NUR2392 Multidimensional Care II Exam 2 Graded A+

NUR2392 Multidimensional Care II Exam 2 Graded A+ Uncompensated pH and one other value is abnormal Partial compensation pH, CO2, and HCO3 are all off Full compensation pH is normal Acidosis reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle. Alkalosis increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation ABG considerations - Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia) - Assess neuro status - Fall precautions Bicarb HC03 kidney compensation (slow and powerful) Respiratory PaC02 Respiratory compensation (fast but limited) Metabolic acidosis causes DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol intoxication Metabolic acidosis signs and symptoms bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin. Metabolic acidosis treatment hydration and medication to treat underlying problems (DKA - give insulin). Metabolic alkalosis causes antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics. Metabolic Alkalosis s/s anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort (muscle weakness). metabolic alkalosis treatment restore fluid/electrolyte imbalances Respiratory acidosis cause Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block. Respiratory acidosis s/s bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin. Respiratory acidosis treatment (Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation. Respiratory alkalosis cause Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage acute pulmonary issues. respiratory alkalosis s/s anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, hyperventilation respiratory alkalosis treatment restore fluid/electrolyte imbalances How do acid/base imbalances affect electrolytes - Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during buffering. - Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when kidney compensation is present - Alkalosis = hypocalcemia and hypokalemia - Acidosis = HYPERkalemia alkalosis hypocalcemia and hypokalemia acidosis HYPERkalemia Upper GI consists of mouth, pharynx, esophagus, stomach, and duodenum. Barret's Epithelium premalignant; columnar epithelium that develops in lower esophagus Zollinger-Ellison syndrome (dumping syndrome) happens in PT with gastrectomy, from rapid emptying of food contents into the small intestine. Dumping syndrome S/S nausea, distension, cramping pains, diarrhea within 15 minutes after eating Leukoplakia thickened, white, firmly attached patches; slightly raised/rounded; most benign Erythroplakia precancerous, red, velvety, the floor of mouth, tongue, palate, mandibular mucosa; difficult to distinguish oral cancer - 90% are squamous cell carcinomas from epithelium surface - Squamous cells are found on the lips, tongue, basal mucosa, and oropharynx - Grow slowly. - Patients who use tobacco products, consume alcohol, have a poor diet, use mouthwash with high alcohol content, and have poor dental hygiene. Early sign of oral cancer - Erythroplasia is early sign - Present on lips, tongue, buccal mucosa, oropharynx oral cancer s/s bleeding from the mouth poor appetite difficulty chewing/swallowing unplanned weight loss thick or absent saliva painless oral lesions RED RAISED ERODED thick/lump in the cheek