exam 3 1509

Gas Exchange

→ Movement of O₂ into blood and CO₂ out of blood at the alveoli

Normal SpO₂

→ 95-100%

Normal PaO₂

→ 80-100 mmHg

Diffusion

→ Movement of gases from high to low concentration

Hypoxia

→ Low oxygen in tissues

Signs of Hypoxia

→ Dyspnea, restlessness, confusion, cyanosis (late), tachycardia

Hypercapnia

→ Excess CO₂ in bloodstream

Signs of Hypercapnia

→ Headache, drowsiness, confusion

COPD

→ Chronic obstructive disease causing airflow limitation

Common Causes of Impaired Gas Exchange

→ COPD, asthma, pneumonia, PE, atelectasis, pneumothorax

Incentive Spirometer Purpose

→ Prevent atelectasis & improve lung expansion

Asthma Rescue Medication

→ Short-acting bronchodilator (albuterol)

Status Asthmaticus

→ Severe asthma attack not relieved by meds (emergency)

Pulmonary Fibrosis

→ Stiff lungs causing decreased oxygenation (restrictive)

Cystic Fibrosis

→ Genetic disease causing thick mucus in lungs

CF Diagnostic Test

→ Sweat chloride test

Ventilation

→ Movement of air in/out of lungs

Perfusion

→ Blood flow to lungs

Diffusion (V/Q relationship)

→ Gas exchange between alveoli & capillaries

Respiratory Acidosis Cause

→ Hypoventilation → CO₂ retention

Restrictive Lung Disease

→ Decreased lung expansion

Obstructive Lung Disease

→ Difficulty exhaling air

Fluid Balance

→ Balance between intake and output

Normal Sodium

→ 135-145 mEq/L

Normal Potassium

→ 3.5-5.3 mEq/L

Normal Calcium

→ 8.2-10.2 mg/dL

Normal Magnesium

→ 1.6-2.2 mg/dL

Isotonic Solution

→ Same concentration as blood (0.9% NS)

Hypotonic Solution

→ Moves fluid INTO cells

Hypertonic Solution

→ Moves fluid OUT of cells

Fluid Volume Deficit Causes

→ Vomiting, diarrhea, burns, hemorrhage

Fluid Volume Excess Causes

→ CHF, kidney failure, excess IV fluids

Hypokalemia

→ Low potassium

Hypokalemia Symptoms

→ Weakness, arrhythmias, ↓ GI motility

Hyperkalemia

→ High potassium

Hyperkalemia Symptoms

→ Arrhythmias, muscle weakness, peaked T waves

Dehydration Signs

→ Dry skin, low BP, tachycardia

Fluid Overload Signs

→ Edema, high BP, bounding pulse

Albumin Function

→ Maintains oncotic pressure, keeps fluid in vessels

Daily Weight Importance

→ Best indicator of fluid status

Diuretics Effect

→ Increase fluid loss and potassium loss

Hypertonic IV Risks

→ Pulmonary edema, fluid overload

Normal pH

→ 7.35-7.45

Acidosis

→ pH < 7.35

Alkalosis

→ pH > 7.45

Respiratory Acidosis

→ CO₂ retention (hypoventilation)

Respiratory Alkalosis

→ CO₂ loss (hyperventilation)

Metabolic Acidosis

→ Low HCO₃ (ex: DKA, diarrhea)

Metabolic Alkalosis

→ High HCO₃ (ex: vomiting)

Compensation

→ Body correcting pH imbalance

Lungs Role

→ Control CO₂ (fast compensation)

Kidneys Role

→ Control HCO₃ (slow compensation)

Kussmaul Respirations

→ Deep, rapid breathing to remove CO₂ (DKA)

ABG Interpretation Step 1

→ Check pH

ABG Interpretation Step 2

→ Check CO₂

ABG Interpretation Step 3

→ Check HCO₃

ABG Interpretation Step 4

→ Determine compensation

pH & CO₂ Relationship

→ Opposite directions

pH & HCO₃ Relationship

→ Same direction

Vomiting Effect on pH

→ Causes metabolic alkalosis

Hypoventilation Effect

→ Causes respiratory acidosis

Priority for Low SpO₂

→ Administer oxygen first

High-Risk Respiratory Patient

→ Elderly with chronic lung disease

Hyponatremia Intervention

→ Restrict water

Hypokalemia Priority

→ Risk for cardiac arrhythmias

DKA ABG Result

→ Metabolic acidosis

Prolonged Vomiting Result

→ Metabolic alkalosis

COPD patient is drowsy with SpO₂ 88%. What’s happening?

CO₂ retention → respiratory acidosis

First action for pneumonia pt w/ PaO2 60 mmhg?

Admin O2 due to impaired gas exchange

Tonsillectomy pt swallowing repeatedly- priority?

Suspect hemorrhage because frequent swallowing means bleeding

Asthma attack along with silent chest means?

Status asthamticus→ airway closing

CF child w/ thick mucus, what is the best intervention ?

Nebulized hypertonic saline or mucolytic

COPD pt on high O2 become confused, why?

Hypoventilation → CO2 retention/narcosis

Child w/ RSV is retracting and fatigued, what is priority?

Suction airway due to secretions causing obstruction

Post‑bronchoscopy patient wants water — what must you check first?

Gag reflex

Patient with pleural effusion has absent breath sounds — next step?

Prepare for thoracentesis (removes fluid)

DKA patient breathing deep and rapid — what is this?

Kussmaul respirations

Child with TEF is coughing, choking, cyanotic — priority?

Stop feeds + suction

Patient with pulmonary fibrosis — what type of disorder?

Restrictive

Pneumothorax patient suddenly has tracheal deviation — priority?

Prepare for needle decompression

Child with bronchiolitis has nasal flaring + retractions — what’s failing?

Airway patency

Patient with pleural effusion has dyspnea + dull percussion. What’s the intervention?

Thoracentesis to remove fluid

Child with croup has inspiratory stridor. What’s the priority?

Humidified oxygen + airway support

TB patient starting isoniazid reports numb hands. What do you give?

Vitamin B6

RSV infant with nasal congestion + retractions — first action?

Suction nose/mouth

Patient with empyema has fever + pus in pleural space. What’s needed?

Chest tube drainage

Post‑thoracentesis patient suddenly has absent breath sounds. What’s happening?

Pneumothorax

Child with tracheoesophageal fistula has abdominal distention. Why?

Air entering stomach through fistula

CF patient with recurrent infections — priority teaching?

Airway clearance (CPT, mucolytics)

Patient with pulmonary edema has crackles + pink frothy sputum. First action?

High‑Fowler’s + oxygen

Patient with pneumonia has fever + productive cough. What confirms diagnosis?

Chest X‑ray

Patient with suspected TB — what isolation?

Airborne (N95, negative pressure)

Patient with DKA has fruity breath + dehydration. What’s the FIRST priority?

IV fluids

Patient with metabolic acidosis from DKA — what compensatory sign?

Kussmaul respirations

COPD patient on bronchodilators still wheezing — next step?

Add corticosteroids

Main causes of hyponatremia?

Diuretics, GI suction, diarrhea, vomiting, excess water, SIADH.

Key symptoms of hyponatremia?

SALT LOSS: lethargy, confusion, seizures, limp muscles.

Main causes of hypernatremia?

Water loss, fever, sweating, diarrhea, diabetes insipidus.

Symptoms of hypernatremia?

YOU ARE FRIED: fever, restlessness, edema, ↓ urine.

Priority care for hypernatremia?

Give hypotonic fluids (0.45% NS), monitor neuro, restrict sodium