Pathophysiology

• Acidosis: Low pH 7.35 or below
• Alkalosis: High pH 7.45 or above
• Increased pH & increased Bicarb HCO3 (give anti vomit meds)
• Excessive vomiting: metabolic alkalosis
• Blood pH: 7.35 to 7.45
• PCO2: 35 to 45 mm Hg
• PO2: 90 to 100 mm Hg
• HCO3: 22 to 26 mEq/L
• SaO2: 95% to 100%
• Lots of H+ = Low pH
• High levels of CO2 body becomes more acidic
• Respiratory acidosis and alkalosis are marked by changes in PCO2
• Lower CO2 = Alkalosis
• Higher CO2 = Acidosis
• First line of defense is respirations

  Second line of defense is Kidney‘s
• If pH and PCO2 are moving in opposite direction then it is the PCO2 levels causing the imbalance, it is respiratory in nature. RESPIRATORY OPPOSITE AND REVERSE
• If PCO2 is normal or moving in the same direction as pH then imbalance is metabolic. Metabolic equal or same.
• High CO2 = hyperventilation, need to blow out CO2 to increase pH
• Respiratory Disorders:

  Respiratory Acidosis: CO2 high, pH low CNS depression

  Obstructive lung disease

  hypoventilation

  Treatment: intubation or administer Bicarb
• Respiratory Alkalosis: CO2 low, pH high

  hyperventilation

  hypoxemia

  Treatment: CO2 rebreather mask
• Metabolic acidosis: pH low due to HCO3 low <22 increase in proton

  due to anion gap that is normal or elevated

  Treatment: sodium bicarb
• Metabolic alkalosis: pH high due to HCO3 high >26

  Treatment: administer vomiting meds
• Risk factors for hypertensive urgency cerebral concussion:

  -headaches

  -lethargy and mental dullness

  -s/s can persist for several months.
• Sprain: over stretching of a ligament, common location is the ankle. It can be caused by a force that displaces a joint from its normal alighnment.

  Strain: over stretching of tendons and muscles. Often in the lower back and hamstring. Pain, weakness, and limited ROM.
• Rilozole: class of benzothiazotes medications used to tx. Amyotrophic Lateral Sclerosis(ALS)
• S/S of dehydration: headache, dizziness, weakness, confusion, bad breathe, dry mouth, dark urine
• *albumin controls osmotic pressure in vascular system, builds volume.
• B12 deficiency causes: conditions of the gastric system (Crohns and celiac disease) heartburn meds to Treatment: Esomeprazole, pantaprazole, famotidine, cimetidine, metformin? THINK OF GASTRIC ISSUES CAN CAUSE B12 DEFICIENCY.
• Cryoablation is treatment for bone cancer/prostate cancer.
• TIA: will resolve itsself within or dissolve the clot within 24.
• Ischemic:

  85% most common

  afib or arteriosclerosis

  thrombosis or embolus

  ischemia-blocks blood flow

  use of oral BC, sickle cell, carotid plaque build up COULD PRESENT AS SPEECH IMPAIRMENT SEVEREA HEADACHE INABILITY TO MOVE ONE SIDE, ARM/LEG
• Hemorrhagic stroke:

  40% less common

  mainly caused by HTN hemorrhagic/blood

  vessels ruptures and no longer

  provides brain blood flow, high BP
• Signs & Symptoms of Cerebral Contusion:

  severe headache, dizziness, vomiting

  -increase size of one pupil, sudden weakness in arm or leg

  -can last for hours to several weeks

  -brain tissue swells, person may become drowsy or confused

  -low heart rate, respiration, HTN are signs of pressure on the brain stem
• Epidural hematoma:

  likely to occur following fracture of the temporal bone

  s/s of cerebral edema: headache, neck pain/stiffness, nausea/vomiting, dizziness, vision loss or change, memory loss, seizures, unstable gait
• Subdural hematoma:

  blood vessel in the space between skull & brain is damaged. Places pressure on the brain.
• Cirrhosis of the liver most common causes,

  Hep C virus

  Alcoholic liver diagnosis

  Non alcoholic liver disease
• Cystitis:

  pelvic inflammatory

  Diagnosis: PID
• Bladder Infection:

  pelvic pain

  urge to pee

  pain with urination(hematuria)
• Kidney Infection:

  Back pain

  Nausea or vomiting, fever
• ERSD (End of the stage renal disease):

  decrease in urination or ability to urinate fatigue

  dry itching skin, bruising, skin and nail changes can dx with kidney US, CT scan, biopsy