ABG, Blood Gases, Alkalosis, Acidosis....

         

Question	Answer	Hint
normal pH	pH 7.35-7.45
most common buffer system	CO2 + H2O — H2CO3 — H+ + HCO3-
normal ratio of carbonic acid to bicarbonate	1:20
respiratory acidosis	Increased CO2 results in decrease in pH
respiratory alkalosis	Decreased CO2 results in increase in pH
respiratory component of acid-base balance	CO2 (carbon dioxide)
metabolic acidosis	Increased HCO3 results in increase in pH
metabolic alkalosis	Decreased HCO3 results in decrease in pH
metabolic component of acid-base balance	HCO3 (bicarbonate)
normal PaCO2	35-45 mmHg
normal PaO2	83-100 mmHg
normal HCO3	22-26 mEq/L
ABG analysis step 1	if pH is <7.35, acidosis if pH is >7.45, alkalosis
ABG analysis step 2	if CO2 is abnormal, respiratory if HCO3 is abnormal, metabolic
ABG analysis step 3	pH is normal: fully compensated pH & opposite number out of range: partially compensated pH out of normal range, opposite number in normal range: no compensation
oxyhemoglobin curve	changes in pH alter ease with hemoglobin releases O2 to plasma
values of metabolic acidosis	pH is low, HCO3 is low
values of metabolic alkalosis	pH is high, HCO3 is high
values of respiratory acidosis	pH is low, PaCO2 is high
values of respiratory alkalosis	pH is high, PaCO2 is low
causes of metabolic acidosis	diabetic ketoacidosis, starvation, lactic acidosis, excess ETOH or ASA, renal failure, diarrhea
s/s of metabolic acidosis	lethargy, confusion, stupor, coma, hyporeflexia, muscle weakness, bradycardia, thready pulses, low BP, Kussmaul resp, warm/flushed/dry skin, hyperkalemia
treatment of metabolic acidosis	treat the cause: insulin, hydration/electrolytes, antidiarrheals, sodium bicarbonate, dialysis
causes of metabolic alkalosis	antacid overuse, IV LR overuse, NaHCO3 overuse, vomiting, NG suctioning, thiazide diuretics
s/s of metabolic alkalosis	anxiety, irritability, hyperreflexia, muscle cramps/weakness, tachycardia, normal or low BP, shallow resps, hypokalemia, hypocalcemia
treatment of metabolic alkalosis	treat the cause: fluid/electrolyte replacement, NS IV, Ca++, K-sparing diuretics, antiemetics
causes of respiratory acidosis	head injury, Rx overdose, chest injury, electrolyte imbalance, severe obesity, ascites, hemothorax, COPD, aspiration, pneumonia, pulm edema, TB, PE
s/s of respiratory acidosis	skin pale to cyanotic & dry, increase PaCO2
treatment of respiratory acidosis	increase CO2 excretion: bronchodilators, steroids, Mucomyst, O2, pulmonary hygiene, PAP
causes of respiratory alkalosis	hyperventilation – anxiety, fear, mechanical ventilation; hypoxemia – asphyxiation, shock, high altitude
s/s of respiratory alkalosis	numbness & tingling around mouth, extremities, resp. effort normal or increase
treatment of respiratory alkalosis	treat underlying condition, support renal function w/ fluids, breath into bag or rebreather, sedatives

Arterial Blood Gas (ABG) Tic-Tac-Toe Examples

Tips to keep your Brain Fit....

 Exercise—Physically active people can reduce their risk of dementia by 30 to 40 percent. Weight Training—Studies have shown that resistance training can increase brain growth factors, which protect nerve cells.

 Learn Something New—Challenging your brain does in fact increase the number of brain cells and the connections between them. 

Relax—Regular, chronic stress can lead to impaired memory because it floods your brain with cortisol.

 Go Greek—Eating a diet rich in fish, vegetables, fruits, nuts and beans (otherwise known as a Mediterranean diet) has been shown to reduce Alzheimer’s risk by 34 to 48 percent in Columbia University studies. 

Spice It Up— Many herbs and spices are high in antioxidants, which may help build brainpower. Set a Goal—Having a clear path or mission in life can reduce your chances of developing Alzheimer's disease. 

Socialize—People who need people, well, they may be protected against dementia because social interaction provides emotional and mental stimulation. 

