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(BQ) Part 2 book Fluids and electrolytes with clinical application has contents: Metabolic acidosis and alkalosis, respiratory acidosis and alkalosis, respiratory acidosis and alkalosis, fluid problems of the older adult,... and other contens.
Licensed to: iChapters User CHAPTER 13 Metabolic Acidosis and Alkalosis William C Rose, PhD INTRODUCTION Two types of metabolic acid-base imbalance are metabolic acidosis and metabolic alkalosis With metabolic acidosis, there is either an excess acid production, e.g., excess hydrogen ions and ketone bodies, or a base (bicarbonate) deficit With metabolic alkalosis, there is an acid (hydrogen ion) deficit or (more likely) a base (bicarbonate) excess Metabolic acidosis and metabolic alkalosis are discussed separately in this chapter 262 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Chapter 13 Metabolic Acidosis and Alkalosis ● 263 ANSWER COLUMN pH or hydrogen ion deficit or excess Acidosis and alkalosis can be determined by the pH; PaCO2; HCO3Ϫ (bicarbonate) As discussed in Chapter 12, Table 12-1, the type of acid-base imbalance can be determined by the arterial blood gases, , , and bicarbonate; base excess; PaCO2 The laboratory values most useful for identifying metabolic acidosis and alkalosis include and The laboratory value for identifying respiratory acidosis and alkalosis is Acid-base balance is maintained by part of acid and 20 parts of base Figure 13-1 demonstrates the normal acid-base balance, and the blood tests for pH, HCO3Ϫ, base excess (BE), are utilized in determining metabolic acidosis and alkalosis acidotic; alkalotic When the acid-base scale tips to the left, it is an indication that an (acidotic/alkalotic) state is present When the scale tips to the right, the type of acid-base imbalance is an (acidotic/alkalotic) state decreased; increased With metabolic acidosis, the pH is With metabolic alkalosis, the pH is decreased; increased In metabolic acidosis, the bicarbonate and base excess are In metabolic alkalosis, the bicarbonate and base excess are Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 264 ● Unit IV Acid-Base Balance and Imbalance Balance HCO3- H+ (Acid) (Bicarbonate) Imbalances Metabolic Alkalosis Metabolic Acidosis Deficit HCO3 (Bicarbonate) Excess H+ Deficit H+ Excess HCO3- (Acid) (Acid) (Bicarbonate) pH HCO3 , BE FIGURE 13-1 pH HCO3 , BE Acid-base balance and metabolic imbalances PATHOPHYSIOLOGY decreased; excess; less Metabolic acidosis is characterized by a(n) (increased/decreased) bicarbonate concentration or acid (deficit/excess) extracellular fluid The pH is (less/more) than 7.35 Ͻ24; ϽϪ2 With metabolic acidosis, the HCO3Ϫ level is mEq/L and the base excess (BE) is (Ͼϩ2/ϽϪ2) in the Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Chapter 13 Metabolic Acidosis and Alkalosis increased; greater than 7.45 10 Ͼ28; Ͼ ϩ2 ● 265 Metabolic alkalosis is characterized by a(n) (increased/decreased) bicarbonate concentration or loss of hydrogen ions (strong acid) in the extracellular fluid The pH is * 10 With metabolic alkalosis, the bicarbonate level is mEq/L and BE is ETIOLOGY The causes of metabolic acidosis and metabolic alkalosis are described in Tables 13-1 and 13-2 The rationale is given with each of the causes Study the tables and then proceed to the questions Refer to the tables as needed 11 bicarbonate; hydrochloric 11 With severe or chronic diarrhea, the anion that is lost from the small intestine is Sodium ions are also lost in excess of the chloride ions The chloride ions combine with the hydrogen ions to produce acid 12 Nonvolatile acids such as lactic acid result from cellular breakdown 12 How does starvation cause metabolic acidosis? * 13 The liver produces fatty acids, which leads to ketone body production 14 catabolism; nonvolatile acids such as lactic acid 13 With uncontrolled diabetes mellitus, glucose cannot be metabolized; therefore, what occurs? * 14 Shock, trauma, severe infection, and fever can cause cellular (anabolism/catabolism) The acid products frequently released from the cells are * Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 266 ● Unit IV Acid-Base Balance and Imbalance Table 13-1 Etiology Gastrointestinal Abnormalities Starvation Severe malnutrition Chronic diarrhea Renal Abnormalities Kidney failure Hormonal Influence Diabetic ketoacidosis Hyperthyroidism, thyrotoxicosis Others Trauma, shock Excess exercise, severe infection, fever Causes of Metabolic Acidosis Rationale Lactic, Pyruvic, and other acids accumulate as the result of cellular breakdown due to starvation and/or severe malnutrition Loss of bicarbonate ions in the small intestines is in excess Also, the loss of sodium ions exceeds that of chloride ions ClϪ combines with Hϩ, producing a strong acid (HCl) Kidney mechanisms for conserving sodium and water and for excreting Hϩ fail Failure to metabolize adequate quantities of glucose causes the liver to increase metabolism of fatty acids Oxidation of fatty acids produces ketone bodies which cause the ECF to become more acid Ketones require a base for excretion An overactive thyroid gland can cause cellular catabolism (breakdown) due to a severe increase in metabolism which increases cellular needs Trauma and shock cause cellular breakdown and the release of acids Excessive exercise, fever, and severe infection can cause cellular catabolism and acid accumulation 15 a, c, d, e 15 Indicate which of the