherapy andvigorouscoughingorsuctioningwill helpthepatientclearherairwaysofexcessmucous andincreasethethepatientclearherairwaysofexcessmucous andincreasethenumberoffunctioning alveoli.numberoffunctioning alveoli.


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Case 2Case 2 Mr. Worried is a 52Mr. Worried is a 52--yearyear--old widow. He is retired and living alone. Heold widow. He is retired and living alone. He

enters the ED complaining of shortness of breath and tingling inenters the ED complaining of shortness of breath and tingling infingers. His breathing is shallow and rapid. He denies diabetes; bloodfingers. His breathing is shallow and rapid. He denies diabetes; bloodsugar is normal. There are no EKG changes. He has no significantsugar is normal. There are no EKG changes. He has no significant

respiratory or cardiac history. He takes several antianxietyrespiratory or cardiac history. He takes several antianxietymedications. He says he has had anxiety attacks before. While beingmedications. He says he has had anxiety attacks before. While beingworked up for chest pain an ABG is done:worked up for chest pain an ABG is done:

ABG results are:ABG results are:

pH= 7.48pH= 7.48

PaCO2= 28PaCO2= 28

HCO3= 22HCO3= 22 PaO2= 85PaO2= 85

Problem:Problem:

pH is high,pH is high,

PaCO2 is lowPaCO2 is low

respiratory alkalosis.respiratory alkalosis.


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ACID BASE CASE STUDYACID BASE CASE STUDY

Solution:Solution:

Ifheis hyperventilatingfrom an anxiety attack,Ifheis hyperventilatingfrom an anxiety attack,thesimplestsolution isto have him breatheintothesimplestsolution isto have him breatheintoa paperbag. Hewillrebreathesomeexhaleda paperbag. HewillrebreathesomeexhaledCO2.ThiswillincreasePaCO2 andtriggerhisCO2.ThiswillincreasePaCO2 andtriggerhisnormalrespiratorydrivetotakeoverbreathingnormalrespiratorydrivetotakeoverbreathingcontrol.control.

* Please notethiswill* Please notethiswillnot worknot work on a person withon a person withchronic CO2 retention, such as a COPD patient.chronic CO2 retention, such as a COPD patient.Thesepeopledevelop a hypoxicdrive, anddoThesepeopledevelop a hypoxicdrive, anddonotrespondto CO2 changes.notrespondto CO2 changes.


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You arethecriticalcare nurse abouttoreceive Mr. Sweet, a 24You arethecriticalcare nurse abouttoreceive Mr. Sweet, a 24--yearyear--oldoldDKA (diabeticketoacidosis)patientfromthe ED. ThemedicaldiagnosistellsDKA (diabeticketoacidosis)patientfromthe ED. Themedicaldiagnosistellsyoutoexpect acidosis. In reportyoulearn that his bloodglucoseon arrivalyoutoexpect acidosis. In reportyoulearn that his bloodglucoseon arrivalwas 780. He has been startedon an insulin drip and hasreceivedone ampwas 780. He has been startedon an insulin drip and hasreceivedone ampofbicarb. Youwill bedoingfingerstick bloodsugarsevery hour.ofbicarb. Youwill bedoingfingerstick bloodsugarsevery hour.

ABG results are:ABG results are:

pH= 7.33pH= 7.33

PaCO2= 25PaCO2= 25

HCO3=12HCO3=12

PaO2= 89PaO2= 89

Problem:Problem:

ThepH is acidotic,ThepH is acidotic, PaCO2 is 25 (low)which shouldcreate alkalosis.PaCO2 is 25 (low)which shouldcreate alkalosis.

Thisis aThisis a respiratory compensationrespiratory compensation fortheforthemetabolic acidosismetabolic acidosis..

Theunderlyingproblemis, ofcourse, aTheunderlyingproblemis, ofcourse, a metabolic acidosismetabolic acidosis..


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ACID BASEACID BASE

Solution:Solution:

Insulin, sothe bodycan usethesugarinInsulin, sothe bodycan usethesugarin

the blood andstopmakingketones, whichthe blood andstopmakingketones, which

are an acidic byare an acidic by--productofproteinproductofprotein

metabolism.metabolism.

