NUR 2392 Multidimensional Care II / MDC II

Exam 2

1.    Which system is more powerful when compensating?

-       Kidneys: can result in rapid changes in ECF composition.

Fully triggered for imbalance of several hours to days.

2.    How to evaluate that treatment is working for respiratory acidosis?

-       Maintains adequate gas exchange

-       Arterial pH above 7.2 and closer to 7.35

-       PaO2 level above 90 mmHg or at least 10 mm Hg higher than their admission level

-       PaCO2 levels below 45 mmHg or at least 15 mm Hg below their admission level

3.    Alkalosis pathophysiology

-       Alkalosis is a decrease in the free hydrogen ion level of the blood and is reflected by an arterial blood pH above 7.45.

4.    Metabolic Alkalosis: Base excess in what?

-       Excessive intake bicarbonates, carbonates, acetates, citrates

5.    Cause of acid deficit?

-       Prolonged vomiting, excess cortisol, hyperaldosteronism, thiazide diuretics, prolonged NG suction, loss of gastric fluids.

6.    Hallmark of base excess acidosis?

-       ABG result with ↑ pH and ↑ bicarbonate level with normal O2 and CO2 levels

7.    What is citrate?

-       citrate is an anticoagulant used in blood products that is rapidly metabolized in the liver

8.    The nurse is reviewing the standing orders for a patient who was admitted for evaluation of chest pain. The patient has a history of chronic obstructive pulmonary disease (COPD) and his laboratory results and assessment reveal that he has mild respiratory acidosis. The nurse would question which order?

A. Encourage oral fluids
B. Keep head of bed elevated
C. Oxygen therapy at 4 L/min as needed
D. Bedrest with bathroom privileges only

RATIONALE:

The bedrest order will help the patient conserve energy. The upright position (mid-Fowler's to high-Fowler's position) helps increase lung expansion. Increasing fluid intake may reduce the thickness of lung secretions and assist in their removal. Oxygen therapy helps promote gas exchange for patients with respiratory acidosis. However, use caution when giving oxygen to patients with COPD and CO2 retention as evidenced by a high Paco2 level. The only breathing trigger for these patients is a decreased arterial oxygen level. Giving too much oxygen to these patients decreases their respiratory drive and may lead to respiratory arrest.

9.    acidosis vs alkalosis (picture)

10. A patient is brought to the ed with respiratory depression the patient has a history of COPD what acid-based balance is most likely

-       respiratory acidosis

11. What can happen when blood is rapidly administered?