following conditions can cause metabolic acidosis: ( ) a Starvation ( ) b Gastric suction ( ) c Excessive exercise ( ) d Shock ( ) e Uncontrolled diabetes mellitus (ketoacidosis) 16 chloride 16 Name the anion that is lost in great quantities due to vomiting or gastric suction Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Chapter 13 Metabolic Acidosis and Alkalosis Table 13-2 Etiology Gastrointestinal Abnormalities Vomiting, gastric suction Peptic ulcers Hypokalemia ● 267 Causes of Metabolic Alkalosis Rationale With vomiting and gastric suctioning, large amounts of chloride and hydrogen ions that are plentiful in the stomach are lost Bicarbonate anions increase to compensate for chloride loss Excess of alkali in ECF occurs when a patient ingests excessive amounts of acid neutralizers such as NaHCO3 to ease ulcer pain Loss of potassium from the body is accompanied by loss of chloride 17 overtreated peptic ulcer, vomiting, gastric suction, and loss of potassium 17 Name conditions that cause metabolic alkalosis * ,* , and * 18 a M Ac; b M Al; c M Ac; d M Ac; e M Al; f M Ac; g M Ac 18 For causes of metabolic acidosis and alkalosis, place M Ac for metabolic acidosis and M Al for metabolic alkalosis for the appropriate condition a Diabetic ketoacidosis b Overtreated peptic ulcer c Severe diarrhea d Shock, trauma e Vomiting, gastric suction f Fever, severe infection g Excessive exercise , CLINICAL APPLICATIONS Anion gap is a useful indicator for determining the presence or absence or metabolic acidosis The serum concentrations (in mEq/L) of sodium (Naϩ), potassium (Kϩ), chloride (ClϪ), and bicarbonate (HCO3Ϫ ) are used to compute the anion gap, as follows: Anion gap (mEq/L) ϭ [Naϩ] ϩ [Kϩ] Ϫ [ClϪ] Ϫ [HCO3Ϫ ] Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 268 ● Unit IV Acid-Base Balance and Imbalance 19 a 20 142 ϩ Ϫ 102 Ϫ 18 ϭ 26 mEq/L; yes; The anion gap is greater than 20 mEq/L 19 If the anion gap is greater than 20 mEq/L, metabolic acidosis is suspected Which of the following acid-base imbalances are indicated by an anion gap that exceeds 20 mEq/L: ( ) a Metabolic acidosis ( ) b Metabolic alkalosis ( ) c Respiratory acidosis 20 A patient’s serum values are Na, 142 mEq/L; K, 4mEq/L; Cl, 102 mEq/L; and HCO3Ϫ, 18 mEq/L The anion gap is * Is metabolic acidosis present? Why? * 21 a, d, e, f 21 Conditions associated with an anion gap that is greater than 20 mEq/L are diabetic ketoacidosis, lactic acidosis, poisoning, and renal failure Indicate which of the following conditions might apply to an anion gap of 25 mEq/L: ( ) a Diabetic ketoacidosis ( ) b Chronic obstructive pulmonary disease (COPD) ( ) c Respiratory failure ( ) d Renal failure ( ) e Poisoning ( ) f Lactic acidosis 22 metabolic alkalosis; There is excess alkali in the extracellular fluid 22 When a patient ingests excessive amounts of baking soda or commercially prepared acid neutralizers to ease indigestion or stomach ulcer pain, what imbalance will most likely occur? * Why? * CLINICAL MANIFESTATIONS When metabolic acidosis occurs, the central nervous system (CNS) is depressed and symptoms can include apathy, disorientation, weakness, and stupor Deep, rapid breathing Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Chapter 13 Metabolic Acidosis and Alkalosis ● 269 is a respiratory compensatory mechanism for the purpose of decreasing acid content in the blood With metabolic alkalosis, excitability of the CNS occurs These symptoms may include irritability, mental confusion, tetany-like symptoms, and hyperactive reflexes Hypoventilation may occur, and it acts as a compensatory mechanism for metabolic alkalosis and conserves the hydrogen ions and carbonic acid Table 13-3 lists the clinical manifestations related to metabolic acidosis and alkalosis Study the table and refer to it as needed when answering the questions 23 depressed; excited Table 13-3 23 With metabolic acidosis, the CNS is (depressed/excited) With metabolic alkalosis, the CNS is (depressed/excited) Clinical Manifestations of Metabolic Acidosis and Metabolic Alkalosis Body Involvement Metabolic Acidosis Metabolic Alkalosis CNS Abnormalities Irritability, confusion, tetany-like symptoms, hyperactive reflexes Shallow breathing Gastrointestinal Abnormalities Restlessness, apathy, weakness, disorientation, stupor, coma Kussmaul breathing: deep, rapid, vigorous breathing Flushing and warm skin Cardiac dysrhythmias, decrease in heart rate and cardiac output Nausea, vomiting, abdominal pain Laboratory Values pH HCO3, BE Ͻ7.35 Ͻ24 mEq/L; ϽϪ2 Ͼ7.45 Ͼ28 mEq/L; Ͼϩ Respiratory Abnormalities Skin Changes Cardiac Abnormalities Vomiting with loss of chloride and potassium Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 270 ● Unit IV Acid-Base Balance and Imbalance 24 a M Al; b M Ac; c M Ac; d M Al; e M Al; f M Ac 24 Indicate which of the following CNS abnormalities are associated with metabolic acidosis (M Ac) and metabolic alkalosis (M Al) a Irritability b Apathy c Disorientation d Tetanylike symptoms e Hyperactive reflexes f Stupor 25 bicarbonate deficit or acid excess; decreased 25 Metabolic acidosis results from a * In metabolic acidosis, the HCO3 and BE are (decreased/ increased) 26 With metabolic acidosis, the renal and respiratory mechanisms try to re-establish pH balance Explain how the renal mechanism works to re-establish balance * 26 The kidneys excrete more Hϩ and retain bicarbonate; As the result of the increased breathing, CO2 is blown off, decreasing