EXAM 1
Normal values ABGs - pH 7.35 - 7.45
PCO2 45-35
HCO3 22-26
[Listed from Acidic to Basic]
Normal Electrolyte levels - Sodium (Na+) 135-145
Potassium (K+) 3.5-5.5
Calcium (Ca+) 8.5-10.5
Phosphorous 3.0-4.5
Magnesium (Mg) 1.6-2.6
Chloride (Cl-) 95-105
Acidosis - Causes CNS depression [sleep]
S/S of Acidosis - Decreased LOC, confusion, lethargy, coma, dysrhythmias
Alkalosis - CNS Irritant (hyperventilation)
S/S of Alkalosis - Twitching, restlessness, irritable, if severe...seizures. Alkalosis causes
a decrease in Ca+ levels; hypocalcemia
Respiratory Acidosis - High CO2 & Low RR, caused by not breathing (slow), coming out
of anesthesia, COPD [difficulty with exhalation], Narcotic use
Respiratory Acidosis Treatment - Find underlying cause, Start with ABC's; oxygen,
bronchodilators, ambulate, narcan if narcotic related
Respiratory Alkalosis - -LOW CO2 & HIGH RR [Imagine Lady freaking out], -Caused by:
Anxiety [hyperventilating], Fever [Increased metabolic, increased O2 demand, increase
RR], PAIN, and hypoxia
Respiratory Alkalosis Treatment - treat underlying cause, Paper bag to rebreathe CO2
Metabolic Acidosis - Add (+) Acid, or Lose (-) Base
-caused by renal failure (+acid) unable to excrete acid, Diabetes (+acid) zero insulin
breaks down body fats resulting in increase ketones [which are acids], Diarrhea (-base)
[**Lose base out your Ass...cidosis]
Metabolic Acidosis Treatment - know cause to treat; insulin in diabetics, antidiarrheals
Metabolic Alkalosis - Loss of (-) Acid, or Excessive (+) Base; caused by VOMITING or
GI suctioning (-acid), or Antacid [like TUMS] OVERDOSE (TOO much base)
,Oral Ulcers Causes - Infection, Mechanical injury: eating or drinking hot and/or spicy
food, Irritants: alcohol, tobacco, Trauma to the tongue, Allergies and/or exposure to
chemicals in toothpaste/mouthwash that irritate
Medications to treat Oral Ulcers - Topical corticosteroids can promote resolution of the
ulcers (paints the mouth), Chlorhexidine mouthwash is recommended, Mouth rinses that
contain topical analgesic; Xylocaine
Oral Ulcers Prevention/Treatment/ Patient Education - Teach pt. to remove irritants,
Good oral hygiene is essential, Any ulcer lasting longer than >3 weeks should be seen
by a doctor
GERD, What is it? - Reflux of gastric contents into the esophagus because of:
Incompetent lower esophageal sphincter (LES), Aging
GERD Signs/Symptoms - Heartburn or pyrosis, Regurgitation of bitter tasting solution in
mouth, Reflux, Dysphagia, Bleeding, Substernal chest pain
GERD Treatments - -Surgery; laparoscopic surgeries to fix LES, or Nissen
fundoplication (much more invasive)
GERD Meds - -Antacids -neutralizes acid in the stomach-PRN, -H2-Receptor blockers
(↓amount of acid [mild symptoms]), Zantac, Pepcid AC, Tagamet- DAILY,
-PPI (MOST powerful!! Med to treat GERD), Omeprazole (Prilosec), prevacid,
pantoprazole/protonix -DAILY
GERD Assessment - Heartburn after eating, or when bending over or laying down, Pain
with swallowing due to irritation from gastric juices, May develop hoarseness
Hiatal hernia - develops when part of the stomach protrudes through the esophagus
Hiatal hernia Symptoms? (similar to GERD) - Heartburn, Many patients are
asymptomatic, Feeling of satiation, Reflux, Dysphagia, Bleeding, Substernal chest pain
Hiatal Hernia Treatment - Surgery- Repair of Hiatal Hernia
Medications (Same as GERDS):
-Antacids -neutralizes acid in the stomach-PRN,
-H2-Receptor blockers (↓amount of acid [mild symptoms]); Zantac, Pepcid AC,
Tagamet- DAILY,
-PPI (MOST powerful!! Med to treat GERD); Omeprazole (Prilosec), prevacid,
pantoprazole/protonix -DAILY
Hiatal Hernia; Pt. Education-prevention - Avoid eating 2-3 hours before lying flat,
Interventions similar to GERD, Eat small meals, Avoid irritating substances; caffeine,
alcohol, acidic foods, Stop smoking
,Hiatal Hernia Causes - Weakened esophageal diaphragm, Increased intra-abdominal
pressure [pregnancy]
Peptic Ulcer Disease (PUD) What is it? - A type of dyspepsia [indigestion].
