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an appreciable decrease in respirations may in time produce acidosis an excessive increase in respirations may in time produce alkalosis What is respiratory acidosis? carbonic acid (H2CO3) excess What is respiratory alkalosis? carbonic acid (H2CO3) deficit What is metabolic acidosis? bicarbonate (NaHCO3) deficit What is metabolic alkalosis? bicarbonate (NaHCO3) excess metabolic disturbances affect what in the blood? bicarbonate (NaHCO3) respiratory disturbances affect what in the blood? carbonic acid (H2CO3)
fluid imbalances: dehydration loss of body fluids = increased concentration of solutes in blood & rise in serum Na+ fluid shifts out of cells & into blood to restore balance, causing cells to shrink & not function properly fluid imbalances: hypovolemia Excessive fluid loss (hemorrhage) can progress to hypovolemic shock isotonic fluid loss from extracellular space (third space fluid shifting) fluid imbalances: hypervolemia Excess fluid in extracellular as a result of fluid or sodium retention, excessive intake, or renal failure occurs when comp mechanisms fail to restore fluid balance leads to CHF & pulmonary edema fluid imbalances: water intoxication hypotonic extracellular fluid shifts into cells to attempt to restore balance cells swell normal carbonic acid (PaCo2) range 45 - 35 normal bicarbonate (HcO3) range 22 - 26 sodium range 135 - 145 mEq/L potassium range 3.5-5 mEq/L Magnesium range 1.5-2.5 mEq/L calcium range 8.9-10.1 mg/dL
hemorrhage; trauma, GI ulcer, surgery, inadequate clotting dehydration; vomiting & diarrhea, diuretic therapy, loss of plasma from burns septic shock risk factors broad spectrum antibiotics immunosuppressive therapy burns or other trauma anatomic obstruction Age (V old & V young) diabetes, AIDS Neurogenic shock causes spinal cord injury spinal anesthesia envois system damage ventilation movement of air in and out of the lungs tidal volume movement of air in one breath cheyne strokes breaths are deep then followed by apnea, cycling back to deep breathing due to severe brain pathology such as brain stem herniation Kussmal's breathing breaths are deep, rapid, & labored due to metabolic acidosis, renal failure, diabetic keto acidosis Tracheal breath sounds loud & high pitched over the largest airway & the loudest length of time heard is equal during expiration & inspiration bronchial breath sounds
loud & high pitch harsh & less turbulent & lower in frequency than tracheal expiration is heard longer than inspiration bronchovesicular breath sounds midway in pitch between brachial & vesicular & are heard during inspiration & expiration vesicular breath sounds soft and low pitched heard longer during expiration, heard over most of thorax crackles (rales) indicate fluid, inflammation in airways-snapping sound when airways open- can be heard when airways close too but softer than on inspiration intermitted or discontinuous fine or course wheezes high pitched musical sounds caused by inflammation in narrowing airways or bronchospasm can be heard inspiration & expiration intermittent Stridor heard only during inspiration as air attempt to flow through an obstruction high pitched crowing sound need immediate intervention pleural friction rub indicate inflamed pleural surfaces easily heard on inspiration hold breath to determine it is not pericardial Atelectasis common Respiratory tract disorder associated W/ immobility & the admin of anesthetic agents clients at risk are encouraged to cough and breathe deeply to aid in preventing atelectasis asthma condition characterized by intermittent airway obstruction in response to variety of stimuli
occurs with diminished heart function neurogenic shock occurs with nervous system problem Long standing change of rheumatic heart disease valvular changes lymphoma is a group of cancers that affect which system lymphatic system lymphangitis may result in what red streaks that follow the course of the lymph channels what is a common method used to promote lymphatic drainage and prevent edema in lymphedema elevate the affected part of the body a large amount of edema post mastectomy is due to an accumulation of lymphatic fluid that results from impaired lymph circulation a patient with hypovolemic anemia may experience postural hypotension coagulopathies bleeding disorders that involve platelets or clotting factors an early sign of impeding heart failure the presence of an S3 sound atherosclerosis will result in fatty deposits in the lumen of the arteries it is appropriate to treat atrial fibrillation with a pacemaker false what is blood pressure the force produced by the volume of blood inaiterial walls