carbonic acid (H2CO3); It decreases 27 bicarbonate excess; increased Explain how the respiratory mechanism works to reestablish balance * When these two mechanisms fail, what happens to the plasma pH? * 27 Metabolic alkalosis results from a * In metabolic alkalosis, the HCO3Ϫ and BE are (decreased/increased) 28 With metabolic alkalosis, the renal, and respiratory mechanisms try to re-establish balance Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Chapter 13 Metabolic Acidosis and Alkalosis ● 271 Explain how the renal mechanism works to re-establish balance 28 The kidneys excrete more bicarbonate and less Hϩ; Pulmonary ventilation is decreased; therefore, CO2 is retained, increasing H2CO3; It increases * Explain how the respiratory mechanism works to re-establish balance * When these mechanisms fail, what happens to the plasma pH? * CLINICAL MANAGEMENT Figure 13-2 outlines the body’s normal defense actions and various methods of treatment for restoring balance in metabolic acidosis and alkalosis Study this figure carefully, with particular attention to the cause of each imbalance, the body’s defense action, the pH of the urine as to whether it is acidic or alkaline, and the treatment for these imbalances Refer to the figure whenever you find it necessary 29 bicarbonate deficit or acid excess; acid; a Lungs blow off CO2 or acid; b Kidneys excrete acid or Hϩ and conserve bicarbonate 30 remove cause, administer IV alkali solution (e.g., NaHCO3), and restore H2O and electrolytes 31 bicarbonate excess; alkaline; a Breathing is suppressed; b Kidneys excrete HCO3 and retain Hϩ 29 What is metabolic acidosis? * The urine is (acid/alkaline) What are the body’s defense actions against it? a * b * 30 Identify three treatment modalities for metabolic acidosis * 31 What is metabolic alkalosis? * The urine is (acid/alkaline) * What are the body’s defense actions against it? a * b * Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 550 ● References/Bibliography diabetes: A consensus statement from the American Diabetes Association Diabetes Care, 29, 2739–2748 Knebel, A R., Bentz, E., & Barnes, P (2000) Brief report Dyspnea management of alpha-1 antitrypsin deficiency: Effect of oxygen administration Nursing Research, 49, 333–338 Kokko, J P., & Tanner, R L (1995) Fluids and electrolytes (3rd ed.) 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Philadelphia: Mosby Wouters, E F M., Creutzberg, E C., & Schols, A M W J (2002) Systemic effects in COPD Chest, 121, 127S–130S Wu, C., Lee, Y Y., Bain, K., & Wichaikhum, O (2001) Coping behaviors of individuals with chronic obstructive pulmonary disease MEDSURG Nursing, 10, 315–321 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index Abbreviations, 536–538t Abnormal breath sounds, 501t Accupril, 123t ACE inhibitors heart failure, 472 hyperkalemia, 107t, 123t potassium imbalances, 97t, 123t, 125, 128 Acetazolamide, 121t, 187t, 231t Acid, 239–240 Acid-base imbalance, 239–294 compensation for, 260t determination of, 254–261 metabolic acidosis/alkalosis, 262–277 See also Metabolic acidosis/alkalosis pH, 240, 242, 244f, 255 pH control, 245–253 See also Regulatory systems for pH control respiratory acidosis/alkalosis, 278–294 See also Respiratory acidosis/alkalosis summary, 289t Acidity, 240 Acidosis, 41, 244f, 256, 257–258 See also Acid-base imbalance Acute renal failure (ARF), 428 causes, 430t pathophysiology, 428–429 phases, 428t Acute respiratory acidosis (ARA), 281 Adenosine triphosphate (ATP), 222 ADH See Antidiuretic hormone (ADH) Adolsterone, 408 Adrenal cortical hormones, 140t Afterload, 384t, 472–473 Aging, effects of, 344–352 See also Older adults Airflow limitation, 499t Albumin, 15, 16t, 249, 393t Albuterol, 122t, 506t Alcoholism, 225 Aldosterone, 16t, 17, 18, 55, 102, 104 Alkalinity, 240 Alkalosis, 244f, 256, 257–258 See also Acid-base imbalance Alpha1-antitrypsin (AAT) deficiency, 465 Alpha-adrenergic blockers, 122t Altace, 123t Alternative therapies, 507t Aluminum antacids, 231t Aluminum/magnesium antacids, 231t American Thoracic Society (ATS), 464 Amikacin, 122t, 187t Aminoglycosides, 187t Amitriptyline, 154t Ammonia, 248 Ammonia buffer, 246 Ammonia-ammonium buffer system, 248, 250t Ammonium ions, 248, 253 Amphetamines, 123t Amphojel, 231t Amphotericin B, 122t, 154t, 211t Ampicillin, 122t Amrinone, 473 Anabolic, 103 Anabolism, 103 Anasarca, 49 Androgens, 187t, 231t Angiotensin II receptor antagonists, 123t Anion gap, 256t, 258, 267 Anions, 90, 91–96 Antacids, 205–206, 226 Antibiotics, 122t, 154t, 211t, 231t, 398 553 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 554 ● Index Anticancer drugs, 154t Anticholinergics, 506t Anticonvulsants, 187t Antidiabetics, 154t Antidiuretic hormone (ADH) actions, 16t, 17 ECFVS, 77 sodium and chloride imbalances, 140t Antineoplastics, 154t Antiproteinase, 497 Antipsychotics, 154t Anuria, 112, 432 ARF See Acute renal failure Arginine vasopressin, 156 Arrhythmia, 109 Arterial bicarbonate (HCO3), 41 Arterial blood gases, 375t, 502t Arterial pH, 256t Arterioles, 13 Artificial kidney (AK), 442, 443 Aspirin, 187t ATP, 222 Auscultatory method, 415 AVP, 156 Azlocillin, 122t Azlocillin Na, 154t Azotemia, 433 Bananas, 101 Barbiturates, 123t, 154t Bariatric surgery, 419–421 Barrel-shaped chest, 501t Basaljel, 231t Base, 239–240 See also Acid-base imbalance Base excess (BE), 256t, 257, 502t Beclomethasone, 506t Bedsores, 60 Beta blockers, 125 Beta2 agonists, 122t, 506t Beta-adrenergic blockers, 