In themean time, pH should beIn themean time, pH should be

maintained nearnormalsothatmaintained nearnormalsothatoxygenation is notcompromisedoxygenation is notcompromised

oral administrationoral administration


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To provideimmediate accessTo provideimmediate access

tothevascularsystemforrapidtothevascularsystemforrapiddeliveryofspecificsolutionsdeliveryofspecificsolutions

withoutthetimerequiredforGIwithoutthetimerequiredforGI

tract absorptiontract absorption

Toprovide a vascularrouteforToprovide a vascularroutefor

the administration ofthe administration ofmedication orbloodmedication orblood

componentscomponents


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TYPES OF SOLUTIONSTYPES OF SOLUTIONS

IsotonicIsotonic

Has the same osmolality as body fluidsHas the same osmolality as body fluids

No osmotic force to shift the fluids so itNo osmotic force to shift the fluids so it

does not enter the cellsdoes not enter the cells Increeases extracellular fluid volumeIncreeases extracellular fluid volume

EXAMPLE:EXAMPLE: 9% NS, Ringers Lactate9% NS, Ringers Lactate


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SolutionstypesSolutionstypes

HypotonicHypotonic

Solutions that are more dilute or have aSolutions that are more dilute or have alower osmolality than body fluidslower osmolality than body fluids

Dilute extracellular fluid and causeDilute extracellular fluid and causemovement of water into cells by osmosismovement of water into cells by osmosis

These solutions whould be administeredThese solutions whould be administered

slowly to prevent cellular edemaslowly to prevent cellular edema EXAMPLES: 0.45% saline, 0.33% or 1/3EXAMPLES: 0.45% saline, 0.33% or 1/3

NS,NS,


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Solution TypesSolution Types

HYPERTONICHYPERTONIC

Solutions that are more concentrated orSolutions that are more concentrated orhave a higher osmolality than body fluidshave a higher osmolality than body fluids

Concentrate ECF and cause movement ofConcentrate ECF and cause movement ofwater from cells into the ECF by osmosiswater from cells into the ECF by osmosis

EXAMPLES: 3% and 5% NS, D5 LREXAMPLES: 3% and 5% NS, D5 LR


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Solution TypesSolution Types

ColloidsColloids

Plasma expandersPlasma expanders

Pull fluid from the interstitial compartmentPull fluid from the interstitial compartment

Into the vascular compartmentInto the vascular compartment

Used to increase the vascular volume rapidly,Used to increase the vascular volume rapidly,

such as in hemorrhage or severe hypovolemiasuch as in hemorrhage or severe hypovolemia EXAMPLES: DEXTRAN, ALBUMINEXAMPLES: DEXTRAN, ALBUMIN


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Intravenous DevicesIntravenous Devices

IV cannulasIV cannulas

1. Steel needles or butterfly sets1. Steel needles or butterfly sets

A. Wing tip needle with a metal cannula, plasticA. Wing tip needle with a metal cannula, plastic

or rubber wing or a plaster catheter or hubor rubber wing or a plaster catheter or hub B. Needle is 0.5 to 1.5 mm in length withB. Needle is 0.5 to 1.5 mm in length with

needle gauge sizes from 16 to 26needle gauge sizes from 16 to 26

C. Used when the infusion time will be shortC. Used when the infusion time will be short

INFILTRATION is more common with this typeINFILTRATION is more common with this type Us for children and elderly or for those withUs for children and elderly or for those with

fragile veinsfragile veins


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IntravenousdevicesIntravenousdevices

Plastic cannulasPlastic cannulas

A. May be either an over the needle device orA. May be either an over the needle device oran in needle catheteran in needle catheter

B. Over the needle consists of a plastic catheterB. Over the needle consists of a plastic cathetermounted over a needle. After venipuncture, themounted over a needle. After venipuncture, thecatheter is guided off the needle and into thecatheter is guided off the needle and into theveinvein

Used for rapid infusion. Is more comfortableUsed for rapid infusion. Is more comfortable Can cause embolism if the tip of the cannulaCan cause embolism if the tip of the cannula

breaksbreaks

For short term therapyFor short term therapy


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IntravenousdevicesIntravenousdevices

IV GAUGESIV GAUGES

The smaller the gauge the larger theThe smaller the gauge the larger thediameter of the cannuladiameter of the cannula

The size used depends on the solution toThe size used depends on the solution tobe infused and the size of the veinsbe infused and the size of the veins

Larger gauges allow a higher fluid rateLarger gauges allow a higher fluid rate

than smaller ones and allow administrationthan smaller ones and allow administrationof higher concentrations of solutionsof higher concentrations of solutions


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EMERGENCY INFUSIONSEMERGENCY INFUSIONS

For rapid emergency fluid administrationFor rapid emergency fluid administration

Such as blood products or anesthetics useSuch as blood products or anesthetics usea large gauge such as 14,16, 18, 19 gaugea large gauge such as 14,16, 18, 19 gaugeneedleneedle

If veins are small use 22 or a 24 gaugeIf veins are small use 22 or a 24 gauge

unless blood or a thick substance is beingunless blood or a thick substance is beinginfuseinfuse


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STANDARD INFUSIONSTANDARD INFUSION

For standard infusionFor standard infusion

Use 22 or 24

gaugeUse 22 or 24

gauge

If the client has very small veins use 24If the client has very small veins use 24 25 gauge25 gauge


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Intravenous ContainersIntravenous Containers

May be glass or plasticMay be glass or plastic

Squeeze plastic bag to be sure it is intactSqueeze plastic bag to be sure it is intact

