Exam 1

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Author:
charissa
ID:
131209
Filename:
Exam 1
Updated:
2012-02-01 23:20:58
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MedSurg
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Description:
Electrolytes, Acid Base Balance, Perioperative care
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  1. Normal pH
    7.35-7.45
  2. Normal BiCarb/HCO3
    22-26mEq/L (kidneys/metabolic)

    Alkaline
  3. Normal PCO2
    35-45Hg or Torr (lungs/respiratory)


    acidic
  4. Normal PO2
    80-100mm Hg or Torr (lungs/respiratory)

    acidic
  5. Lung buffering
    If metabolic imbalance; kidneys cannot compensate; Carbonic Acid is broken down into carbon dioxide/CO2 and H2O through fluid buffering, then released by lungs during experation.

    Occurs within minutes but less effective over time.
  6. Kidney buffering
    If respiratory imbalance and lungs cannot compensate; Kidneys excrete(during alkalosis) or retain(during acidosis) bicarb ion in the loop of Henle.

    Response in hrs or day

    EX. If high pH/alkaline kidneys excrete more bicarb and retain more hydrogen
  7. Respiratory Acidosis
    low pH + high CO2

    Causes: COPD, Hypoventilation
  8. Respiratory Alkalosis
    high pH + low CO2

    Causes: hyperventilation, ICU venilation rate set too high
  9. Metabolic Alkalosis
    high pH + high HCO3

    Cause: diuretics...
  10. Metabolic Acidosis
    low pH + low HCO3

    Causes: diabetic, OD on aspirin
  11. 3 types of compensation:
    Total/complete - pH restored to norm

    Partial - pH moves toward normal, but never gets within normal range

    Absent/uncompensated - pH remains abnormal; carbon dioxide/bicarb may not increase or decrease as needed
  12. Intracellular Fluid (IFC)
    found in cells

    essential for normal cell function
  13. Extracellular Fluid (ECF)
    outside cells

    further classified by location

    blood, plasma
  14. osmosis
    lower concentration to higher concentration
  15. hypertonic
    • more ions than normally found in body; loose H2O and shrink
    • more than 295 mOsm/L
    • ex. 3%NS saline
  16. isotonic
    • just like body, neither gain or loose H2O
    • Between 275-295 mOsm/L
    • ex. Lactate Ringers, 0.5% NS
  17. hypotonic
    • absorb H2O and may burst
    • less than 275 mOsm/L
    • ex.
  18. Fluid Volume Def (FVD)
    Cause: internal bleeding; a lot of diuretics; a lot of sweating; vomiting/diahrrea

    Effects: excess skin tugor; low BP; High HR/tachycardia

    Action: rehydration; teach prevention (drink H2O)
  19. Fluid Volume Excess (FVE)
    Cause: heart failure; kidney/renal failure

    Effects: edema; full bounding pulse/tachycardia; hypertension; ascites; low O2 Sat; high urine output

    Action:
  20. hyponatremia
    sodium less than 135 mEq/L

    cause: diuretics

    effect: muscle cramps, weakness, fatique; low sodium = more neurological effects.

    Action: IV slowly (given too high rate = brain swelling)
  21. hypernatremia
    sodium greater then 145 mEq/L

    cause: sodium gained in excess of H2O

    action: give diuretics
  22. hypokalemia
    potassium less than 3.5

    cause: duiretics

    effects: nausea, leg cramps, weakness, low bowel sounds and cardiac output, dsyrhythmias

    action: monitor hrt rate, check for low level before admin diuretics, give by IV no more than 10 me bag through IV (too fast= cardiac arrest)
  23. hyperkalemia
    potassium more than 5.0 mEq/L

    • Causes: renal failure, meds, adrenal insufficiency
    • Effects: dysrhythmia
    • Action: diuretics, Kayexalate (sodium potassium exchange through stool), insulin
  24. hypocalcemia
    • Normal Range: 8.5-10.5
    • calcium below 8.5

    tests: chvostek- muscle twitching when tap portion of cheek in front of ear; and Truso- fingers twitch when pump up cuff on BP.
  25. Magnesium
    • Normal Range: 1.5-2.5
    • Tests for hypomagnesium: Chvostek and Truso
    • hypo = irritability; give mag tablet or IV
    • hyper = flacid; give calcium

    Foods: dark green leafy veggies, chocolate, nuts
  26. Phosphate
    Normal Range: 2.5-4.5

    hypophosphatemia = weakness

    hyperphophatemia = acute renal failure
  27. Chloride
    Normal Range: 96-106
  28. Outpatient
    does not need nursing care; quick recovery time.

    Ex.- cataract removal, hernia, tubal ligation...

    Advantages: low cost, low interruption to life, lower chance of hospital related infection.
  29. Pre-operative Care
    begins when decision for surgery is made until go to surgery.

    Get good history; Labs (CBC, type and cross match, electrolytes, glucose); EKG; chest xray; NPO after midnight, no meds day of surgery except for hypertensive; signed consent form; no dentures, jewelry, bobby pins, polish (note in chart where things were placed).
  30. Intraoperative Care
    During surgery

    sterile environment
  31. Postoperative Care
    admittance to recovery room to go to floor to complete recovery.

    Monitoring stats and BP every few minutes for Aldrete scale (cant leave PACU until at least an 8 out of 10)
  32. Types of Anethesia
    Local

    Regional

    Concious sedation: bersaid, perpoball, versaid
  33. Maligrant Hyperthermia antidote
    Dantrolene
  34. Benzodiazepan and Versaid antidote
    romazican
  35. Narcotic antidote
    Narcan
  36. Antelactasis
    part of the lung collapses and fluid builds

    common in post op patients
  37. evisoration
    intestine spilling out of opened wound

    cover with saline soaked sterile gauze and call Dr.
  38. dehiscence
    opened wound with nothing coming out

    cover with saline soaked sterile gauze and call Dr.
  39. Tubes and drains
    Jackson pratt: connected to compressed small plastic bulb to create suction; soft tube placed in operative site to drain blood and inflammatory fluid post surgery. Has smaller capacity

    Hemovac: wound suction device compressed to provide gentle suction post surgery. Has a larger capacity and can collect blood to give back to patient.

    Penrose Drain: Drains off fluids and blood post surgery
  40. Primary Healing
    sutured and stapled laceration
  41. Secondary Healing
    unsutured laceration; ragged edge
  42. Tertiary Healing
    absess or contaminated wound more likely; tissue regenerated by the granulation process; larger scar
  43. Sodium norms
    135-145
  44. Potassium norms
    3.5-5.0
  45. Magnesium norms
    1.5-2.5
  46. Calcium norms
    8.9-10.1
  47. Phosphorus norms
    2.5-4.5
  48. Chloride norms
    96-106
  49. Chvostek's and Trousseau's Signs
    High Phosphorus

    Low Magnesium

    Low Calcium
  50. Types of anesthesia:
    Local

    General

    Twilight
  51. What is the antidote for Maligrant hyperthermia?
    Dantrolene
  52. Antidote for Narcotics?
    Narcan
  53. Antidote for Benzodiazepans and Versaids?
    Romazicon
  54. Diffusion
    Higher concentration to lower concentration

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