123t Bicarbonate, 41, 91t, 255, 257, 479 Bicarbonate-carbonic acid, 246, 246–247, 250t, 252 Blood clotting, 171, 443 Blood products, 393t Blood sugar levels, 479 Blood urea nitrogen See BUN Blood vessels, 5, Body fluid, 1–27 See also Fluid imbalance assessment factors, 26 clinical applications, 22–23 definitions, 10–12 electrolyte composition of, 94t evaluation/outcome, 27 fluid compartments, 5–7, 51f functions of body water, homeostasis, 7–9 intake/outtake, 9f interventions, 26–27 milligram (mg) vs milliequivalent, 21–22 nursing diagnosis, 26 osmolality, 18–21 patient management, 26–27 regulators of fluid balance, 15–18 Starling’s law, 12–15 water, 2, 4–5 Body weight, 39 Bradycardia, 109, 112, 383, 389 BRAT diet, 317 Breast-fed infants, 302–303 Breathing retraining, 507t Bronchodilators, 506t Buffer systems, 246–252 BUN, 18, 19, 412, 413 Calcitonin, 169, 185 Calcitriol, 221 Calcium, 91t, 96–97t, 166–168 functions, 168–171 Calcium antacids, 231t Calcium carbonate, 182t, 231t Calcium chloride, 182t Calcium citrate, 182t Calcium gluceptate, 182t Calcium gluconate, 182t, 211t Calcium imbalances, 166–197 See also Hypercalcemia; Hypocalcemia assessment factors, 192–193, 194–195 calcium replacement, 182–184 clinical applications, 189–190 clinical considerations, 190 clinical management, 181–188 clinical manifestations, 177–181 drugs, 186–188 ECG/EKG, 180–181 etiology, 173–177 evaluation/outcome, 196–197 interventions, 193–194, 195–196 nursing diagnosis, 193–194, 195–196 pathophysiology, 171–173 patient management, 192–197 Calcium lactate, 182t Calcium salts, 187t Calcium-rich foods, 533–534t Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index Cancers, 186 Cantor tube, 409 Capillaries, 13 Capillary membrane changes, 290 Capillary permeability, 53t, 55 Capoten, 123t Capreomycin, 211t Captopril, 123t Carbenicillin, 122t, 154t, 211t Carbonic acid, 246, 247, 253, 255 Carbonic anhydrase inhibitors, 121t Cardiac dysrhythmias, 109, 128, 188, 201 Cardiogenic shock, 380, 385t, 388t, 396t, 397 Catabolic, 103 Catabolism, 103, 127 Catapres, 154t Cations, 90, 91–96 CAVH, 441 CAVHD, 441 Cells, Cellular fluid, CeraLyte, 315t Cerebral edema, 76 Chemical buffer systems, 246, 246–252 Chemical compounds, 90 Chemistry, laboratory tests/values, 520–528t Chest physiotherapy, 507t Chest X-ray, 502t Children See Infants and children Chloride, 91t, 137 functions, 142–143 Chloride imbalances See Sodium and chloride imbalances Chloride-rich foods, 533–534t Chlorothiazide, 121t Chlorpropamide, 154t Chlorthalidone, 187t Cholestyramine, 154t Chronic bronchitis, 464 Chronic diseases, 463–515 COPD, 464–465, 497–515 diabetes mellitus, 464, 478–497 heart failure, 464, 465–478 Chronic kidney disease (CKD), 428 causes, 431t pathophysiology, 429–430 stages, 429t Chronic obstructive pulmonary disease (COPD), 282, 464–465, 497–515 assessment factors, 510–511 case study, 508–510 clinical applications, 503–506 ● 555 clinical management, 506–508 clinical manifestations, 500–503 diagnostic/laboratory studies, 502t evaluation/outcome, 515 fluid/electrolyte considerations, 500 interventions, 511–515 nursing diagnosis, 511–515 pathophysiology, 497–500 patient management, 510–515 Chvostek’s sign, 179 Cigarette smoking, 465, 497 Ciliary dysfunction, 499t Cisplatin, 122t, 154t, 211t CKD See Chronic kidney disease (CKD) Class I hypovolemic shock, 395t Class II hypovolemic shock, 395t Class III hypovolemic shock, 395t Class IV hypovolemic shock, 395t Clinical situations, 295–515 See also individual subject headings chronic diseases, 463–515 GI surgery, 406–426 infants and children, 297–342 older adults, 343–362 renal failure, 427–462 trauma and shock, 363–405 Clonidine, 154t CNS agents, 123t CNS depressants, 154t Cochicine, 187t Colloid, 12 Colloid osmotic pressure gradient, 13, 15 Colloid osmotic pressures, 12, 13 Colloids, 392–394 Combivent, 506t Complementary therapies, 507t Conivaptan, 156 Constipation, 354t Continuous arteriovenous hemofiltration (CAVH), 441 Continuous artriovenous hemodialysis (CAVHD), 441 Continuous replacement therapy (CRRT), 440–442, 447, 448t COPD See Chronic obstructive pulmonary disease (COPD) Cor pulmonale, 499t Corgard, 123t Corticosteroids, 122t, 154t, 187t, 211t, 231t Cortisone calcium imbalances, 185, 187t, 188 magnesium imbalances, 211t Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 556 ● Index phosphorus imbalances, 231t potassium imbalances, 122t, 125 sodium and chloride imbalances, 154t Cough medicines, 154t, 501t Coughing techniques, 507t Cozaar, 123t Creatinine, 433 Creatinine/BUN, 423 CRRT, 440–442, 447, 448t Crystalloids, 391–392, 394 Cushing’s disease, 408 Cushing’s syndrome, 96t, 106t, 150 Cyanosis, 58, 501t Cyclophosphamide, 123t, 154t Cyclosporine, 123t Darvon, 154t Decubiti (bedsores), 60 Deficient knowledge (parental), 340–341 Dehydration, 23, 30, 35 See also Extracellular fluid volume deficit (ECFVD) clinical assessment of, 309t degrees of, 36t DKA, 484 hyponatremic, 313t hypernatremic, 313t infants and children, 307–319 isonatremic, 312t older adults, 354t oral rehydration solutions, 315t treatment, 315–318 types of, 311–315 Demeclocycline, 154t Deoxyhemoglobin, 249–250 Dependent edema, 58, 59 Dextran 40, 393t Diabetes mellitus (DM)/diabetic ketoacidosis (DKA), 464, 478–497 assessment factors, 494 case study, 492–494 causes, 481t clinical applications, 484–488 clinical management, 488–492 clinical manifestations, 481–484 electrolyte correction, 491–492 etiology, 481 