NUR 490 Mark Klimek Lecture Notes new.

NUR 490 Mark Klimek Lecture Notes new. Mark Klimek Lecture Notes LECTURE 1: Acid Base Balance & Ventilator Interpreting blood gases (remember the rules of the B’s) • If the pH and the bicarb are both in the same direction then it’s metaBolic (Bicarb Both Bolic), if they are in different directions then it is respiratory • If bicarb is normal and the pH is low or high then its respiratory • You will be given 8 values for arterial blood gas, always first look at the pH and the bicarb first • You get acidosis and alkalosis from the pH LABS: ABG’s The normal pH is 7.35-7.45 The normal bicarb is 22-26 (the bicarb years where you make all the decisions [22-26 years old], or 2+2+2=6) The normal CO2 is 35-45 (same as pH) Signs and Symptoms with ABG’s • As the pH goes up so does my patient o If the pH goes up, every system in your body gets more irritable/hyperexcitable • As the pH goes down so does my patient o If the pH goes down, systems in your body shut down • Except for potassium- When pH goes down, potassium goes up • If the pH goes up (alkalosis): you will find irritability, hyperreflexia (3&4), tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure (need suctioning at the bed side because they can seize and aspirate) • If pH goes down (acidosis): hyporeflexia, bradycardia, lethargy, obtunded, paralytic ileus, coma, respiratory arrest (need bag-mask ventilation bag at bedside for respiratory arrest), +1 reflexes • MACkussmal- compensatory and respiratory pattern for only acid base disorder: MAC- Metabolic ACidosis Respiratory Acidosis multiple choice example: What would you see with a patient who is in respiratory acidosis? a. +1 reflex, b. diarrhea, c. adynamic ileus (no movement), d. spasm, e. urinary retention, f. paraxysmol atrial tachycardia, g. second degree lovitz, type 2 heart block (impulse is being slowed), h. hypokalemia LAB: REFLEXES 0&1-hyporeflexia 2-normal 3&4- hyperreflexia EXAMPLE: (In general what do pain meds do? ANSWER: They sedate you, they are CNS depressants: lethargy, lucidity, reflexes at +1, hyporeflexia, obtundent Causes of Acid Base Imbalance • Don’t get signs and symptoms mixed up with causation!!! • What causes something is the opposite of what the signs and symptoms are o EXAMPLE: diarrhea will cause a metabolic acidosis but once you get acidotic, it will shut your bowels down and you will get a paralytic ileus. • The first question you should ask yourself if the scenario involves a lung problem. o Is it a respiratory problem? BUT remember it can still be respiratory acidosis/alkalosis… • Next question you ask yourself… o is the client overventilating or underventilating? o If the patient is overventilating pick alkalosis o If they are underventilating pick acidosis • If the client is overventilating.. it has an attachment to the word- alkalosis (because they are both OVER)… ventilating OVER becomes respiratory ALKALOSIS