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- Asses oxygenation and acid base balance
- used to measure PaCO2
- regulated by lungs
Respiratory conditions that effect PH
Acidosis: hypoventilation, asthma, copd, embolism, CABG surgery, hypoxia, ventilatory management
Alkalosis: hyperventilating, panic attacks, head injury possible, fever, salicylate poisoning impairs cellular respiration.
Metabolic conditions that effect PH
- acidosis: ingestion of salicylates, ethylene glycol, uncontrolled DM, Starvation, Shock, Renal disease.
- alkalosis: protracted vomiting, excessive antacids, excessive bicarb admin.
PaCO2 value=respiratory low value is basic, high value is acidic.
- Normal value: 40
- Acceptable 35-45
- <35 is alkalosis
- >45 acidosis
HCO3=metabolic low value is acidic, high value is basic
- Kidney regulation of PH indicated by Bicarbonate.
- HCO3- main base for regulation of PH
- METABOLIC CONTROL
- Normal: 24
- Acceptable: 22-26
- <22: acidosis
- >26: alkalosis
- Bicarb-carbonic acid buffer
- Protein buffer: hemoglobin
- phosphate buffer
- Resp rate will compensate sooner (12min or less) than metabolic (48-72h).
Determining Origin of PH imbalance
- PaCO2 and HCO3
- abnormal results indicate imbalance of respiratory or metabolic origin.
PH Panic values=Death
<6.8 or >7.8
PH tic tac toe
PaCO2: 35-45 H: acid, L: basic
HCO3: 22-26 H: basic, L: acid
Diagnostic test results for pnemonia
- CBC: elevated wbc to 12,500. neutrophils 80%=bacterial
- Cx Xray: infiltrates in lungs
- sputum culture results-takes 24-48 hours
- Blood culture: organism invaded the bloodstream? sepsis?
- ABG: O2 status, respiratory compromise.
Risk factors for pneumonia
- rib fractures
COPD Risk factors
- environmental factors
- genetic predisposition
- Malnutrition or poor diet
- Chronic bronchitis
RSV-respiratory syncytial virus-manifests-bronchiolitis
- invades mucosal cells that line the small bronchi or bronchioles.
- infected cells die and fuse with healthy cells creating large masses of syncytia.
- Most individuals <2 years
RR for Pediatrics
- newborn 30-60
- 1 year: 20-40
- 3 year: 20-30
- 6 year: 16-22
- 10 year: 16-20
Croup Causative organisms
- Viruses: parainfluenza, adenovirus, RSV & measles
- Bacteria: staphylococcus, hemophilus influenzae
- S/S stridor
- Incubation: 18-72 hours
- S/S: Headache, fever, malaise, arthralgia, vomiting, cough, rhinorrhea
- info: inflammation of nasal or mucous membranes, epithelial necrosis leads to secondary infection-pneumonia.
- Droplet precautions
- altered immune system can allow inactive TB to progress in elderly or HIV/immunosuppression
- macrophages attack bacterium in alveoli walling them off in tubercules.
Inactive vs active TB
- Inactive: is latent-positive skin test, but no S&S and not contagious. risk for developing disease later in life.
- Active: Chronic cough, hemoptysis, malaise or cachexia, night sweats.
TB diagnosis? test?
- smear for acid fast bacillus-dyes the waxy coating and Cx X-ray.
- TB test: Mantoux-PPD
TB Treatment Latent
- INH & rifampin
- pyrazinamide + ethambutol
- Different drug combinations take longer
- There is a 12 dose treatment for latent TB
TB treatment active
- infectious for first 2-3 weeks of treatment
- takes 6-9months for treatment
- can spread through blood to other organs.
Bacille Calmette-Guerin not used in the U.S and it's 85% effective
uncomp. Met. Alkalosis
Uncompensated Respiratory acidosis
Fully compensated respiratory acidosis
Partially compensated respiratory alkalosis
Large use of Alka-Seltzer leads to?
Extreme dieting/starvation leads to?
COPD can lead to what type of PH imbalance?
Salicylate poisoning can lead to?
Respiratory alkalosis and metabolic acidosis
- Used to measure plasma CO2; done as part of electrolyte panel
- regulated by kidneys
- present in main for of Bicarb
Sputum culture results?
- 24 hours for initial culture for gram positive or negative.
- 48 hours to ID the pathogen. Strep/staph etc.
ANA Key response?
Treatment of human responses
- Heavy sputum, pleuritic pain
- patchy consolidation
- Variable sputum production, no pain
Alveolar or interstitial pneumonia
- usually viral
- fever pattern varies
- influenza A&B
Rapid Response Indicators
if they decrease?
- RR < 8
- HR < 40
- SBP < 71-80
- No longer responds to voice
- Temp < 35∘C
Rapid Response indicators
if they increase?
- RR 21-29
- HR 111-129
- SBP 200-220
- New onset agitation or confusion
- Temp > 38.55 ∘C