311 midterm

• nasal cannula?

  1-6 L per min

  24-44% FiO2
• simple face mask?

  5-8 L per min

  40-60% FiO2
• nonrebreather mask?

  10-15 L per min

  80-95% FiO2
• high flow nasal cannula?

  5-40 L per min

  up to 100% FiO2
• bag valve mask?

  15 L O2
• bronchodilators?


  relax muscles and allow bronchioles to open them up
• corticosteroids?


  reduce inflammation
• mucolytic agents?


  break up mucus
• anti-tussive agents?


  anti cough
• ABG values?

  pH 7.35-7.45

  PaCO2 35-45 mmHG

  HCO3 22-26 mEq/L

  PaO2 80-100 mmHg
• potassium range?


  3.5 to 5 mEq/L
• sodium range?


  135-145 mEq/L
• chloride range?


  97-107 mEq/L
• calcium range?


  9-10.5 mg/dL total

  4.5-5.1 mEq/L ionized
• magnesium range?


  1.3-2.1 mg/dL
• phosphorus range?


  2.5-4.5 mg/dL
• room air FiO2?

  21%
• signs of early hypoxemia?


  irritation, agitation, restless
• signs of late hypoxemia?


  stupor, coma
• chronic hypoxemia?


  clubbing, barrel chest
• acute hypoxemia?


  tachycardia into bradycardia
• pulmonary toilet?


  coughing and deep breathing
• causes of respiratory acidosis?


  hypoventilation, CNS depression, narcotics, neuromuscular diseases, respiratory disorders, pulmonary embolism
• causes of respiratory alkalosis?


  hyperventilation due to... anxiety, fear, exercise, excessive mechanical ventilation, fever, hypoxemia, respiratory stimulants
• causes of metabolic acidosis?


  too much metabolic acid-

  anaerobic metabolism: increased lactic acid

  DKA, Renal failure

  sepsis

  aspirin overdose

  starvation

  too little metabolic base

  diarrhea

  pancreatitis

  intestinal fistulas

  hyperkalemia
• causes of metabolic alkalosis?

  too much base-

  excessive antacids

  excessive use of bicarbonate

  lactate in dialysate (pt in renal failure)

  too little acid in blood-

  hyperaldosteronism

  electrolyte disorders (hypokalemia, hypochloremia)

  diuretics, steroids

  vomiting, bulimia

  nasogastric suctioning
• hyponatremia signs and interventions?

  Stupor/coma

  Anorexia (nausea/vomiting)

  Lethargy

  Tendon reflexes (decreased)

  Limp muscles (weakness)

  Orthostatic hypotension

  Seizures/headache

  Stomach cramping

  Diet

  Iv fluids

  Medications

  Electrolyte replacement
• causes of hyponatremia?

  vomiting, nausea, diarrhea, nasogastric suctioning, medications, excess water intake, excess alcohol intake, heart, kidney, liver problems, severe burns, SIADH
• hypernatremia signs and interventions?

  Flushed skin and fever (low grade)

  Restless, irritable, anxious, confused

  Increased blood pressure and fluid retention

  Edema: peripheral and pitting

  Decreased urine output and dry mouth

  Skin flushed

  Agitation

  Low grade fever

  Thirst

  Sodium intake (decrease)

  Oral hygiene

  Diuretic (loop)

  Increase water intake, I/Os

  Use hypotonic (0.45% saline) or isotonic IVF

  Monitor for inadequate renal output
• causes of hypernatremia?

  loss of body water, medications, gastroentritis, vomiting, prolonged suction, burns, excessive, CKD, diabetes, impaired thirst response
• what has a direct relationship with sodium?

  chloride
• what works with Mg and Ca for nerve and muscle contraction?

  chloride
• Signs and symptoms of hypokalemia:

  • T waves depressed: monitor
  • Arrhythmias: monitor for tachycardia, bradycardia, and prominent U wave
  • Shallow ineffective respirations: monitor
  • Sounds of diminished breathing: monitor
  • Muscle cramping
  • GI motility issues (GUTS LOW AND SLOW)
  • Alkalosis
  • Shallow respirations
  • Irritability
  • Confusion
  • Drowsiness
  • Weakness
  • Fatigue
  • Irregular rate arrhythmias
  • PVCs (preventricular contractions)
  • Lethargy
  • Thready pulse
  • Decreased intestinal motility
  • Nausea
  • Vomiting
  • Ileus
• Interventions for hypokalemia:

  • Potassium replacements: squash, potatoes, avocados, cantaloupe, bananas, white beans
  • Oral K+ supplements
  • IV supplement (20 mEq in 1000L saline): never push
  • Monitor urine output
• causes of hypokalemia?

  vomiting, diarrhea, diet intake, medications, cardiac conditions, gastrointestinal losses, metabolic alkalosis, decreased oral intake, excessive alcohol use, CKD, DKA, excessive sweating, folic acid deficiency
• hyperkalemia signs and symptoms and interventions?

  Stop IV infusion of K+ or avoid salt substitutes

  Tall T waves (peaked/tented)

  Order kayexalate (sodium polystyrene) or regular insulin (move glucose and potassium into cell) with dextrose (so blood glucose doesn't drop low)

  Provide K+ restricted foods, loop diuretics

  Muscle cramps

  Urine abnormalities

  Respiratory distress

  Decreased cardiac contractility

  EKG changes

  Reflexes
• causes of hyperkalemia?

  renal failure, dehydration, diabetes mellitus, medications, trauma, excess intake of potassium, burns, transfusions of packed red blood cells, acidosis, sepsis
• hypocalcemia signs and symptoms and interventions?

  Convulsions

  Arrythmias

  Tetany

  Spasms and stridor

  Trousseaus sign

  Watch for arrhythmias (decrease pulse, increased ST on EKG)

  Increase in bowel sounds

  Tetany

  Chovsteks sign

  Hypotension/ hyperactive deep tendon reflexes

  Seizure precautions

  Administer Ca+ supplements (oral, vitamin D)

  Foods high in Ca+ (dairy, greens)

  Emergency equipment on standby
• causes of hypocalcemia?

  meds caused decreased absorption of calcium, not enough vitamin D, hormonal changes, hypoparathyroidism, renal disease, multiple blood transfusion, electrolyte imbalances of magnesium or phosphate, sepsis, low albumin
• hypercalcemia signs and symptoms and interventions?

  Bone pain

  Arrhythmias

  Cardiac arrest

  Kidney stones

  Muscle weakness

  Excessive urination

  
  

  increase Fluids

  increase Fiber

  administer ivF ordered

  administer Furosemide