Reduce Other Risk Factors—Many chronic health conditions, such as diabetes, obesity and hypertension, have been linked with an increased risk of dementia. 

Take a Vitamin—Declines in digestive acids or as a result of medication interference can inhibit your absorption of some of the nutrients you need from foods, particularly B12, which can affect your brain’s vitality. Incorporate some or all of these tips into your daily life and you will be doing your part to keep your mind sharp and your brain active long into your golden years.....

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NCLEX Tips....

Tonometry: normal (10-21 mm Hg)NC

PR Interval: normal (0.12-0.20 seconds)

Serum Amylase: normal (25-151 units/dL)

Serum Ammonia: normal (35 to 65 mcg/dL)

Calcium: adult (8.6-10 mg/dL)
child (8 to 10.5 mg/dL)
term<1week hg =" inadequate">11 mm Hg = too much fluid

Potassium: 3.5-5.0 mEq/L
Sodium: 135-145 mEq/L
Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL
Magnesium: 1.5-2.5 mEq/L
Chloride: 96-107 mEq/L
Phosphorus: 2.7 to 4.5 mg/dL

PR measurements: normal (0.12 to 0.20 second)

QRS measurements: normal (0.04 to 0.10 second)

Ammonia: 35 to 65 ug/dL
Amylase:25 to 151 IV/L

Lipase: 10 to 140 U/L

Cholesterol: 140 to 199 mg/dL
LDL: <130>0.1 to 0.2 ng/mL = MI

Erythrocyte studies: 0-30 mm/hour

Serum iron: Male 65-175 ug/dL
Female 50-170 ug/dL

RBC: Male 4.5 to 6.2 M/uL
Female 4.0 to 5.5 M/uL



Theophylline levels normal (10 to 20 mcg/dl)




MOTOR DEVELOPMENT


Chin up
1 month

Chest up
2 month

Knee push and “swim”
6 month

Sits alone/stands with help
7 month

Crawls on stomach
8 month

Stands holding on furniture
10 month

Walks when led
11 month

Stands alone
14 month

Walks alone
15 month


AT THE PLAY GROUND

* Stranger anxiety: 0 -1 year
* Separation anxiety: 1 - 3 years
* Solitary play: 0 – 1 year
* Parallel play: 2 – 3 years
* Group play: 3 – 4 years


PSYCHOLOGICAL DEVELOPMENT

AGE
ERIKSON
FREUD
PIAGET
Infant
0 – 1.5
Trust vs. mistrust Oral (trust & dependence
sensorimotor
Toddler
1.5 -3
Autonomy vs. shame Anal (holding vs. letting out)
preoperational
Pre-school
3 - 6
Initiative vs. guilt Phallic (Oedipus complex)
preoperational
School age
6 - 11 Industry vs. inferiority
latency
Concrete operational

11 - 20 Identity vs. role confusion
genital
Formal operational

20 – 25
Intimacy vs. isolation

25 – 50 Generativity vs. stagnation

50 - ?
Integrity vs.despair


LABORATORY VALUES

ELECTROLYTES

Sodium (Na+): 135 – 145 meq/L
(increase-dehydration; decrease overhydration)
Potassium (K+): 3.5 - 5.0 meq/L
Magnesium (Mg++): 1.5 – 2.5 meq/L
Calcium (Ca++): 4.5 – 5.8 meq/L
Neonate : 7.0 to 12 mg/dL
Child: 8.0 to 10.5 mg/dL
Phosphorus (PO4): 1.7 – 2.6 meq/L
Chloride (Cl-): 96 – 106 meq/L

COAGULATION STUDIES

Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used
Prothrombin time(PT): male: 9.6 – 11.8 seconds
Female: 9.5 – 11.3 seconds
International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy
3.0 – 4.5 for high-dose Coumadin therapy
Clotting time: 8 – 15 minutes
Platelet count: 150,000 to 400,000 cells/Ul
Bleeding time: 2.5 to 8 minutes

