BN705 EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS GRADED A++ LATEST UPDATE
Blood pH below 7.35
Acidic/Acidotic
Blood pH above 7.45
Alkalotic/Alkalosis
ROME
Respiratory = Opposite
Metabolic = Equal
pH less than 7.35, HCOS less than 22mmol/L =
Metabolic ACIDOSIS
causes: diarrhoea, pancreatic, ketoacidosis
T/m = vol. replacement with saline, correct the cause + electrolytes, monitor.
pH less than 7.35, PaCO2 GREATER than 45mmHg =
Respiratory ACIDOSIS
causes: obstruction, fx body, resp depression, GA, narcotic od, decreased c/o
T/m = maintain a/way, o2 therapy, deep breathing, reverse narcotic
pH over 7.45, PCO3 GREATER than 26mmol/L =
Metabolic ALKALOSIS
causes: gastric fluid losses, transfusion, post diuretic therapy
,T/m = minimise pH rise, treat cause, discont lactate + gastric suctioning, hold antacids,
replace electrolytes, observe muscle spasms.
pH over 7.45, PACO2 LESS than 45mmHg =
Respiratory ALKALOSIS
causes: decreased o2 delivery, CNS stimulation, anxiety/hyperventilation, pain, fever,
trauma, infection, pulmonary disease, oedema
T/m = treat cause
Metabolic alkalosis is caused by
A decrease in H+ production, blood pH above 7.45 and bicarbonate (HCO3) ABOVE
26mmol/L.
Can cause: coma, arrhythmias, death.
Commonly assoc. with hypokalaemia
Most common cause of metabolic alkalosis is
excessive acid loss via the GI tract - vomiting causes loss of hydrochloric acid from
stomach.
Prolonged NG suctioning can cause what ABG imbalance?
Metabolic alkalosis
Metabolic acidosis occurs
when H+ production INCREASES, pH below 7.35 and HCO3 (bicarb) below 22mmol/L.
Depresses the CNS - untreated can lead to ventricular arrhythmias, coma, cardiac
arrest.
Respiratory alkalosis occurs when
CO2 elimination INCREASES aka too much CO2 lost
,commonly caused by: hyperventilation, conditions increasing RR and depth,
hypercapnia, liver failure, PE, hypotension
Respiratory acidosis results from
compromise in breathing, characterised by alveolar hypoventilation = body unable to rid
CO2 = hypercapnia
caused by: hypoventilation, neuromuscular disorders affecting resp drive, lung
diseases, chest-wall trauma, a/way obstruction, drugs depressing resp centre.
NG effects on pH
prolonged vomiting or NG suctioning - metabolic alkalosis. gastric secretions have
HIGH H+ levels - so as acid is lost, the pH level of blood INCREASES
Crystalloid fluids/therapy
aqueous solution of mineral salts/or other water-soluble molecules - low osmotic
pressure in blood (haemodilution)
Crystalloid solutions
-Saline: most common, isotonic - does not cause dangerous fluid shifts, used for ECF
replacement - not suitable for HF/oedema pts (o2 carrying capacity is decreased)
-Dextrose: hypoglycaemic or hypernatremia - becomes hypotonic when glucose
metabolised so can cause fluid o/load.
-Hartmann's: solution of multiple electrolytes (Na+, chloride, lactate, K+, Ca+) - used in
haemorrhage, trauma, surgery, burns, and to buffer ACIDOSIS
Colloid fluids/therapy
mix of larger insoluble molecules (BLOOD IS ONE) - preserve a HIGH colloid-osmotic
pressure in blood.
, Colloid solutions include
-Albumin - 40g/100mL - liver diseases, severe sepsis, extensive surgeries.
-Albumin - 200g/100mL - haemorrhage/plasma loss due to burns, crush injuries,
peritonitis, pancreatitis, haemodialysis.
-Polygeline - gelatine cross linked urea - dehydration due to GI upset
(vomiting/diarrhoea)
Nursing responsibilities when transfusing blood
-Trf 1 unit @ a time
-Ensure consent form signed
-NO other meds/fluids trf in the SAME line
-ONLY SALINE can be given @ same time - other fluids cause clumping
-2 RNS verify order, ID, blood bank info, exp dates - all must match before product
given
-Start transfusion slowly 2mL/min for 1st 15mins - stay at pts bedside - if tolerated, rate
may be increased
Type O is the universal
DONOR
Type AB is the universal
RECIPIENT
S&S of blood transfusion reaction include
sweating, chills, chest pain, SOB, headache, back pain, N+V, itching, rash.
STOP transfusion immediately - notify Dr, monitor VS every 5 mins, meds as
appropriate for symptoms, labs, document.
