ABG Practice – Part 2

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What ABG lab values would you expect to find given the symptoms in the scenario?

Example:  Patient has been nauseous & vomiting.  What ABG values might you expect, and why?

Metabolic Alkalosis pH: high(alkaline)   PaCO2: normal or decreasing     HCO3: high   Puking rids the body of stomach acid, decreasing the total amount of acid in the body.    So acid would decrease, which causes the pH to increase (become more alkaline).  Reduced amounts of acid means that more free bicarb will be available, which makes the HCO3 value higher.  Since the problem is found in the GI system and HCO3 is the abnormal value, then this imbalance is considered a Metabolic type.  The PaCO2 would be normal because there is not a respiratory cause, or it might begin increasing (trying to make the body more acidic) if the respiratory system is starting to compensate.  

 

1) Client is in Acute Renal Failure due to prolonged hypovolemia. What ABG values might you expect, and why?

 

 

2) Client reports that he ate some really spicy hot wings last night, and has been having diarrhea ever since. What ABG values might you expect, and why?

 

 

3) You realize that the mechanical ventilation for a comatose client has been set at too high a rate. What ABG values might you want to check for, and why?

 

 

4) Client has COPD. What ABG values might you want to watch for, and why?

 

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ABG Practice – Part 1

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Interpret the following ABG Values to determine what type of Acid-Base Imbalance is present.

Uncompensated examples

1) pH: 7.30, PaCO2: 38, HCO3-: 18

2) pH: 7.25; PaCO2: 50; HCO3-: 23

3) pH: 7.49; PaCO2: 33; HCO3-: 25

Partially Compensated examples

1) pH: 7.48; PaCO2: 47; HCO3-:30

2) pH: 7.33; PaCO2: 49; HCO3-: 28

3) pH: 7.52; PaCO2: 52; HCO3-: 33

Compensated examples

1) pH: 7.43; PaCO2: 27; HCO3-: 18

2) pH: 7.35; PaCO2: 48; HCO3-: 31

3) pH: 7.39; PaCO2: 34; HCO3-: 21

Unknown – Figure it out for yourself! :)

1) pH: 7.32; PaCO2: 33; HCO3-: 20

2) pH: 7.49; PaCO2: 30; HCO3-: 25

3) pH: 7.32; PaCO2: 47; HCO3-: 30

4) pH: 7.43; PaCO2: 48; HCO3-: 35

5) pH: 7.38; PaCO2: 43; HCO3-: 24

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Basics of the Respiratory System

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1) What is the primary function of the respiratory system?

2) How many lobes do the lungs have? Why do you think that one side has fewer lobes than the other?

3) Besides providing a path for air, what are the 3 main functions of the nose? Or another way of phrasing the question: what are the benefits of breathing through your nose rather than breathing through your mouth?

4) Describe the pathway of air. Where does it enter the body? What structures does it pass through? Describe it in words or draw a picture and label it. Hint: It starts with your nose!

5) What is surfactant? Where do you find it? What is its function?

6) What would happen to the alveoli if there was not enough surfactant? In what kind of patient would you expect to see a lack of surfactant (hint: the answer to the second question is probably in your Maternity textbook)?

7) The first question in this study guide asked you what the primary function of the respiratory system is. In what part of the respiratory system does this primary function happen?

8) What is the difference between “Impaired Gas Exchange” and “Ineffective Airway Clearance?” Name a few reasons why air might not be able to get to the alveoli for Gas Exchange.

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Basics of the Renal System

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Identify the 4 major parts of the urinary system. What does each one do?

o

o

o

o

 

2. Let’s go waaay back to A&P. Remember the nephron, the functional unit of the kidneys? Not so much? Well it’s time to review! Describe the different parts (and sub-parts) of the nephron, and identify what each part does. You could even draw a picture if you want! (Don’t peek ahead to #4 until you answer this question first!)

·         Part 1:

o   Function:

·         Part 2:

o   Function:

·         Part:

o   Sub-part 1:

 

o Function:

o   Sub-part 2:

 

o Function:

o   Sub-part 3:

 

o Function:

3. What is the glomerular filtration rate (GFR)? I want a definition AND a number. What factors can affect GFR?

 

4. Describe how the blood is filtered on a cellular level. Basically, if you were floating along in the blood stream, what would happen to you when you get to the kidneys? Where would you go and how would you get there? And don’t you dare just copy it out of the book, you’ll never begin to understand it that way!

In the Glomerulus:

In Bowman’s Capsule:

In the Proximal Convoluted Tubule:

In the Loop of Henle:

In the Distal Convoluted Tubule:

5) Name a common medication that has its effect on the Loop of Henle. What classification is this medication, what does it do, and why is it given? How does it works?

 

6)   The kidneys have 3 other important functions besides filtering blood. What are they and what effect do they have on the body?

7) Now that you know the 3 major functions of the kidneys (besides filtering blood), what kinds of signs and symptoms would a patient have if the kidneys weren’t able to do these things?

o

o

o

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Level of Consciousness (LOC)

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1) What do you think it means to have an altered Level of Consciousness (LOC), and what are some possible causes?

 

 

 

 

 

 

 

2) What are some common terms that nurses and other medical personnel use to describe various levels of consciousness, and describe what kind of pt they would be used for. For example, I’ll do the first one.

  • Alert: Oriented to person, place, and time

 

Your turn now!

·

·

·

·

 

 

3) Tell me about the Glasgow Coma Scale. You’ll definitely see a question about this at some point.

 

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Intracranial Pressure (ICP)

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1) What is ICP?

 

 

 

 

 

2) What are the 3 things inside the skull that affect ICP?

