General Discussion

oxygen-hemoglobin disassociation curve

Up/Down axis=Spo2-Pulse oximetry

Horizontal axis=PaO2

Left Shift=Increased affinity for oxygen

• Too much oxygen

• Low CO2 (blowing off too much CO2)-less than 35

• Respiratory Alkalosis

• Low hydrogen ions

• High pH=Alkalotic

• Decreased Temp

• Panic, Pain, Anxiety, Hyperventilation

Right Shift=Decreased affinity for oxygen

• High CO2 (Carbonic Acid) CO2 is greater than 45

• Acidosis

• Increased Hydrogen ions

• Low pH=Acidotic

• Increased Temp

Types of ACIDS

• CO2=Carbonic Acid

• Hydrogen ions=ACIDS

• Ketones=ACIDS

• Lactate=Lactic Acid

Hyperventilating

• Blowing off CO2=Alkalotic

• CO2=less than 35

ABG Numbers

pH-7.35-7.45

PaCO2/PCO2-35-45-Carbon Dioxide (Carbonic Acid)

PaO2/PO2-Partal Pressure of O2 (oxygenated arterial blood in the alveoli)

• 75-100

• Less than 60=Severe Hypoxemia=need intubation

HCO3 (Bicarbonate)-22-26

Spo2 (Pulse oximetry)-94-100%

95%-95% of all the RBCs are carrying oxygen

Electrolytes=Anions (-) & Cations (+) (+ and - Electrically charged minerals) which are responsible for certain functions in the body

Cation=A + charged electrolyte

Anion=A - charged electrolyte

• Sodium-Na+ (Cation)

• Potassium-K+ (Cation)

• Chloride-Cl- (Anion)

• Calcium-Ca+ (Cation)

• Magnesium-Mg+ (cation)

• Bicarbonate-HCO3- (Anion)

• All electrolytes, with the exception of Bicarbonate, do the same 2 things, but each one has certain specialties

All electrolytes (except Bicarb) are responsible for nerve conduction and muscle function

Sodium-Na+ Regulate water inside and outside of the cell. Helps with muscle contraction and transmission of nerve impulses, really plays a role in the brain (Neuro ---Extracellular (resides outside the cell)

• nerve conduction (especially the brain)

• muscle contraction

• fluid balance

Potassium-Helps with fluid balance like sodium, especially inside the cell. In addition, potassium is responsible for nerve impulse conduction and muscle contraction, especially the heart.----Intracellular (resides inside the cell)

• Nerve conduction

• Muscle contraction

• Especially in the heart

Chloride-Plays a role with acid-base balance in the body along with balancing the fluids in our body by working with sodium to maintain osmotic pressure. Sodium and chloride really go together, and if sodium is decreased, chloride is likely to be decreased as well

• Fluid balance/Hydration

Calcium-Plays a huge role in bone and teeth health along with muscle contraction/nerve transmission, and blood clotting. Calcium helps to excite muscles

• Nerve conduction

• Muscle contraction

• Bone health/Blood clotting

Magnesium-Another major ion found inside the cell just like potassium. Magnesium plays a big role with muscle and nerve function. Mag helps with muscle relaxation.

• Nerve conduction

• Muscle relaxation

Sodium/Potassium Pump

• Is needed in order for the heart muscle to contract!!!!

• When the heart is at rest (Na is extracellular/K+ is intracellular)

• During a contraction they switch places

• On relaxation-They both go back to their original locations

• Hypocalcemia

• Hypercalcemia

• Hyponatremia

• Hypernatremia

• Hypokalemia

• Hyperkalemia

Hypocalcemia=CRAMPS

Convulsions

Reflexes Hyper

Arrhythmias

Muscle spasms

Positive signs (Chvostek's & Trousseau's Sign)

Hypercalcemia=WEAK

Weak muscles

EKG changes

Absent reflexes

Kidney stones (Calcium or uric acid deposits)

Hypokalemia=7 L's

Lethargy

Low respirations

Lethal rhythms (Flattened T-waves, Presence of a U-wave)

Lots of urine

Leg cramps

Limp muscles

Low BP/HR

Hyperkalemia=MURDER

Muscle weakness

Urine output little

Resp failure

Decreased cardiac contractility

Early muscle twitching

Rhythm changes (Peaked T-waves, Absent P-waves, Widened QRS)

Hyponatremia=SALT LOSS

Seizures/stupor

Abdominal cramping

Lethargic

Tendon reflexes diminished

Loss of urine

Orthostatic hypotension

Shallow respirations

Spasms of muscles

Hypernatremia=FRIED "No FRIED foods"

Fatigue

Restless

Increased reflexes

Extreme thirst

Decreased urine/dry mouth

Potassium=Acid go hand and hand-----------The higher the K+, the more acidotic we become!!!!!!!!!

Neonate

• Birth-1 month

Infant

• 1 month-1 year

• Obligate Nose breathers up to approx. 3 months old

Toddler

• 2-3 years

Pre-schooler

• 4-5 years

School Aged

• 6-11 years

Adolescent

• 12-17 Years