SOLUTIONS GRADED A++ LATEST UPDATE
Blood pH below 7.35
Acidic/Acidotic
Blood pH above 7.45
Alkalotic/Alkalosis
ROME
Respiratory = Opposite
Metabolic = Equal
pH less than 7.35, HCOS less than 22mmol/L =
Metabolic ACIDOSIS
causes: diarrhoea, pancreatic, ketoacidosis
T/m = vol. replacement with saline, correct the cause + electrolytes, monitor.
pH less than 7.35, PaCO2 GREATER than 45mmHg =
Respiratory ACIDOSIS
causes: obstruction, fx body, resp depression, GA, narcotic od, decreased c/o
T/m = maintain a/way, o2 therapy, deep breathing, reverse narcotic
pH over 7.45, PCO3 GREATER than 26mmol/L =
Metabolic ALKALOSIS
causes: gastric fluid losses, transfusion, post diuretic therapy
,T/m = minimise pH rise, treat cause, discont lactate + gastric suctioning, hold antacids,
replace electrolytes, observe muscle spasms.
pH over 7.45, PACO2 LESS than 45mmHg =
Respiratory ALKALOSIS
causes: decreased o2 delivery, CNS stimulation, anxiety/hyperventilation, pain, fever,
trauma, infection, pulmonary disease, oedema
T/m = treat cause
Metabolic alkalosis is caused by
A decrease in H+ production, blood pH above 7.45 and bicarbonate (HCO3) ABOVE
26mmol/L.
Can cause: coma, arrhythmias, death.
Commonly assoc. with hypokalaemia
Most common cause of metabolic alkalosis is
excessive acid loss via the GI tract - vomiting causes loss of hydrochloric acid from
stomach.
Prolonged NG suctioning can cause what ABG imbalance?
Metabolic alkalosis
Metabolic acidosis occurs
when H+ production INCREASES, pH below 7.35 and HCO3 (bicarb) below 22mmol/L.
Depresses the CNS - untreated can lead to ventricular arrhythmias, coma, cardiac
arrest.
Respiratory alkalosis occurs when
CO2 elimination INCREASES aka too much CO2 lost
,commonly caused by: hyperventilation, conditions increasing RR and depth,
hypercapnia, liver failure, PE, hypotension
Respiratory acidosis results from
compromise in breathing, characterised by alveolar hypoventilation = body unable to rid
CO2 = hypercapnia
caused by: hypoventilation, neuromuscular disorders affecting resp drive, lung
diseases, chest-wall trauma, a/way obstruction, drugs depressing resp centre.
NG effects on pH
prolonged vomiting or NG suctioning - metabolic alkalosis. gastric secretions have
HIGH H+ levels - so as acid is lost, the pH level of blood INCREASES
Crystalloid fluids/therapy
aqueous solution of mineral salts/or other water-soluble molecules - low osmotic
pressure in blood (haemodilution)
Crystalloid solutions
-Saline: most common, isotonic - does not cause dangerous fluid shifts, used for ECF
replacement - not suitable for HF/oedema pts (o2 carrying capacity is decreased)
-Dextrose: hypoglycaemic or hypernatremia - becomes hypotonic when glucose
metabolised so can cause fluid o/load.
-Hartmann's: solution of multiple electrolytes (Na+, chloride, lactate, K+, Ca+) - used in
haemorrhage, trauma, surgery, burns, and to buffer ACIDOSIS
Colloid fluids/therapy
mix of larger insoluble molecules (BLOOD IS ONE) - preserve a HIGH colloid-osmotic
pressure in blood.
, Colloid solutions include
-Albumin - 40g/100mL - liver diseases, severe sepsis, extensive surgeries.
-Albumin - 200g/100mL - haemorrhage/plasma loss due to burns, crush injuries,
peritonitis, pancreatitis, haemodialysis.
-Polygeline - gelatine cross linked urea - dehydration due to GI upset
(vomiting/diarrhoea)
Nursing responsibilities when transfusing blood
-Trf 1 unit @ a time
-Ensure consent form signed
-NO other meds/fluids trf in the SAME line
-ONLY SALINE can be given @ same time - other fluids cause clumping
-2 RNS verify order, ID, blood bank info, exp dates - all must match before product
given
-Start transfusion slowly 2mL/min for 1st 15mins - stay at pts bedside - if tolerated, rate
may be increased
Type O is the universal
DONOR
Type AB is the universal
RECIPIENT
S&S of blood transfusion reaction include
sweating, chills, chest pain, SOB, headache, back pain, N+V, itching, rash.
STOP transfusion immediately - notify Dr, monitor VS every 5 mins, meds as
appropriate for symptoms, labs, document.
