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Study Guide Final NUR 255 Spring 2024 Allie version
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Study Guide for NUR 255Spring 2020
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These are only approximates and not all inclusive but close
Fluid and Electrolytes/Acid Base Balance-
Metabolic Acidosis Metabolic Alkalosis
Definition: INCREASE in hydrogen ions (acid) and LOSS of Definition: DECREASED in hydrogen ions (acidic) and a
bicarb (basic) GAIN of bicarb (basic)
Cause: Ketoacidosis, renal failure, GI loss of bicarb Cause: Vomiting, NG suction, ingestion of antacids that
(diarrhea), fistula, intestinal malabsorption, ileostomy, contain bicarb.
aspirin poisoning
Manifestations: Confusion, tetany, weakness,
Manifestations: Confusion, headache, n/v, lower BP, hyperreflexia, hypotension, seizures, respiratory failure
cardiac dysrhythmias, stupor, dizziness, drowsiness
Treatment: Give Diamox to make Bicarb excrete out of the
Treatment: Give IV-Bicarb, Insulin if diabetic, fluids body, give K+ and NaCl fluid, antiemetic to treat vomiting
Nursing Care: VS, monitor cardiac rhythm, neuro status, Nursing Care: Vs, cardiac arrhythmias, seizures
and REALLY monitor potassium levels because as precautions, EKG, irrigate NG with NaCl to prevent loss of
hydrogen ions enter the cell so does potassium GI
Respiratory Acidosis Respiratory Alkalosis
Definition: INCREASE in hydrogen ions (acidic), Definition: DECREASE in hydrogen ions (acidic), and
DECREASED in Bicarb (basic). INCREASE in bicarb (basic)
Cause: HYPOventilation aka NOT breathing enough, COPD, Cause: HYPERventilation aka breathing to fast, panic
Guillain-Barre, sedatives attacks, CPR ventilation
Manifestations: Headache, n/v, blurred vision, confusion, Manifestations: Dizziness, numbness, tingling around the
altered mental status, cardiac arrest, restlessness mouth or hands or feet, dyspnea, anxiety, tremors,
seizures, tetany
Treatment: Improve ventilation, give Bronchodilators,
antibiotics, oxygen, chest physiotherapy Treatment: Figure out the cause and go from there, treat
sepsis, reduce fever, calm pt down
Nursing Care: VS, monitor change in respirations,
neurostatus, arrhythmias, assess ABG Nursing Care: assess respiratory status, ABG monitoring,
decreased patient anxiety, seizures precautions, need
oxygen
How to read an ABG
R respiratory
O opposite
M metabolic
E equal
,PaCO2 ALWAYS goes with respiratory
HCO3 ALWAYS goes with metabolic
HCO3= bicarb
PaCO2 = partial pressure oxygen
Ph: 7.35-7.45
HCO3: 22-26
PaCO2: 35-45
**The compensatory mechanism will be out of whack if it is working*
Sodium
135-145
Hypo Hyper
Cause: not enough sodium intake, dilution of Cause: fluid deprivation, hypertonic tube
the sodium level, and sodium loss from feedings, excess sodium chloride
draining wounds, diarrhea, vomiting administration
Manifestations: Confusion, N/V, headache, Manifestations: hallucinations, thirst,
dizziness, muscle cramps, irritability, seziures pulmonary edema, increased pulse, and BP
Treatment: administer sodium, may need to Treatment: lower sodium gradually,
decrease fluids if its due to fluid overload. 3% hypotonic IV such as 0.3% sodium or D5W.
sodium chloride solution. Reduce no faster than 0.5-1 meg/L per hour
Potassium
3.5-5.0
, Hypo Hyper
Cause: GI loss from vomiting, gastric Cause: acidosis, insulin deficiency, most
suctioning, diarrhea, ileostomy, metabolic common is renal failure
alkalosis, kidney, insulin.
Manifestation: muscle tremors, skeletal
Manifestation: leg cramps at night, muscle weakness, paralysis, ECG- tall tented
orthostatic hypotension, skeletal muscle narrow T waves widened QRS.
weakness,
Treatment: restrict K intake, IV calcium
Treatment: oral or IV intake of K. Don’t give gluconate, give diuretics, insulin (lets K+ back
more than 10-20 mEq/hr IV. Never give into the cell), dextrose, kayexalate.
potassium IV push or IM.
Calcium
8.6-10.2
Hypo Hyper
Causes: renal failure, alcohol abuse, Cause: hyperparathyroidism, malignancies
inadequate vit D intake, kidney disease cause bone destruction and increased serum
calcium, thiazide diuretics.
Manifestations: Tetany, positive Chvostek
(facial spasm) and trousseau signs (BP and Manifestations: deep bone pain, polydipsia,
hand stiffens up). Bronchospasm with polyuria, decreased reflexes,
laryngeal stridor
Treatment: IV fluids and loop diuretics.
Treatment: give IV calcium or calcium Calcitonin (inhibits bone resorption) +
gluconate. Do not give too fast as it can cause Biphosphate (decreased bone breakdown)
cardiac arrest preceded by bradycardia
Nur Interventions: increase fluid up to
Nur interventions: Dilute calcium D5W, give 4000ml, give Na to help excrete calcium.
slow and with a pump. Administer Vitamin D
as well.
Magnesium
1.5-2.5
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