evaluation/outcome, 497 fluid replacement, 488–489 HHS, 464 insulin replacement, 489–491 interventions, 495–497 nursing diagnosis, 494–497 pathophysiology, 478–481 patient management, 494–497 Type 1, 464 Type 2, 464 Diablenease, 154t Dialysate, 441, 442, 444, 445–446 Dialysis, 439–449 CRRT, 440–442, 448t hemodialysis, 442–444, 448t peritoneal dialysis, 444–447, 448t Diamox, 121t Diarrhea, 354t, 410 Dibasic phosphate, 247–248 Diet, 60 Diffusion, 10t, 11, 439 Di-Gel, 231t Digitalis, 473 Digitalis toxicity, 124, 188, 212, 473 Digitalization, 473 Digoxin, 60, 123t, 124, 125, 188, 211t, 212, 473 Disequilibrium syndrome, 453 Diuresis, 479 Diuretics, 60 loop, 121t, 124, 187t, 188, 231t magnesium imbalances, 211t osmotic, 82, 121t potassium-sparing, 120–121, 121t potassium-wasting, 120–121, 121t sodium balance, 154t thiazides, 187t, 231t Diuril, 121t DKA See Diabetes mellitus (DM)/diabetic ketoacidosis (DKA) DM See Diabetes mellitus (DM)/diabetic ketoacidosis (DKA) Do Not Use abbreviations, 536t Dobutamine, 399, 473 Dopamine, 473 Dopamine HCI, 399 Doriden, 187t Drugs calcium imbalances, 186–188 magnesium imbalances, 210–212 phosphorus imbalances, 230–232 potassium imbalances, 120–125 sodium and chloride imbalances, 153–155 Dry weight, 440, 443 Dumping syndrome, 420 Duresing, 60 Dyspnea, 501t Dysrhythmia, 109, 128, 188, 201 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index Early shock, 384 ECFVD See Extracellular fluid volume deficit (ECFVD) ECFVE See Extracellular fluid volume excess (ECFVE) ECFVS See Extracellular fluid volume shift (ECFVS) ECG/EKG calcium imbalances, 180–181 potassium imbalances, 109–115 Edecrin, 121t, 211t Edema, 23, 50, 51f cerebral, 76 compared with water intoxication, 77 dependent, 58, 59 nondependent, 59 older adults, 354t peripheral, 51, 52, 59 physiologic factors, 52, 53–54t pulmonary, 51, 52, 55–56, 58 refractory, 59 EKG See ECG/EKG Electrolyte imbalances calcium imbalances, 166–197 See also Calcium imbalances clinical problems, 96–97t magnesium imbalances, 198–219 See also Magnesium imbalances phosphorus imbalances, 220–238 See also Phosphorus imbalances potassium imbalances, 98–136 See also Potassium imbalances sodium and chloride imbalances, 137–165 See also Sodium and chloride imbalances Electrolytes, 15, 16t, 89–90 cations/anions, 91–96 concentration of, in stomach/intestine, 409t electrolyte composition of body fluid, 94t equivalents, 94t Elvail, 154t Emphysema, 464 Enemas, 122t Enfalyte, 315t Enzymes, 16t Epinephrine, 231t, 398 Epsom salts, 211t Equilibrium, 11 Estrogens, 122t, 187t Ethacrynic acid, 121t, 211t European Respiratory Society (ERS), 464 Exercise, 507t Extracellular fluid (ECF), 6–7, 12, 95f ● 557 Extracellular fluid volume deficit (ECFVD), 30–48 assessment factors, 45–46 causes, 34t clinical applications, 38–39 clinical considerations, 42–43 clinical management, 39–42 clinical manifestations, 35–38 etiology, 33–35 evaluation/outcome, 47–48 IFVD vs HFVD, 33, 34t interventions, 46–47 nursing diagnosis, 46–57 pathophysiology, 31–33 patient management, 45–48 solution replacement for, 42t Extracellular fluid volume excess (ECFVE), 49–67 assessment factors, 63–64 clinical applications, 59–60 clinical considerations, 61 clinical management, 60–61 clinical manifestations, 56–59 etiology, 52–56 evaluation/outcome, 66–67 interventions, 64–66 nursing diagnosis, 64–66 pathophysiology, 50–52 patient management, 63–67 Extracellular fluid volume shift (ECFVS), 68–74 Fatal dehydration, 36t Fleet sodium phosphate, 231t Fluid balance regulators of, 15–18 Fluid compartments, 5–7 Fluid imbalance, 28–88 clinical problems, 29t ECFVD, 30–48 See also Extracellular fluid volume deficit (ECFVD) ECFVE, 49–67 See also Extracellular fluid volume excess (ECFVE) ECFVS, 68–74 ICFVE, 75–88 See also Intracellular fluid volume excess (ICFVE) patient management, 26–27 Fluid pressures, 12–15 Furosemide, 60, 121t, 184, 185, 187t, 211t Gas exchange abnormalities, 499t Gastric intubation, 409 Gastrin, 231t Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 558 ● Index Gastrointestinal (GI) surgery, 406–426 assessment factors, 421–423 bariatric surgery, 419–421 case study, 417–419 clinical applications, 410–413 clinical management, 414–417 evaluation/outcome, 426 fluid/electrolyte impairments, 408–410 interventions, 424–426 laboratory studies, 411t nursing diagnosis, 424–425 patient management, 421–426 postoperative, 414–417 preoperative, 414 Gastrointestinal (GI) tract, 407 Gelusil, 231t Gentamicin, 122t, 187t, 211t Global Initiative for Chronic Obstructive Lung Disease (GOLD), 465 Glucagon, 231t Glucocorticosteroids, 506t Glucose, 18, 119t, 122t, 231t, 479 Glutethimide, 187t Glycosuria, 479 HCI, 41 HCO3, 502t Health problems See Clinical situations Heart failure (HF), 464, 465–478 afterload, 472–473 assessment factors, 475 case study, 474–475 clinical applications, 470–471 clinical management, 471–473 clinical manifestations, 468–469 evaluation/outcome, 477–478 interventions, 476–477 myocardial contractility, 473 nursing diagnosis, 475–477 pathophysiology, 465–468 patient management, 475–478 physiologic/neurohormonal changes, 467t preload, 472 Hematocrit (Hct), 502t Hematology, 517–519t Hemodialysis, 441, 442–444, 448t Hemofilter, 440 Hemoglobin, 249, 250t Hemoglobin (Hb), 502t Heparin, 123t, 125, 443 Heroin, 123t Hetastarch, 393t HF See Heart failure (HF) HFVD, 33, 34t HHS, 464 High-peaked T wave, 114 Holiday-Segar method, 306t Homeostasis, 7–9 Hormones, 15, 16t, 17 