 

3) If one or more of those things increase and the body can’t compensate by reducing one of the others, then the ICP will increase. Identify the most common cause of ICP, and list its 3 subtypes.

 

 

4) Almost everyone knows that dilated and fixed pupils are a sign of ICP. This means that the pupils are big, and stay big even when you shine a light into them. But did you know that this is a very late sign of ICP?  As a nurse, if you’re only noticing s/sx of ICP at that point, then either the ICP progressed very rapidly, or you’d better have some good malpractice insurance! Most test questions are going to want you to know how to catch ICP early. So what are some earlier signs of ICP that you should be assessing for?

    • Early signs of ICP

·

·

    • Variable signs of ICP (sometimes early, sometimes late, sometimes never!)

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·

·

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    • Late signs of ICP

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Basics of Neuro

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1) What is a neuron? Draw one, and identify the major parts.  Don’t peak at the second page until you try it. And don’t complain about drawing, I’m definitely not an artist, but I drew one for the answer sheet!

 

 

 

 

2) What are the functions of the different parts of the neuron? P.S. If you didn’t label the above neuron with all of the parts below, maybe you should go back and do that now…

1.      Dendrites

a.

2.      Soma

a.

3.      Axon hillock

a.

4.      Axon

a.

b.

c.

5.      Myelin sheaths

a.

 

3) What are the 4 lobes of the brain, where are they located, and what function are they most known for?

1.

a.       Located:

b.      Function:

2.

a.       Located:

b.      Function:

3.

a.       Located:

b.      Function:

4.

a.       Located:

b.      Function:

4) How is the nervous system divided up?

1.

a.

i.

b.

i.

2.

a.

i.

b.

i.

c.

i.

1.

ii.

1.

 

5) What are some other major structures in the brain, and what do they do? Name as many as you can, your list may not be exactly the same as mine.

1.

a.

2.

a.

3.

a.

4.

a.

5.

a.

6.

a.

b.

i.

ii.

 

6) Describe what the blood-brain barrier is, and summarize its function.

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Musculoskeletal Issues

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Compare Osteoarthritis to Rheumatoid arthritis.  What are the causes?  When do the affected joints get stiff?  Are they more painful with rest or with use? 

Osteoarthritis

 

Rheumatoid arthritis

 

What are the primary types of medications used for Osteoarthritis?  What are the nursing considerations?

 

 

What are the primary types of medications used for Rheumatoid Arthritis?  What are the nursing considerations?

 

 

What is Muscular Dystrophy?  What are the early symptoms?  What causes it?  How is it diagnosed?

 

 

What medications are commonly given for Muscular Dystrophy?  What are the goals of nursing care?  What special considerations should you have for people who have Muscular Dystrophy in their family? 

 

 

 

What is Systemic Lupus Erythematosus (SLE)?  What causes it?  What are the effects of SLE on the body?  What are some common types of medications used to manage SLE? 

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Heart Failure

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In the latest textbooks, the terminology has changed. It used to be called Congestive Heart Failure (CHF), but the new term is just Heart Failure (HF). In this study guide we will use the term heart failure.

 

1) Review and redefine the terms preload, after load, cardiac output, stroke volume, and Starling’s law of the heart.

 

2) How do the baroreceptors in the carotid arch influence hormone secretion in heart failure?

 

3) Explain the role of these hormones in heart failure:

Adrenalin

Aldosterone

Antidiuretic Hormone

Rennin

Angiotensin

 

4) What is the physiology that causes the primary symptoms of dyspnea, edema, and fatigue in heart failure?

5) Why does paroxysmal nocturnal dyspnea (PND) occur primarily at night?

 

6) Contrast the etiology of left and right sided heart failure.

7) Differentiate Cor Pulmonale from right sided heart failure.

 

Comparison of heart, kidney, and liver failure symptoms

Symptom heart kidney liver
Ascitesedema
hypertension
breath
Change sensorium
hepatomegaly
puritis
anemia
Diagnostic labs
acidosis
anorexia
Diet
hepatomegaly
Treatments

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Basics of the Gastrointestinal System

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1)  Describe how food gets from your lips to butt.  What organs does it travel through?  Name the organ, and include sphincters, valves, or other important landmarks in the sub-headings.  See if you come up with the same ones that I do.  Don’t peek at the answers until you have tried answering #1 and 2!

1.

2.

3.

a.

b.

c.

4.

a.

b.

c.

5.

a.

b.

c.

d.

e.

6.

7.

8.

 

2)  What are the 3 ‘supplementary’ organs in the digestive system?


3)  What are the important functions of each part of the GI system?  Your answers probably won’t be “word for word” the same as mine, so don’t sweat over that, but the gist of it should be the same.

1.      Mouth

a.

2.      Esophagus

a.

3.      Stomach – __________________________

 

a.       Cardiac Sphincter (Lower Esophageal Sphincter)

i.

b.      Body

i.

1.

2.

3.

4.

c.       Pyloric sphincter – _______________________

4.      Small Intestines

a.

b.

i.

ii.

iii.

5.      Large Intestines

a.

b.

6.      Sigmoid Colon – ­­­­­­­­­­­­­­­­­____________________

7.      Rectum – ________________________

8.      Anal Sphincters – ____________________________

9.      Liver

a.

10.  Biliary Tract (Gall Bladder)

a.

b.

11.  Pancreas – ___________________________

a.

b.

c.

d.

 

Fun (but gross) fact:  Solid feces is made of of 30% dead bacteria, 30% fiber, 10-20% fat (from digested epithelial cells and dead bacteria).

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