MED SURG 245 Lecture STUDY GUIDE Notes LATEST

MED SURG 245 Lecture STUDY GUIDE Notes
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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

MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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 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




MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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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



MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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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




MED SURG 245 Lecture STUDY GUIDE Notes
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