normal PH of blood 7.35-7. PH greater than 7 base (alkaline) PH less than 7 Acid if co2 increases, whats the result in ph? it becomes acidic if co2 increases, what does your body do? increases resp rate to remove co what is shock? A failure of the circulatory system to support vital body functions. inadequate tissue perfusion. neurogenic shock Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries. hypovolemic shock shock resulting from blood or fluid loss caused by bleeding/hemorrhage, severe vomiting, severe diarrhea, third-spacing cardiogenic shock Shock caused by inadequate function of the heart, or pump failure. anaphylactic shock
T - Tetany (involuntary contraction of muscles) S - Spasms and stridor sensible fluid loss Measurable and perceived; urine, diarrhea, ostomy, gastric drainage. insensible fluid loss Occurs daily through lungs and skin--cannot be measured for accurate output hypervolemia s/s
- Hypertension
- Bounding pulse
- JVD
- Peripheral edema
- ↑ urine output that is dilute
- Acute, rapid weight gain
- S3 heart sound in adults
- Bulging fontanels in infants
- Crackles on auscultation
- Dyspnea, cough and increased RR
- Mental status changes (headache, confusion, lethargy; seizures possible) what is urine specific gravity? The ratio of weight of a given volume of urine to the weight of the same volume of distilled water at a constant temperature normal urine specific gravity 1.005 - 1. Dehydration - High (concentrated) Overhydration - Low (dilute) Diabetes insipidus - Low (inability to concentrate urine) Diabetes mellitus - High (due to glucose in urine) Chronic kidney disease (CKD) - Fixed, often around 1.010 (loss of concentration ability) Proteinuria (e.g., nephrotic syndrome) - High Heart failure - High (due to reduced perfusion to kidneys) what is creatine
A naturally occurring compound produced by your body that helps muscles produce energy and delays muscle fatigue. normal creatine levels 0.6-1.2 mg/dL high creatine labs are caused by: Kidney Dysfunction, Dehydration, Muscle Damage (Rhabdomyolysis): low creatine labs caused by: Inadequate Diet, Liver or Kidney Disease leads to reduced muscle strength and neurological issues what is fibrin an insoluble protein formed from fibrinogen during the clotting of blood. It forms a fibrous mesh that impedes the flow of blood. dehydration s/s Skin turger Dry mucous membranes Lower urine output and concentrated Sunken eyes Weakness Hypotension what is erythrocytosis Increase or high level of RBCs high altitude long term = high concentration of RBC (less oxygen in atmosphere, body compensates) left vs right sided HF Left sided: Blood backs into lungs, can't fill, CAD and HTN Side effects: Fatigue, activity intolerance, dyspnea, SOB, cough, orthopnea, inspiratory crackles, wheezes, S gallop.
Subcutaneous Emphysema: Air trapped under the skin. Tracheal Injury: Damage to the trachea or surrounding structures. Tracheal Stenosis: Narrowing of the trachea at the site of the tracheostomy. Tracheomalacia: Weakening or collapse of the trachea around the stoma. Granulation Tissue: Excessive tissue growth at the stoma or around the tracheostomy tube. Tube Obstruction: Blockage due to mucus plugs or secretions. Aspiration: Inhalation of saliva or food into the lungs. indications for a tracheostomy
- acute or chronic upper airway obstruction
- edema
- anaphylaxis
- burns
- trauma
- head/neck surgery
- copious secretions
- obstructive sleep apnea refractory to conventional therapy
- the need for long term mechanical ventilation or reconstruction after laryngeal trauma or laryngeal cancer surgery care for a tracheostomy
- Protect from dust/foreign objects/threads of dressing/water
- Inner cannula needs cleaned/replaced at least daily
- PRN suctioning if cannot clear own secretions
- prevent infections
- monitor oxygen what is epistaxis nose bleed some causes of epistaxis
Trauma, inflammatory disorders, structure abnormalities, or bleeding disorders what is emphesema a type of COPD in which alveoli are damaged caused by smoking!! what is ARDS acute respiratory distress syndrome risks for ARDS smoke inhalation, drowning CBC ranges WBC: 4,000 - 11, RBC: 4ish - 6ish Hgb: 12 - 20 Hct: 35 - 50% Lactate: Less than 1 BNP: Below 100 sodium ranges 135 - 145 mEq/L what is a key issue with sodium imabalance? affects your neuro system what is a "chem7"? a blood test that tests for: Sodium (Na⁺): Regulates water balance and nerve and muscle function. Potassium (K⁺): Crucial for heart function and muscle contractions. Chloride (Cl⁻): Helps maintain fluid balance and acid-base balance. Bicarbonate (HCO₃⁻) / CO₂: Reflects acid-base balance and lung function.