Assess glass bottles for cracksAssess glass bottles for cracks

Do not write on the plastic IV bage withDo not write on the plastic IV bage withmarkers or pen because it could seepmarkers or pen because it could seepthroughthrough

Write on label then place it on the bagWrite on label then place it on the bag


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TUBINGTUBING

Vented and nonvented tubingVented and nonvented tubing

A vent allows air to enter the IV container as theA vent allows air to enter the IV container as the

fluid leaves.fluid leaves. A vented adapter can be used to add a vent to aA vented adapter can be used to add a vent to a

nonvented IV tubing systemnonvented IV tubing system

Use nonvented tubing for flexible containersUse nonvented tubing for flexible containers

Use vented tubing for glass or nonflexibleUse vented tubing for glass or nonflexiblecontainers to allow air to enter and displace thecontainers to allow air to enter and displace thefluid s it leaves. FLUIDS WILL NOT FLOW FROMfluid s it leaves. FLUIDS WILL NOT FLOW FROM

A RIGID IV CONTAINER UNLESS IT IS VENTEDA RIGID IV CONTAINER UNLESS IT IS VENTED


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TUBINGTUBING

Add extension tubing for children, clientsAdd extension tubing for children, clientswho are restless, or clients who havewho are restless, or clients who havespecial mobility needsspecial mobility needs

Use shorter secondary tubing forUse shorter secondary tubing forpiggyback solution, connecting them topiggyback solution, connecting them to

the injection sites nearest the dripthe injection sites nearest the dripchamber.chamber.


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DRIP CHAMBERSDRIP CHAMBERS

Microdrip chambersMicrodrip chambers

There is a short vertical metal piece where theThere is a short vertical metal piece where thedrop formsdrop forms

Delivers between 50Delivers between 50 60 drops/millimeter60 drops/millimeter READ the tubing pakg to determine how manyREAD the tubing pakg to determine how many

drops per mldrops per ml

Used for slow drips of less than 50 ml/hourUsed for slow drips of less than 50 ml/hour

Used if the solutions contains potentUsed if the solutions contains potentmedications that need to be titrated.medications that need to be titrated.

DRI CHAMBERSDRI CHAMBERS


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DRIP CHAMBERSDRIP CHAMBERS

MacrodripMacrodrip

Drop factor from 8Drop factor from 8 20/ml20/ml

Used if the solution is thickUsed if the solution is thick

Read the tubing package to determine howRead the tubing package to determine howmany drops per ml are delivered or the dropmany drops per ml are delivered or the dropfactorfactor

FILTERSFILTERS


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FILTERSFILTERS

Provide protection by preventing particles fromProvide protection by preventing particles fromentering the clients veinsentering the clients veins

Used in IV lines to trap small particles sucha sUsed in IV lines to trap small particles sucha sundissolved antibiotics or salt, or medicationsundissolved antibiotics or salt, or medicationsthat have precipitated in solutionthat have precipitated in solution

Assess the agency policy regarding the useAssess the agency policy regarding the usefiltersfilters

FILTERSFILTERS


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FILTERSFILTERS

Use a 0.22 micron filter for most solutions,Use a 0.22 micron filter for most solutions,a l.2 micron ilter for solutions containinga l.2 micron ilter for solutions containinglipids or slbumin, and a special filter forlipids or slbumin, and a special filter for

blood componentsblood components

Change filters every 24Change filters every 24 72 hours to72 hours to

prevent bacterial growthprevent bacterial growth

NEEDLESS SYSTEMSNEEDLESS SYSTEMS


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NEEDLESS SYSTEMSNEEDLESS SYSTEMS

Include recessed needles, plasticInclude recessed needles, plasticcannulas, or one way valves, and decreasecannulas, or one way valves, and decrease

The exposure to contaminated needlesThe exposure to contaminated needles

Do not administer total parenteralDo not administer total parenteralnutrition or blood products through a onenutrition or blood products through a one

way valveway valve

INTERMITTENT INFUSIONINTERMITTENT INFUSION


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INTERMITTENT INFUSIONINTERMITTENT INFUSION

SETSSETS Used when intravascular accessibility is desiredUsed when intravascular accessibility is desired

for intermittent administration of medications byfor intermittent administration of medications byeither IV push or IV piggybackeither IV push or IV piggyback

IV lock is attached for intermittent infusionIV lock is attached for intermittent infusiondevicesdevices

Patency is maintained with periodic flushing withPatency is maintained with periodic flushing withNS solut ionNS solut ion

When administering meds flush with 1When administering meds flush with 1 2 ml of2 ml ofisotonic saline to confirm placement of theisotonic saline to confirm placement of the

cannula then flush again 1cannula then flush again 1 2 ml of saline to2 ml of saline to


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acid base & fluid & electrolytes[1]

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