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Review Guide for Mdcii EXAM 2

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Med-Surg III (NSG 233)

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Herzing University

Academic year: 2022/2023

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Med Surg 3

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CH: 12: Acid-Base Imbalances

1. Blood Gases

a. Compensation

i. Chemical rapid response, handles small fluctuation in hydrogen ion

production during normal metabolic conditions

ii. Respiratoryprimarily assist buffering systems when the fluctuation of

hydrogen ion concentration is acute

iii. Kidneys most powerful, take hours to days, slowest response, longest

durations

b. PH, PCO2, HCO3 (know the normal range)

i. Analyze and determine Blood Gas Imbalance

ii. Determine if there is compensation (full/partial/none)

2. Imbalance: Remember you need to treat the underlying cause

3. What is the MOST important system to monitor in Acidosis? cardiovascular

4. What is a common electrolyte imbalance identified in renal failure? Hyperkalemia

5. What kind of fluid replacement be indicated for a patient with DKA? “Potassium chloride” NS

6. Aspirin (saliscyate)toxicity can lead to what ACID-BASE imbalances explain? MAC, R-ALK

a. Metabolic Acidosis  CO2 excess (overproduction/under elimination

i. Causes: DKA, diarrhea, overproduction of hydrogen ions, starvation, heavy

exercise, hypoxia, fever, seizure, ethanol intox, kidney failure, liver failure

ii. S/S: kusmall respiration, warm flushed dry skin

iii. Interventions: fall precautions, fix underlying cause, fluid replacements

b. Respiratory Acidosis:  CO2 excess High potassium

i. Causes: COPD, emphysema, anesthetics, muscle weakness, airway obstruction

(Depress/hypoventilation-mechanical/obstruction), electrolyte imbalance

ii. S/S: tall T waves, wide QRS, bradycardia, hypotension, thready pulses, cns

depressed, flaccid paralysis, variable respirations, pale to cyanotic dry skin

iii. Interventions: fall precautions, fix the underlying cause, fluid replacements

c. Metabolic Alkalosis:  Base Excess or CO2 deficit (loss). Low potassium, Low calcium

i. Causes: antacids, blood transfusion, sodium bicarb, TPN, vomiting, NG suction,

Hypercortisolism (Cushing’s), hyperaldosteronism (aldosterone keeps sodium in

body, U pee a lot and lose potassium), loop diuretics

ii. S/S: increased activity, CNS stimulation, anxiety, trousseau and chovesk,

paresthesia, hyperreflexia, cramps, muscle weakness, Increased HR, normal or

hypotension, increased digoxin toxicity, decreased respiration effort

iii. Interventions: fall precautions, fix the underlying cause, fluid replacements

d. Respiratory Alkalosis:  CO2 deficit

i. Causes: Hyperventilation, aspirin toxicity, early stage pulmonary problems, high

altitude

ii. S/S: hyperventilation, increased activity, CNS stimulation, anxiety, trousseau and

chovesk, paresthesia, hyperreflexia, cramps, muscle weakness, Increased HR,

normal or hypotension, increased digoxin toxicity

iii. Interventions: fall precautions, fix underlying cause, fluid replacements

Multidisciplinary needs encompass:

1. Emotional

2. Education

3. Cultural Assessment

4. Dietary

Multidisciplinary Care-How do these roles assist the patient?

 Social Worker

 Dietician

 Chaplain

 Financial Services

CH: 53: Care of Patients With Oral Cavity Problems

 Stomatitis: (what causes this) Chocolate pudding Ok

1. Signs and Symptoms: painful ulceration in the mouth, looks like plaque

2. Causes

a. Primary: aphthous stomatitis, herpes, traumatic ulcer

b. Secondary: opportunistic viruses, chemo, steroids

3. Priorities: provide oral care, diet, stress, hydration, weekly mouth examination, no

alcohol mouthwash

 Oral Cancer:

1. Post-op Management priority: airway, pain

2. Management: assess LOC, high flower, assess gag reflex, suction nearby, feed in small

amounts, thick liquids possible , education

3. Treatment: chemo, removal of tissue

CH: 54: Care of Patients with Esophageal Problems:

 Gastroesophageal Reflux Disease (GERD) No chocolate

-Duodenal: duodenal ulcers present in the upper portion of the duodenum, high gastric

acid secretion, pH levels are low (excess acid) in the duodenum,

-Gastric: develop in the antrum of the stomach near acid-secreting mucosa, bile refluxes

(backs up) into the stomach, H. pylori

-Stress: acute gastric mucosal lesions occurring after an acute medical crisis or trauma,

such as sepsis or a head injury, most patients who have major trauma or surgery receive

IV drug therapy (e., PPIs) to prevent stress ulcer development

3. Health Promotion and Disease Management: consult dietitian (bland diet), monitor I/O,

vitals and lab, heal ulcerations/prevent reoccurrence, medications-PPI, H2 blockers,

antibiotics

4. Complications of Ulcers: hemorrhage, perforation, pyloric obstruction, intractable

disease (H. pylori)

(6 small meals a day, avoid bedtime snacks, reduce stress)

 Gastric Cancer

1. Signs and Symptoms: dyspepsia, abdominal discomfort, feeling of fullness,

epigastric/back/retrosternal pain

(advanced gastric cancer)-n/v, iron deficiency anemia, palpable epigastric mass, enlarged

lymph nodes, weak/fatigue, progressive weight loss

2. Causes: H. pylori is the most significant risk; gastritis, intestinal metaplasia, pernicious

anemia

3. Management

a. Non-surgical: radiation, chemo

b. Surgical: resection by removing the tumor (preferred treatment)

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Review Guide for Mdcii EXAM 2

Course: Med-Surg III (NSG 233)

147 Documents

Students shared 147 documents in this course

University: Herzing University

Was this document helpful?

Multidimensional Care II-Guide

CH: 12: Acid-Base Imbalances

1. Blood Gases

a. Compensation

i. Chemical rapid response, handles small fluctuation in hydrogen ion

production during normal metabolic conditions

ii. Respiratoryprimarily assist buffering systems when the fluctuation of

hydrogen ion concentration is acute

iii. Kidneys most powerful, take hours to days, slowest response, longest

durations

b. PH, PCO2, HCO3 (know the normal range)

i. Analyze and determine Blood Gas Imbalance

ii. Determine if there is compensation (full/partial/none)

2. Imbalance: Remember you need to treat the underlying cause

3. What is the MOST important system to monitor in Acidosis? cardiovascular

4. What is a common electrolyte imbalance identified in renal failure? Hyperkalemia

5. What kind of fluid replacement be indicated for a patient with DKA? “Potassium chloride” NS

6. Aspirin (saliscyate)toxicity can lead to what ACID-BASE imbalances explain? MAC, R-ALK

a. Metabolic Acidosis  CO2 excess (overproduction/under elimination

i. Causes: DKA, diarrhea, overproduction of hydrogen ions, starvation, heavy

exercise, hypoxia, fever, seizure, ethanol intox, kidney failure, liver failure

ii. S/S: kusmall respiration, warm flushed dry skin

iii. Interventions: fall precautions, fix underlying cause, fluid replacements

b. Respiratory Acidosis:  CO2 excess High potassium

i. Causes: COPD, emphysema, anesthetics, muscle weakness, airway obstruction

(Depress/hypoventilation-mechanical/obstruction), electrolyte imbalance

ii. S/S: tall T waves, wide QRS, bradycardia, hypotension, thready pulses, cns

depressed, flaccid paralysis, variable respirations, pale to cyanotic dry skin

iii. Interventions: fall precautions, fix the underlying cause, fluid replacements

c. Metabolic Alkalosis:  Base Excess or CO2 deficit (loss). Low potassium, Low calcium

i. Causes: antacids, blood transfusion, sodium bicarb, TPN, vomiting, NG suction,

Hypercortisolism (Cushing’s), hyperaldosteronism (aldosterone keeps sodium in

body, U pee a lot and lose potassium), loop diuretics

Review Guide for Mdcii EXAM 2

Med-Surg III (NSG 233)