calcium - range: 8.5-10.5 mg/dL phsophate range Phosphate range: 2.5-4.5 mg/dL potassium range Potassium - range: 3.5-5.0 mEq/L magnesium range Magnesium - range: 1.5-2.5 mEq/L chloride range Chloride - range: 96-106 mEq/L Hypernatremia (high Na⁺) Causes: Dehydration, diabetes insipidus, excessive salt intake. S/S: Thirst, dry mucous membranes, agitation, restlessness, seizures. sodium - range: 135-145 mEq/L Hypokalemia (low K⁺) Causes: Diuretics, GI losses (vomiting/diarrhea), inadequate intake. S/S: Muscle weakness, cramps, fatigue, arrhythmias, flattened T waves. Potassium - range: 3.5-5.0 mEq/L Hyperkalemia (high K⁺) Causes: Renal failure, acidosis, tissue damage. S/S: Muscle weakness, paresthesia, arrhythmias, peaked T waves, cardiac arrest. Potassium - range: 3.5-5.0 mEq/L Hypocalcemia (low Ca²⁺) Causes: Hypoparathyroidism, vitamin D deficiency, renal disease.
S/S: Tetany, paresthesia, Chvostek's and Trousseau's signs, seizures. calcium - range: 8.5-10.5 mg/dL Hypomagnesemia (low Mg²⁺) Causes: Malnutrition, alcoholism, diuretics, diarrhea. S/S: Tetany, tremors, seizures, arrhythmias, increased DTRs. Magnesium - range: 1.5-2.5 mEq/L Hypermagnesemia (high Mg²⁺) Causes: Renal failure, excessive intake. S/S: Lethargy, muscle weakness, hypotension, bradycardia. Magnesium - range: 1.5-2.5 mEq/L Hypochloremia (low Cl⁻) Causes: GI losses, metabolic alkalosis. S/S: Irritability, muscle cramps, twitching. Chloride - range: 96-106 mEq/L Hyperchloremia (high Cl⁻) Causes: Dehydration, metabolic acidosis. S/S: Weakness, lethargy, deep rapid breathing. Chloride - range: 96-106 mEq/L Metabolic Acidosis (low HCO₃⁻) Causes: Kidney failure, diarrhea, diabetic ketoacidosis. S/S: Kussmaul respirations, fatigue, confusion. Bicarbonate (HCO₃⁻): 22-28 mEq/L
hypercalcemia can make blood clot too easily s/s of excess fluid volume edema, weight gain, high bp, crackles, JVD testing for excess fluid volume !Serum Creatinine and BUN: Can indicate kidney function and fluid retention. Serum Sodium (Na⁺): Hyponatremia may occur due to dilution (dilutional hyponatremia). Hematocrit and Hemoglobin: May be decreased due to hemodilution. Daily Weights and Intake/Output (I&O)!! excess fluid volume treatments it depends on the cause, but in general sodium and water restrictions can help diuretics and vasodilators Venous insufficiency inadequacy of the venous valves and impairment of venous return from the lower limbs (venous stasis), often with edema and sometimes with skin ulcers (particularly at the ankles) Heart failure a chronic condition in which the heart is unable to pump out all of the blood that it receives Lymphatic disorder a condition in which there is an abnormality in the functioning of the lymphatic system, or the system that helps remove waste liquids and excess proteins Lymphedema
swelling due to an abnormal accumulation of lymph fluid within the tissues tx: Compression therapy, manual lymphatic drainage, exercise, skin care. Lymphangitis inflammation of lymph vessels from bacteria Fever, chills, swollen/tender lymph nodes. Red streaks on the skin following lymphatic vessels. how is nonhogkins lymphoma diagnosed Non-Hodgkin lymphoma (NHL) is diagnosed through a combination of tests, including a biopsy, blood tests, CT scan, and PET scan. A biopsy is the only way to confirm a diagnosis. external defibrillation electrical shock applied to the heart via the chest wall used for Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (pVT) - (chaotic irregular rhythm, and a very fast rhythm) it is NOT used for: flatline (use CPR instead) iron supplement side effects
- Nausea
- Constipation
- Black or dark green stools when to discontinue iron Severe gastrointestinal symptoms (e.g., nausea, constipation, diarrhea) may warrant stopping or switching formulations (e.g., slow-release or liquid iron). Serum Ferritin >300 ng/mL or Transferrin Saturation >45%: Indicates potential overload. Lung tidal volume Tidal volume (VT) is the amount of air that moves in and out of the lungs during a normal, relaxed breath. It is a fundamental parameter in respiratory physiology and is crucial for assessing lung function and managing ventilation in patients. typically 500ml per breath