Hydration, 506t Hydrochloric acid (HCI), 41 Hydrochlorothiazide (Hydro DIURIL), 60, 121t HydroDiuril, 121t, 185 Hydrogen ions, 240, 246, 479 Hydrostatic, 12 Hydrostatic pressure, 14, 51 Hydrostatic pressure gradient, 13, 14 Hydrostatic pressures, 12, 13 Hydroxl ions, 240 Hygroteon, 187t Hypercalcemia, 171, 173 causes, 175t clinical management, 182 clinical manifestations, 177–181 correction, 184–186, 185t drugs, 187t patient management, 194–196 Hypercapnia, 283, 499t Hyperchloremia, 139 causes, 149t clinical manifestations, 152t patient management, 162–165 Hyperglycemia, 126–127 Hyperglyxemic hyperosmolar state (HHS), 464 Hyperinflation, 499t Hyperkalemia, 102, 109–115 causes, 107t clinical manifestations, 110t correction, 118–120, 119t drugs, 123t patient management, 134–136 renal failure, 434t Hypermagnesemia, 201 causes, 202–206, 204t clinical manifestations, 207t correction, 209–210 drugs, 211t patient management, 217–219 Hypernatremia, 139 causes, 149t clinical manifestations, 150t drugs, 154t in infants, 302 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index patient management, 162–165 renal failure, 434t Hypernatremic dehydration, 313t Hyperosmolality, 19, 20 Hyperosmolar fluid volume deficit, 33, 34t Hyperosmolar hyponatremia, 144 Hyperphosphatemia, 176, 223, 228t causes, 225t drugs, 231t patient management, 236–238 renal failure, 435t Hypertonic, 20 Hypertonic saline, 154t Hypertonicity, 19 Hyperventilation, 259 Hypervolemia, 50, 58 Hypocalcemia, 171 causes, 174t clinical management, 181, 183–184, 183t clinical manifestations, 177–181 drugs, 187t patient management, 192–194 renal failure, 435t Hypochloremia, 139 causes, 145–146t clinical manifestations, 152t patient management, 161–162 Hypokalemia, 102, 104 causes, 106t clinical manifestations, 110t drugs, 122t ECG/EKG, 109–115 in infants, 304 patient management, 132–133 renal failure, 434t Hypomagnesemia, 172, 201 causes, 202–206, 203t clinical manifestations, 207t drugs, 211t patient management, 215–217 Hyponatremia, 139, 144–145 causes, 145–146t clinical manifestations, 150t drugs, 154t in infants, 303 patient management, 161–162 renal failure, 435t Hyponatremic dehydration, 313t Hypo-osmolality, 19 Hypo-osmolar, 20 Hypo-osmolar fluid, 76 Hypo-osmolar fluid volume excess, 50 ● 559 Hypo-osmolar hyponatremia, 144 Hypoparathyroidism, 226 Hypophosphatemia, 173, 223 causes, 224t clinical manifestations, 228t drugs, 231t patient management, 235–236 Hypotonic, 20 Hypotonic fluid volume excess, 50 Hypovolemia, 38–39, 43, 69 Hypovolemic shock, 380, 384t, 388t, 394, 395t, 396t, 397 Hypoxemia, 499t Ibuprofens, 123t, 125, 154t ICFVE See Intracellular fluid volume excess (ICFVE) Immunosuppressive drugs, 123t Inderal, 123t Indomethacin, 123t Infants and children, 297–342 assessment, 319–325t, 325–328, 331–333 breast-fed infants, 302–303 case study, 328–330 clinical applications, 305–307 dehydration, 307–319 etiology, 301–305 evaluation/outcome, 341–342 fluid/electrolyte requirements, 306t interventions, 333–341 juices/sodas, 307 low-birth-weight, 304, 305 newborn infants, 305 nursing diagnosis, 333–341 oral rehydration solutions, 315t patient management, 331–342 physiologic factors, 298–301 treatment, 315–318 Infants formulas, 302–303 Inotropes, 473 Insensible perspiration, 11 Insulin, 102, 119t, 122t, 211t, 231t, 485 Intercostal retractions, 501t Interstitial fluid, 6, Intracellular fluid, 6, 95f Intracellular fluid volume excess (ICFVE), 75–88 assessment factors, 86 causes, 78t clinical applications, 81–82 clinical considerations, 83–84 clinical management, 82–83 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 560 ● Index clinical manifestations, 79–81 etiology, 77–79 evaluation/outcome, 87–88 interventions, 86–87 low-birth-weight, 302 nursing diagnosis, 86–87 pathophysiology, 76–77 patient management, 86–88 signs and symptoms, 80t Intravascular fluid, Intravenous phosphates, 231t Ionization, 90 Ions, 10t, 90, 91 Ipratropium, 506t Isonatremic dehydration, 312t Iso-osmolality, 19, 20 Iso-osmolar fluid volume deficit, 33, 34t Iso-osmolar fluid volume excess, 50 Iso-osmolar fluid volume loss, 32 Iso-osmolar hyponatremia, 144 Isotonic, 20 IV lipids, 187t IV phosphate, 185, 231t IV sodium bicarbonate, 119t IV solution concentration of, 20 Juices/sodas, 307 Juvenile-onset diabetes, 464 K penicillin, 123t Kayexalate, 119t, 122t, 187t Ketones, 480 Ketosis, 479 Kidneys, 15 See Renal failure KPO4 enema, 123t Kussmaul breathing, 480 Laboratory test/values, 517–531t chemistry, 520–528t hematology, 517–519t others, 531t urine chemistry, 529–530t Lactated Ringer’s, 391t Lactic acid, 41 Lactulose, 154t Lasix, 60, 121t, 184, 187t, 211t Late shock, 384 Law of Capillaries, 12 Laxatives, 122t, 206, 211t L-dopa, 122t Levine tube, 409 Levodopa, 122t Levophed, 398, 399 Licorice, 122t Lithium, 122t, 154t, 211t Loop diuretics, 60, 121t, 124, 187t, 188, 231t Losartan potassium, 123t Low-birth-weight infants, 304, 305 Low-molecular-weight heparin (LMWH), 123t, 125 Lungs, 16t Lymphatic drainage, 54t, 55 Lymphatics, 15, 16t, 18 Maalox, 231t Maalox Plus, 231t Magnesium, 91t, 96–97t, 198–200 functions, 200–201, 200t Magnesium citrate, 211t Magnesium hydroxide, 211t Magnesium imbalances, 198–219 assessment factors, 215–216, 217–218 clinical applications, 212–213 clinical considerations, 213–214 clinical management, 208–212 clinical manifestations, 206–208 drugs, 210–212 etiology, 202–206 evaluation/outcome, 218–219 interventions, 216–217, 218 magnesium replacement, 209 nursing diagnosis, 216–217, 218 pathophysiology, 201–202 patient management, 215–218 Magnesium salts, 211t Magnesium sulfate, 187t, 211t Magnesium-rich foods, 533–534t Mannitol, 82, 121t, 211t, 231t Marked dehydration, 36t, 37 Medulla oblongata, 252 Mellaril, 154t Membrane, 10t Metabolic acidosis/alkalosis, 258, 259, 262–277 assessment factors, 274 causes, 266t, 267t clinical applications, 267–268 clinical management, 271–272 clinical manifestations, 268–271, 268t etiology, 265–267 evaluation/outcome, 277 interventions, 275–277 nursing diagnosis, 275–277 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index pathophysiology, 264–265 patient management, 274–277 renal failure, 435t summary, 289t Methicillin, 231t Methulxanthines, 506t Mezlocillin Na, 154t Mild dehydration, 36t, 309t Miller-Abbott tube, 409 Milliequivalent, 21–22, 92–93 Milligram (mg), 21–22, 92–93 Milliosmol (mOsm), 18 Milrinone, 473 Mithracin, 187t Moderate dehydration, 309t MOM, 211t Monobasic phosphate, 253 Morphine, 154t mOsm, 18 Motrin, 154t Mucus hypersecretion, 499t Mylanta, 231t Mylanta II, 231t Myocardial contractility, 473 Nadolol, 123t Nafcillin, 122t Nail clubbing, 501t Narcotics, 123t Nasogastric tube (NG), 420 Navane, 154t Neomycin, 122t, 187t, 211t Neurogenic shock, 380, 385t, 388t, 396t, 398 Neutra-Phos K, 231t Newborns See Infants and children Nicotine, 154t Nondependent edema, 59 Nonsteroidal anti-inflammatory drugs (NSAIDs), 123t Normal saline solution (NSS), 184, 391t Nutritional support, 507t Ocean water, 139 Older adults, 343–362 assessment factors, 352–356 case study, 356–359 constipation, 354t dehydration, 354t diarrhea, 354t edema, 354t evaluation/outcome, 362 interventions, 359–362 ● 561 nursing diagnosis, 359–362 physiologic changes, 344–352 potential problems, 354t Oliguria, 112, 127, 432 Oncotic pressure, 12, 51 Oral phosphates, 231t Oral potassium supplements, 116t Oral rehydration solutions (ORS), 315t Orinase, 154t Osmol, 10t, 18 Osmolality, 10t, 18–21 Osmolarity, 10t Osmosis, 10t, 21, 76, 439 Osmotic diuretics, 82, 121t Osmotic pressure, 11, 12 Overhydration, 50, 58 Oxygen, 506t Oxyhemoglobin, 249 P wave, 113 PaCO2, 256t, 502t Pain medications, 398 PaO2, 502t Parathyroid glands, 168–169 Parathyroid hormone (PTH) calcium imbalances, 170, 186 phosphorus imbalances, 221, 225 Parnate, 154t Pedialyte, 315t Penicillin, 122t Penicillin Na, 154t Peripheral edema, 51, 52, 59 Peritoneal dialysis, 441, 444–447, 448t Permeability, 10t Perspiration, 9, 11 pH, 240, 242, 244f, 255, 256t, 502t pH balance compensation for, 259–261 pH control, 240 regulatory mechanisms for, 245–253 Phopho-soda, 231t Phosphate, 91t Phosphate buffer system, 246, 247–248, 250t Phosphate enema, 231t Phosphate laxatives, 231t Phosphorus, 96–97t, 176, 220–221 functions, 222–223, 222t Phosphorus imbalances, 220–238 See also Hyperphosphatemia; Hypophosphatemia assessment factors, 235, 236–237 clinical applications, 232 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User 562 ● Index clinical considerations, 232–233 clinical management, 229–232 clinical manifestations, 227–229 drugs, 230–232 etiology, 223–227 evaluation/outcome, 237–238 interventions, 235–236, 237 nursing diagnosis, 235–236, 237 pathophysiology, 223 patient management, 235–238 phosphorus replacement, 229–230 Phosphorus-rich foods, 533–534t Piperacillin, 122t Plasma, 10t Plasma colloid osmotic pressure, 13, 14, 14t, 53t Plasma hydrostatic pressure, 13, 14t, 53t Plasma hydrostatic pressure gradient, 15 Plasma protein, 22 Plasma protein fraction, 393t Plasmanate, 393 Plicamycin, 185, 186, 187t, 188 Polymyxin B, 122t, 211t Polyuria, 480 Posterior pituitary gland, 17 Potassium, 41, 42, 91t, 96–97t, 98 functions, 100t normal range of, 99–100 Potassium chloride, 123t Potassium imbalances, 98–136 See also Hyperkalemia; Hypokalemia assessment factors, 132, 134 clinical applications, 126–129 clinical considerations, 129–130 clinical management, 115–125 clinical manifestations, 109–115 drugs, 120–125 ECG/EKG, 109–115 etiology, 105–109 evaluation/outcome, 136 hyperkalemia correction, 118–120, 119t interventions, 133, 134–135 nursing diagnosis, 132–133, 134–135 pathophysiology, 102–104 patient management, 132–136 potassium replacement, 116–118 Potassium phosphate, 187t, 231t Potassium restriction, 119t Potassium salt, 123t Potassium-rich foods, 101, 533–534t Potassium-sparing diuretics, 120–121, 121t Potassium-wasting diuretics, 120–121, 121t Prednisolone, 506t Prednisone calcium imbalances, 187t magnesium imbalances, 211t phosphorus imbalances, 231t potassium imbalances, 122t sodium imbalances, 154t Preload, 384t, 472 Pressure gradient, 13, 14, 15 Prolonged expiration, 501t Propacil, 187t Propoxyphene, 154t Propranolol, 123t Propylthiouracil, 187t Protein, 15, 16t, 22 Protein buffers, 246, 248–249, 250t Proteinase, 497 Protons, 239–240 PTH See Parathyroid hormone (PTH) Pulmonary edema, 51, 52, 55–56, 58 Pulmonary hypertension, 499t Pulmonary rehabilitation program, 507t Pulse oximetry, 502t QRS wave complex, 113 Quinapril, 123t Quinidine, 125 Ramipril, 123t Red blood cells (RBCs), 502t Refractory edema, 59 Regulatory systems for pH control, 245–253 chemical buffer systems, 246–252 renal regulation, 251, 253 respiratory regulation, 251, 252 Rehydralyte, 315t Renal failure, 427–462 acute, 428 assessment factors, 457 case study, 455–457 chronic, 428 clinical applications, 449–455 clinical management, 439–449 clinical manifestations, 433–439 CRRT, 440–442, 448t etiology, 430–433 evaluation/outcome, 461–462 fluid, electrolyte, acid-base imbalances, 433–438 hemodialysis, 442–444, 448t interventions, 458–461 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Licensed to: iChapters User Index nursing diagnosis, 457–461 pathophysiology, 428–430 patient management, 457–462 peritoneal dialysis, 444–447, 448t systemic effects, 439t Renal regulation, 251, 253 Renin, 16t, 18 Renin-angiotensin-aldosterone system, 55 Respiratory alkalosis/alkalosis, 258, 259, 278–294 assessment factors, 290 causes, 281t clinical applications, 283 clinical management, 285–287 clinical manifestations, 283–285 COPD, 499t etiology, 280–282 interventions, 291–294 nursing diagnosis, 290–293 pathophysiology, 279–280 patient management, 290–294 summary, 289t Respiratory regulation, 251, 252 Roux-en-Y gastric bypass, 419 Salem sump, 409 Salicylate overdose, 231t Salmeterol, 506t Salt, 62 Salt substitues, 107t SaO2, 502t SCUF, 441 Seawater, 90 Secondary polycythemia, 499t Sedatives, 123t Selectively permeable membrane, 10t, 11, 12 Semipermeable membrane, 10t Sensible perspiration, 11 Sensory-perceptual disturbances, 340 Septic shock, 380, 385t, 388t, 396t, 397 Serum, 10t Serum albumin, 22, 23 Serum CO2, 41 Serum globulin, 22, 23 Serum osmolality, 31, 43, 158 Serum potassium, 99–100 Serum protein, 22, 23 Serum sodium, 140t Severe dehydration, 36t, 38, 41, 309t Shock, 380–405 See also Trauma assessment factors, 401–402 blood loss/fluid replacement, 395t ● 563 cardiogenic, 380, 385t, 388t, 396t, 397 case study, 400–401 causes, 384–385t class I-IV, 395t clinical applications, 389–390 clinical management, 390–399, 396t clinical manifestations, 387–389 colloids, 392–394 crystalloids, 391–392 evaluation/outcome, 405 hypovolemic, 380, 388t, 394, 395t, 396t, 397 interventions, 402–404 neurogenic, 380, 385t, 388t, 396t, 398 nursing diagnosis, 402–404 pathophysiology, 381–384 patient management, 401–405 physiologic changes, 382t seot, 388t septic, 380, 385t, 396t, 397 types, 384–385t SIADH, 81–82, 366 Skin, 15, 16t Slow continuous ultrafiltration (SCUF), 441 Smoking cessation, 506t Sodium, 16, 18, 19, 32, 41, 91t, 96–97t, 137 functions, 140–142 influences affecting serum, 140t Sodium and chloride imbalances, 137–165 assessment factors, 161, 162–163 clinical applications, 155–158 clinical considerations, 158–159 clinical management, 153–155 clinical manifestations, 150–152 deficit See Hypochloremia; Hyponatremia drugs, 153–155 etiology, 147–150 evaluation/outcome, 164–165 excess See Hyperchloremia; Hypernatremia interventions, 162, 163–164 nursing diagnosis, 161, 163–164 pathophysiology, 143–146 patient management, 161–165 sodium correction, 153 Sodium bicarbonate, 119t, 154t Sodium biphosphate, 231t Sodium citrate, 187t Sodium phosphate, 154t, 187t, 231t Sodium polystyrene, 119t Sodium pump, 141, 366 Sodium retention, 54t, 55 Sodium salicylate, 154t Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part 564 ● Index Sodium-potassium pump, 102 Sodium-rich foods, 533–534t Solu-Medrol, 506t Solute, 10t, 11 Solvent, 10t, 11 Spirometry, 501, 502t Sputum, 501t Starling’s law, 12–15 Steroids, 188 Succinylcholine, 123t Sucralfate, 231t Syndrome of inappropriate ADH (SIADH), 81–82, 366 T wave, 113–114 Tachycardia, 111 Tacrolimus, 123t Terbutaline, 122t, 506t Tetracycline, 122t, 231t The Joint Commission (TJC), accepted abbreviations, 536–538t Theophylline, 506t Thiazide diuretics, 60, 121t, 124, 185, 187t, 231t Thioridazine, 154t Thiothixene, 154t Third-space fluid, 68, 69 Thirst, 15, 16t, 17, 35 Ticarcillin, 122t Ticarcillin disodium, 154t Tissue colloid osmotic pressure, 13, 14 Tissue hydrostatic pressure, 13 Tobacco smoking, 465, 497 Tobramycin calcium imbalances, 187t magnesium imbalances, 211t potassium imbalances, 122t Tolbutamide, 154t Tonicity, 10t, 19 Tranylcypromine, 154t Trauma, 364–380 See also Shock assessment, 371–375t case study, 378–380 clinical applications, 370 clinical manifestations, 367–370 evaluation/outcome, 405 interventions, 402–404 nursing diagnosis, 402–404 pathophysiology, 364–367 physiologic changes, 365t Triamcinolone, 506t Tripod position, 501t Trousseau’s sign, 179 Tumor-secreting (ectopic) PTH production, 186 2,3-diphosphoglycerate, 222Type diabetes, 464 Type diabetes, 464 Ultrafiltration, 439, 443, 444–445, 446 Urea, 18 Urine chemistry, laboratory tests/values, 529–530t Vaccinations, 507t Vasoconstriction, 350, 381 Vasopressors, 395–396, 398 Vasotec, 472 Ventricular fibrillation, 201 Venules, 13 Vincristine, 154t Vital signs, 39 Vitamin D, 168, 187t, 231t Volemia, 38 Water, 2, 4–5, See also Body fluid Water intoxication, 76, 78t See also Intracellular fluid volume excess (ICFVE) Web sites, 515 White blood count, 411t WHO, 315t Whole blood, 393t Zantac, 415 Zestril, 472 Copyright 2009 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part ... duplicated, in whole or in part Licensed to: iChapters User 26 8 ● Unit IV Acid-Base Balance and Imbalance 19 a 20 1 42 ϩ Ϫ 1 02 Ϫ 18 ϭ 26 mEq/L; yes; The anion gap is greater than 20 mEq/L 19 If the anion... sugar (slightly elevated with trauma and shock and highly elevated with uncontrolled diabetes mellitus), and decreased arterial bicarbonate level and pH (HCO3 24 mEq/L and pH Ͻ7.35) Monitor vital... excreted; It is decreased 22 deficit; greater 35 mm Hg 23 an increased HCO3 excretion and a Hϩ retention; It increases ● 28 5 21 With respiratory acidosis, the renal and respiratory mechanisms