NURS 3375 NURSING OF ADULTS WITH COMPLEX NEEDS
Critical CARE EXAM 1 2025 University of Texas, Arlington
RN-BSN HEALTH POLICY, LEGAL ASPECTS AND INFORMATICS IN
NURSING. 3 Hours
Study Guide
EXAM 1
ACID BASE DISTURBANCES
1. Explain the roles of the lungs, kidneys, and chemical buffers in maintaining acid–base balance.
a. Buffers: fastest acting , and primary regulator
i. Change strong acids into weaker or to bind acids to neutralize the effect
b. Renal system: takes 2-3 days to respond
i. To compensate for acidosis the kidneys can generate and additional bicarb and eliminate
excess H+
c. Respiratory system: responds in minutes, reaches max in hours
i. CO2 is formed and excreted by the lungs.
1. Retention of CO2 = hyperventilation to “blow off” cO2
2. If low CO2 = hypoventilation to retain
d. Acidosis- caused by an increase in carbonic acid (respiratory acidosis) or decrease in bicarb
(metabolic acidosis)
e. Alkalosis- caused by decrease in carbonic acid (respiratory alkalosis) or increase in bicarb (metabolic
alkalosis)
2. Compare respiratory and metabolic acidosis and alkalosis with regard to causes, clinical
manifestations, diagnosis, and management.
a. Metabolic Acidosis acid accumulation or bicarb lost
i. renal failure, sepsis, hypoxia, DKA, severe diarrhea.
ii. Manifestations: headache, confusion, drowsiness, increases resp rate (compensatory to blow
off
CO2) hypotension, electrolyte imbalance, dysrhythmia K move out of cell to,
(hyperkalemia hypocalcemia)
iii. Treatment: Sodium bicarb
b. Metabolic alkalosis: excess of bicarbonate
i. Loss of acid: prolonged vomiting, gastric suctioning, baking soda ingestion
ii. Manifestations: respiratory depression ( to retain CO2) , tachycardia, symptoms of hypokalemia
iii. Treatment: restore fluid volume with sodium chloride, restore K+.
1. Diamox (acetazolamide) given to assist in the excretion of bicarb
c. Respiratory Acidosis carbonic acid excess.
i. Hypoventilation
, ii. Manifestation: may be asymptomatic or sudden increase in pulse, resp rate and BP,
mental changes, feeling of fullness in head. CO2 concentration = vessel dilation =
headache
iii. Treatment: improve ventilation, increase HOB, mechanical ventilation.
1. Renal compensatory mechanism conserve bicarb and secrete H+ into urine
d. Respiratory Alkalosis:
i. Hyperventilation, anxiety, hypoxemia from acute pulmonary problems, CNS disorders
ii. Manifestations: lightheadedness, inability to concentrate, numbness and tingling, and
sometimes loss of consciousness.
iii. Treatment: correct cause of hyperventilation, renal excretion of bicarb.
3. Interpret arterial blood gas measurements. Respiratory
a. PH 7.35 (7.4) 7.45 Opposite
b. PaCo2 35 (40) 45 Metabolic
c. HCO3 22 (24) 26 Equal
d. PaO2 80-100
AIRWAY ADJUNCTS/TRACH CARE/SUCTIONING
1. Verbalize indications for using different advanced airways.
a. Oropharyngeal
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