Characterized by a loss of the mucosal lining of the stomach or duodenum [due to
hypersecretion of hydrochloric acid and pepsin]
PUD Signs/Symptoms? - Nausea/ Vomiting, Abdominal pain and distention, Recurrent
pain in epigastric area, Weight loss/ poor appetite, Bloating
PUD Assessment - Abdominal pain (burning) is the main presenting symptom, Burning
pain is relieved by FOOD and ANTACIDS, Bloating in the middle of the night, poor
appetite, weight loss
PUD Treatment - -Discontinue use of NSAIDs
-Antibiotics- treat H. pylori
-OTC Antacids (For right now pains)- Maalox, Tums
-H2 Receptor blockers- reduce acid secretions (works SLOW); Ranitidine,
-PPI- inhibit acid production (creates less acid to calm stomach); omeprazole,
pantoprazole,
-Cryoprotective agents- bind to mucosal layer and form a protective barrier; Sucralfate
-Vagotomy; if severe, surgical cutting of vagus nerve to reduce acid secretions to the
stomach
Bowel obstruction/Paralytic ileus. What are they? - Two types of bowel obstruction:
-mechanical
-paralytic ileus
-Paralytic ileus- Arrest of intestinal movement (peristalsis HALTED)
-Mechanical obstruction- can be from within the bowel (TUMOR blocking), or outside of
the bowels occluding bowels (adhesions)
Bowel obstruction/Paralytic ileus Signs/Symptoms? - Abdominal pain, nausea/ vomiting
Bowel obstruction/Paralytic ileus Assessment - Assess S/S; High pitched bowel sounds,
Ask about previous surgeries
Bowel obstruction/Paralytic ileus Treatments - NPO, NG tube to suction, Surgery if
mass or if there are adhesions present
What is Appendicitis? - Inflammation of the appendix organ
Appendicitis Symptoms - RLQ pain, low grade fever, nausea, tenderness at McBurney's
point
Appendicitis Treatment - Antibiotic therapy (third gen. cephalosporins), Surgical removal
of appendix
, Appendicitis Testing - CT scan with and without contrast, WBC
Acute Diarrhea - < 3 Weeks in duration - Medications (OTC); Imodium (Loperamide),
Lomotil
Questions you may ask the patient about Acute Diarrhea: - Find the cause of diarrhea.
What did you last eat? Have you been traveling? Have you been hanging out with other
suffering from the same problem?
Clostridium Difficile Causes - -C. diff is passed in feces and spread to food, surfaces
and objects and passed on by bad hand washing (hospital occurring).
-Antibiotic use; In pt. currently taking other antibiotics, their healthy gut bacteria is
destroy, C. diff takes advantage and grows out of control.
C.diff Symptoms? - Watery diarrhea 10 to 15/day, Abdominal cramping, Fever, Blood or
pus in the stool, Nausea/ vomiting, Dehydration, Loss of appetite/ Weight loss, Swollen
abdomen, Kidney failure, Increase WBC
C.diff Treatment - Antibiotic therapy; metronidazole (Flagyl) or for more severe recurrent
cases vancomycin (Vancocin), Surgery to removed diseased portion of colon, Fecal
microbiota transplant (FMT), Probiotics
C.diff Nursing Considerations - Private room [isolation] or share with someone with the
same illness, Contact precautions; Hospital staff and visitors wear disposable gloves
and gowns while in the room.
-Proper hand washing with soap and water (alcohol NO good), Clean room with bleach
wipes only.
Colorectal Cancer - transformation of normal gut to polyp to carcinoma
Colorectal Cancer Signs/Symptoms - Fatigue, Unintended weight loss, bloody stool,
melena (black tarry stool), changes in bowel habits, persistent abdominal discomfort
Colorectal Cancer Screening questions: - Changes in bowel habits? Unintended weight
loss? Anorexia? Alternating diarrhea/constipation? Bloody stool?
Colorectal Cancer Prevention screening (Know schedule) - -Fecal occult blood test -
ANNUALLY (non-invasive cheap)
-Flexible sigmoidoscopy - Every 5 years after the age of 50
-Colonoscopy -Every 10 years after the age of 50
Irritable Bowel Syndrome Pathophysiology - UNKNOWN - there might be a genetic link,
stress, diet high in fat, irritating foods, alcohol and smoking exacerbates manifestations
of IBS