Herzing University

Recommended for you

Comments

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Related Studylists

Preview text

CH: 12: Acid-Base Imbalances

1. Blood Gases

a. Compensation

i. Chemical rapid response, handles small fluctuation in hydrogen ion

production during normal metabolic conditions

ii. Respiratoryprimarily assist buffering systems when the fluctuation of

hydrogen ion concentration is acute

iii. Kidneys most powerful, take hours to days, slowest response, longest

durations

b. PH, PCO2, HCO3 (know the normal range)

i. Analyze and determine Blood Gas Imbalance

ii. Determine if there is compensation (full/partial/none)

2. Imbalance: Remember you need to treat the underlying cause

3. What is the MOST important system to monitor in Acidosis? cardiovascular

4. What is a common electrolyte imbalance identified in renal failure? Hyperkalemia

5. What kind of fluid replacement be indicated for a patient with DKA? “Potassium chloride” NS

6. Aspirin (saliscyate)toxicity can lead to what ACID-BASE imbalances explain? MAC, R-ALK

a. Metabolic Acidosis  CO2 excess (overproduction/under elimination

i. Causes: DKA, diarrhea, overproduction of hydrogen ions, starvation, heavy

exercise, hypoxia, fever, seizure, ethanol intox, kidney failure, liver failure

ii. S/S: kusmall respiration, warm flushed dry skin

iii. Interventions: fall precautions, fix underlying cause, fluid replacements

b. Respiratory Acidosis:  CO2 excess High potassium

i. Causes: COPD, emphysema, anesthetics, muscle weakness, airway obstruction

(Depress/hypoventilation-mechanical/obstruction), electrolyte imbalance

ii. S/S: tall T waves, wide QRS, bradycardia, hypotension, thready pulses, cns

depressed, flaccid paralysis, variable respirations, pale to cyanotic dry skin

iii. Interventions: fall precautions, fix the underlying cause, fluid replacements

c. Metabolic Alkalosis:  Base Excess or CO2 deficit (loss). Low potassium, Low calcium

i. Causes: antacids, blood transfusion, sodium bicarb, TPN, vomiting, NG suction,

Hypercortisolism (Cushing’s), hyperaldosteronism (aldosterone keeps sodium in

body, U pee a lot and lose potassium), loop diuretics

ii. S/S: increased activity, CNS stimulation, anxiety, trousseau and chovesk,

paresthesia, hyperreflexia, cramps, muscle weakness, Increased HR, normal or

hypotension, increased digoxin toxicity, decreased respiration effort

iii. Interventions: fall precautions, fix the underlying cause, fluid replacements

d. Respiratory Alkalosis:  CO2 deficit

i. Causes: Hyperventilation, aspirin toxicity, early stage pulmonary problems, high

altitude

ii. S/S: hyperventilation, increased activity, CNS stimulation, anxiety, trousseau and

chovesk, paresthesia, hyperreflexia, cramps, muscle weakness, Increased HR,

normal or hypotension, increased digoxin toxicity

iii. Interventions: fall precautions, fix underlying cause, fluid replacements

Multidisciplinary needs encompass:

1. Emotional

2. Education

3. Cultural Assessment

4. Dietary

Multidisciplinary Care-How do these roles assist the patient?

 Social Worker

 Dietician

 Chaplain

 Financial Services

CH: 53: Care of Patients With Oral Cavity Problems

 Stomatitis: (what causes this) Chocolate pudding Ok

1. Signs and Symptoms: painful ulceration in the mouth, looks like plaque

2. Causes

a. Primary: aphthous stomatitis, herpes, traumatic ulcer

b. Secondary: opportunistic viruses, chemo, steroids

3. Priorities: provide oral care, diet, stress, hydration, weekly mouth examination, no

alcohol mouthwash

 Oral Cancer:

1. Post-op Management priority: airway, pain

2. Management: assess LOC, high flower, assess gag reflex, suction nearby, feed in small

amounts, thick liquids possible , education

3. Treatment: chemo, removal of tissue

CH: 54: Care of Patients with Esophageal Problems:

 Gastroesophageal Reflux Disease (GERD) No chocolate

-Duodenal: duodenal ulcers present in the upper portion of the duodenum, high gastric

acid secretion, pH levels are low (excess acid) in the duodenum,

-Gastric: develop in the antrum of the stomach near acid-secreting mucosa, bile refluxes