SERUM GASTROINTESTINAL STUDIES

Albumin: 3.4 to 5 g/dL
Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL
Ammonia: 15 to 45 ug/dL
Amylase: 50 – 180 Somogyi U/dL in adult
20 – 160 Somogyi U/dL in the older adult
Bilirubin: direct: 0 - 0.3 mg/dL
Indirect: 0.1 – 1.0 mg/dL
Total: less than 1.5 mg/dL
Cholesterol: 120 – 200mg/dL
Lipase: 31 -186 U/L
Lipids: 400 – 800 mg/dL
Triclycerides: Normal range: 10 – 190 mg/dL
Borderline high: 200 – 400 mg/dL
High: 400 – 1000mg/dL
Very high: greater than 1000mg.dL
Protien: 6.0 – 8.0 g/L
Uric acid: male: 4.5 – 8 ng/dL
Female: 2.5 – 6.2 ng/dL


GLUCOSE STUDIES

Fasting blood sugar: 70 – 105 mg/dL
Glucose monitoring (capillary Blood): 60 – 110 mg/dL





RENAL FUNCTION TEST

Creatinine: 0.6 – 1.3 mg/dL
Blood urea nitrogen (BUN): 5 – 20 mg/dL

ERYTROCYTES STUDIES

Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age
Hemoglobin: male: 14 – 16.5 g/dL
Female: 12 – 15 g/dL
Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration)
Female: 35% - 47% ( decreased in fluid retention)
Red blood cell (RBC): male: 4.5 to 6.2 million/uL
Female: 4 to 5.5 million/uL

White blood cell (WBC): 4500 to 11,000/uL
Erytrocyte Protoporthyrin (EP) : <9ug/dl>25 mg/dL

CRANIAL NERVES

MAJOR FUNCTIONS

I. Olfactory (S)
smell

II. Optic (S)
vision

III. Oculomotor (M)
IV. Trochlear (M)
Eye movement

V. Trigeminal (S-M) Facial sensation
Jaw movement

VI. Abducent (M)
Eye movement

VII. Facial (S-M) Taste
Facial expression

VIII. Acoustic (S)
Hearing and balance

IX. Glossopharyngeal (S-M) Taste
Throat sensation
Gag and swallow

X. Vagus (S-M) Gag and swallow
Parasympathetic activity

XI. Spinal Accessory (M) Neck and back muscles

XII. Hypoglossal (M)
Tongue movement

On Old Olympus’ Towering Tops, A Finn And German Viewed Some Hops
Some Says Marry Money, But My Brother Says Bad Business Marry Money

ARTERIAL BLOOD GAS (ABG)

pH: 7.35 – 7.45
PCO2: 35 - 45 mmHg
PO2: 80 - 100 mmHg
HCO3: 22 - 27 mEq/L
O2 saturation: 96% - 100%
Acid-base “RAMS”(Respiratory Alternate, Metabolic Same)

GLASGOW COMA SCALE

Eye opening response
Motor response
Verbal response

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC/
ADRENERGIC PARASYMPATHETIC/
CHOLINERGIC

Heart Increased heart rate
Increased conduction
Increased force
Decreased heart rate

Bronchi
dilation
constriction

GI tract
Reduced motility
Increased motility

Rectum
Allows filling Empties rectum
Relaxes internal sphincter

Bladder
Allows filling Empties bladder
Relaxes internal sphincter

Erection
Maintains erection

Ejaculation
Triggers ejaculation

Pupils of eye
Big (mydriasis)
Small (miosis)

Salivary glands
Secretion

Blood vessels Depends on receptors
-a contrict
-b dilates






FLOW OF BLOOD THROUGH THE HEART

Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle – pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle – aortic valve aorta – systemic circulation

CARDIAC IMPULSES

Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s fibers – ventricles contract.

Blood volume: 5000mL
Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)
Pressure within the right atrium: 2 to 7 mmHg
Capillary refill time: <3 gr =" 60" gr =" 300" gr =" 1000mg" gr ="0.4" oz =" 30" dr =" 4" t =" 15" min =" 1" min =" 1mL" min =" 1" dr =" 1" qt =" 1000mL" qt =" 2" pt =" 16" oz =" 1" 2lb =" 1" 8 =" C" 32 =" F" q =" X" factor =" gtt" infuse =" Infusion">25 mg/dL
Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus
Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndrome
Normal CSF pressure: 5 – 15 mmHg
Normal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration;
Decrease in over hydration
Normal scalp pH: 7.26 and above
Borderline acidosis: 7.20 to 7.25
Acidosis: