Answers to practice ABG's: #12 pH 7.

#12 pH 7.4 = perfectly normal behavior is often aggressive, impulsive, reckless, • · Conversion disorder : Involves unexplained,
#1 pH 7.52 = alkalosis pCO2 60 = respiratory acidosis and irresponsible. Antisocial personality disorder
usually
pCO2 40 = normal HCO3 30 = metabolic alkalosis has been referred to in the past as sociopathy or
HCO3 35 =metabolic alkalosis Two imbalances with complete compensation, so it psychopathy. • sudden deficits in sensory or motor function
Metabolic alkalosis (no compensation) is difficult to tell which is (blindness,
• Somatoform disorders
#2 pH 7.25 = acidosis the problem and which is the compensation. • paralysis). These deficits suggest a neurological
pCO2 60 = respiratory acidosis However, since only the kidneysare strong enough • Somatization: The transference of mental
• disorder but are associated with psychological
HCO3 27 = slight metabolic alkalosis experiences and
in compensation to bring the pH back to perfectly factors.
Respiratory acidosis, and kidneys are beginning to
compensate (retain normal, the primary problem has to be respiratory • states into bodily symptoms.
• An attitude of la belle indifference, a seemingly
bicarb. Note that the pH has a long way to go before acidosis, with complete • Somatoform disorders: Characterized as the lack
it comes back into presence of
normal range, so compensation has just begun.) compensation by the kidneys. • of concern or distress, is the key feature.
• physical symptoms that suggest a medical
#3 pH 7.25 = acidosis condition without • · Pain disorder : Pain is the primary physical
pCO2 40 = normal symptom
HCO3 12 = metabolic acidosis • demonstrable organic basis to account fully for
• which is generally unrelieved by analgesics and
Metabolic acidosis (no compensation) Personality Disorders them. The
greatly
• three central features of somatoform disorders
• affected by psychological factors in terms of
#4 pH 7.55 = alkalosis are as
Personality disorders are stable patterns of experience onset,
pCO2 20 = respiratory alkalosis and behavior that differ noticeably from patterns that are • follows:
HCO3 26 = normal considered normal by a person’s culture. Symptoms of a • · Physical complaints suggest major medical
• severity, exacerbation, and maintenance.
Respiratory alkalosis (no compensation) personality disorder remain the same across different illness but • · Hypochondriasis : Preoccupation with the fear
#5 pH 7.29 = acidosis situations and manifest by early adulthood. These that one
pCO2 20 = respiratory alkalosis symptoms cause distress or make it difficult for a person to • have no demonstrable organic basis.
• has a serious disease (disease conviction) or will
HCO3 18 = metabolic acidosis function normally in society. There are many types of
Metabolic acidosis with some compensation by the personality disorders, including the following:
• · Psychological factors and conflicts seem get a
lungs (not very effective; important in • serious disease (disease phobia). It is thought that
has not returned pH to acceptable range yet) • initiating, exacerbating, and maintaining the • clients with this disorder misinterpret bodily
#6 pH 7.48 = alkalosis • Schizoid personality disorder: entails social symptoms. sensations
pCO2 50 = respiratory acidosis
HCO3 34 = metabolic alkalosis
withdrawal and restricted expression of emotions • · Symptoms or magnified health concerns are not • or functions.
under
Metabolic alkalosis with almost complete • Borderline personality disorder: characterized • · Body dysmorphic disorder : Preoccupation with
compensation by the lungs
by impulsive behavior and unstable relationships, • the client’s conscious control. an
#7 pH 7.5 = alkalosis • The five specific somatoform disorders are as
emotions, and self-image • imagined or exaggerated defect in personal
pCO2 20 = respiratory alkalosis followed: appearance
HCO3 30 = metabolic alkalosis
• Histrionic personality disorder: involves • · Somatization disorder : Characterized by • such as thinking one’s nose is too large or teeth
Combined respiratory & metabolic alkalosis#8 pH attention-seeking behavior and shallow emotions are
multiple
7.18 = acidosis
• Narcissistic personality disorder: • physical symptoms. It begins by 30 years of age, • crooked and unattractive.
pCO2 60 = respiratory acidosis characterized by an exaggerated sense of • extends over several years, and includes a • Symptoms of a somatization disorder
HCO3 26 = normal importance, a strong desire to be admired, and a combination
Respiratory acidosis • · Pain symptoms : complaints of headache, pain in
#9 pH 7.29 = acidosis
lack of empathy • of pain and GI, sexual, and pseudoneurologic the
pCO2 60 = respiratory acidosis • Avoidant personality disorder: includes social • symptoms. • abdomen, head, joints, back, chest, rectum; pain
HCO3 35 = metabolic alkalosis during
withdrawal, low self-esteem, and extreme • o Client’s jump from one physician to the next, or
Respiratory acidosis with some compensation from sensitivity to negative evaluation
• may see several providers at once in an effort to
• urination, menstruation, or sexual intercourse.
kidneys
#10 pH 7.48 = alkalosis • Antisocial personality disorder: characterized • obtain relief of symptoms. • · GI symptoms : nausea, bloating, vomiting (other
pCO2 20 = respiratory alkalosis by a lack of respect for other people’s rights, than
HCO3 34 = metabolic alkalosis feelings, and needs, beginning by age fifteen.
• o They tend to be pessimistic about the medical
• pregnancy), diarrhea, or intolerance of several
Combined respiratory and metabolic alkalosis People with antisocial personality disorder are • establishment and often believe their disease
foods.
#11 pH 7.43 = normal deceitful and manipulative and tend to break the • could be diagnosed of the providers were more
pCO2 35 = normal • · Sexual symptoms : Sexual indifference (don’t
HCO3 23 = normal
law frequently. They often lack empathy and • competent.
care to do
remorse but can be superficially charming. Their
Normal
• the dirty), erectile or ejaculatory dysfunction, • volunteers. • · Ineffective coping • improve the client’s confidence in making
irregular • relationships.
• menses, excessive menstrual bleeding.
• · Primary gain : Direct external benefits that being • o The client will identify the relationship between
sick • stress and physical symptoms. • · Anxiety
• · Pseudoneurologic symptoms : Impaired • provides, such as relief of anxiety, conflict, or • o The client will demonstrate alternative ways to
coordination or • Emotion-focused coping strategies help the
distress. • deal with stress, anxiety, and other feelings
• balance, paralysis or localized weakness, difficulty
• • clients relax and reduce feelings of stress.
• swallowing or lump in throat, aphonia (loss of
· Secondary gains : Internal or personal benefits
• This includes progressive relaxation, deep
• · Disturbed sleep pattern
received
speech • from others because one is sick, such as attention • breathing, guided imagery, and distractions • o The client will demonstrate healthier behaviors
• sounds), urinary retention, swollen tongue, from • such as music. • regarding rest, activity, and nutritional intake.
• hallucinations, double vision, blindness, deafness, • family members and comfort measures (being
• Problem-focused coping strategies help to • The nurse explains that inactivity and poor
• seizures; disassociative symptoms such as brought
• resolve or change a client’s behavior or • eating habits perpetuate discomfort and that
amnesia; or • tea, receiving a back rub).
• loss of consciousness other than fainting. • Treatment:
• situation or to manage life stressors. This • often it is necessary to engage in behaviors

• • even though one doesn’t feel like it.

• Related disorders: • · Treatment focuses on managing symptoms and includes learning problem solving methods.
• • • · Fatigue
· Malingering : The intentional production of false • improving quality of life. The nurse should help the client role play the
or
• · A trusting relationship helps to ensure that • above situations. • · Pain
• grossly exaggerated physical or psychological
client’s stay • · Ineffective denial
• symptoms; it is motivated by external incentives • with and receive care from one provider instead of
Eating disorders
such • o The client will verbally express emotional The distinguishing factor of anorexia includes an earlier
• as avoiding work, evading criminal prosecution, • “doctor shopping.” feelings age
of onset and below-normal body weight; the person fails to
• obtaining financial compensation, or obtaining • · SSRIs are commonly used for depression that • The nurse should not attempt to confront
recognize the eating behavior as a problem. Clients with
drugs. may • clients about somatic symptoms or attempt
• Their purpose is some external incentive or • accompany somatoform disorders. • to tell them that these symptoms are not bulimia have a latter age at onset and a near-normal body
outcome • Assessment • “real.” weight. They usually are ashamed and embarrassed by the
• that they view as important and results directly eating disorder.
from
• · The nurse must investigate physical health • Encourage the client to write in a daily Eating disorders appear to be equally common among
status • journal
• their illness. People who malinger can stop the • thoroughly to ensure there is no underlying
Hispanic and white women and less common among
physical pathology
• Limiting the time that clients can focus on African
American and Asian women.
• symptoms as soon as they have gained what they
• requiring treatment. It is important not to dismiss • physical complaints alone may be necessary.
• wanted. all • The nurse may have to explain to the family Anorexia Nervosa
• · Factitious disorder : This is also known as • future complaints because at any time the client • about primary and secondary gains; this will · A life-threatening eating disorder characterized by the
could client’s refusal or inability to maintain a minimally
Munchausen • encourage relatives to stop reinforcing the
• develop a physical condition that would require normal body weight, intense fear of gaining weight or
• syndrome. Occurs when a person intentionally
medical • “sick role.” becoming fat, significantly disturbed perception of the
produces shape or size of the body, and steadfast inability or
• or feigns physical or psychological symptoms • attention. • · Impaired social interactions
refusal to acknowledge the seriousness of the problem
solely to • · In many cases, the client’s appearance brightens • o The client will follow an established daily routine or even that one exists.
· Has experienced amenorrhea for at least 3 consecutive
• gain attention. and • The nurse must help the client to establish cycles
• they look much better as the assessment
• o Munchausen syndrome by proxy occurs when a
interview • this that includes improved health behaviors. · Complaints of constipations and abdominal pain
• · Cold intolerance
person inflicts illness or injury to someone else to • begins because they have the nurse’s undivided • The challenge for the nurse is to validate the · Hypotension, hypothermia, bradycardia
• gain the attention of emergency medical
• attention. • client’s feelings while encouraging him to o Intravascular volume is decreased; less blood to
• personnel or to be a “hero” for saving the victim.
• pump through heart, also due to excessive
• This occurs most often in people who are in or
• · Client’s often have sleep pattern disturbances, participate in activities.
exercise
• familiar with medical professions, such as nurses,
lack • The nurse should help the client plan social · Elevated BUN
• physicians, medical technicians, or hospital • basic nutrition, and get no exercise. • contact with others, what to talk about (other o Normal levels: 10-20 mg/dl
• Nursing diagnoses • than the client’s complaints), and can o Urea is formed in the liver and is the end product
 of protein metabolism. o Weight gain and adequate food intake are most · May be underweight, overweight, but are generally diuretics
o In anorexia, the body has already used fat for often the criteria for determining the effectiveness close to expected body weight for age and size · The client will demonstrate coping mechanisms not
energy; it is now breaking down muscles for of treatment. · Appear open and willing to talk; initially pleasant and related to food
energy—the reason for the elevated BUN o Amitriptyline (Elavil) and the antihistamine cheerful as though nothing is wrong · The client will verbalize feelings of guilt, anger, anxiety,
· Decreased albumin cyproheptadine (Periactin) in high doses (up to or an excessive need for control
o Normal levels: 3.5-5 g/dl 28mg/d) can promote weight gain in inpatients. Nursing outcomes/interventions o Help the client recognize emotions such as anxiety
o Measures amount of protein in the body; albumin o Olanzapine (Zyprexa) has been used with success Imbalanced Nutrition: Less than/More than body or guilt by asking them to describe what they are
is a protein formed in the liver. because of both its antipsychotic effect (on bizarre requirements feeling; allow adequate time for response. Do not
body image distortions) and associated weight · The client will establish adequate nutritional eating ask “are you anxious? Sad?” because the client
Albumin tests are a great indicator of nutritional gain. Patterns may quickly agree rather than struggle for an
status o Fluoxetine (Prozac) has shown some effectiveness answer
· Leukopenia and mild anemia in preventing relapse in clients whose weight has o Encourage self-monitoring (page 414); a
Implement and supervise the regimen for
o Not enough food and nutrients to replenish cells been partially or completely restored; close behaviorcognitive
nutritional rehabilitation
· Has a preoccupation with food and food-related monitoring is needed because weight loss can be a approach
o A diet of 1200-1500 calories is ordered, with
activities side effect.
gradual increases in calories until clients are
· Can be divided into 2 subgroups: · Family members often describe clients with anorexia as Disturbed body image
ingesting adequate amounts for height, activity
o Restricting subtype : lose weight primarily through perfectionists with above average intelligence, · The client will verbalize acceptance of body image with
level, and growth needs.
dieting, fasting, or excessively exercising. dependable, eager to please, and seeking approval stable body weight
Start slowly—will have massive diarrhea
o Binge eating and purging subtype : engage before their condition began. o Help clients identify areas of personal strength
o The client with anorexia may be critically
regularly in binge eating followed by purging. · Clients with anorexia appear slow, lethargic, and that are not food-related broadens clients’
malnourished.
· Engage in unusual or ritualistic food behaviors fatigued; they may appear emaciated, depending on perceptions of themselves
TPN through central line
o Refusing to eat around others the amount of weight loss. May be slow to respond and
Electrolyte balance
o Cutting food into minute pieces have difficulty deciding what to say.
Tube feeds TIC disorders
o Not allowing the food they eat to touch their lips · Reluctant to answer questions fully because they do not
o A liquid protein supplement is given to replace any · Sudden, rapid, recurrent, non-rhythmic motor
· Excessive exercise is common want to acknowledge any problem.
food not eaten to ensure consumption to ensure movement or vocalization
· Diagnosed between 14 and 18 years of age · Often wear loose clothing in layers
total number of calories prescribed · Stress and fatigue exacerbates tics
· Pleased with their ability to control their weight and · Seldom smile, laugh, or enjoy any attempts at humor o Must monitor meals and snacks and will sit at the · Treatment: Risperadol and Zyprexia
may express this. table during eating away from the other clients · Complex vocal tics
· As the illness progresses, depression and lability in Bulimia Nervosa A major goal is to first get them to the table o Coprolalia : Use of socially unacceptable words,
mood become more apparent · Characterized by recurrent episodes (at least twice a o Diet beverages and food substitutions may be often obscene
· Isolate themselves week for 3 months) of binge eating followed by prohibited o Palilalia : Repeating own sounds or words
· Believe peers are jealous of their weight loss and o Specified time may be set for consuming each o Echolalia : Repeating the last heard sound, word, or
believe family and health care professionals are trying inappropriate measures to avoid weight gain such as meal and snack phrase
to make them “fat and ugly”. purging (vomiting, laxatives, diuretics, enemas, or o Discourage clients from performing food rituals
· Clients who use laxatives are at a greater risk for emetics), fasting, or excessively exercising. such as cutting food into tiny pieces or mixing Autistic disorder
medical complications. · Engaging in binge eating secretly foods in unusual combinations · Most prevalent in boys; identified no later than 3-years
· Autonomy may be difficult in families that are · Binging or purging episodes are often precipitated by o Be alert for any attempts by client to hide or of age
overprotective or in with enmeshment (lack of clear strong emotions and followed by guilt, remorse, shame, discard food · Child has little eye contact, few facial expression,
boundaries) exists. By losing weight, these clients have or self-contempt. o Must remain in view of staff for 1-2 hours to doesn’t use gestures to communicate
some control in their lives. · Recurrent vomiting destroys tooth enamel, has dental ensure they do not vomit; access to bathrooms is · Does not relate to parents or peers, lacks spontaneous
· Have body image disturbance (page 409) caries and ragged or chipped teeth. Dentists are often supervised. enjoyment, apparent absence of mood and emotional
· Can be very difficult to treat because they are often the first health care professionals to recognize this. o Client is weighed daily on awakening and after affect, can not be engaged in play or make believe
resistant, appear uninterested, and deny their · Bulimia is typically diagnosed at 18 or 19. they have emptied their bladder. Have the client · Repetitive motor behaviors such as hand-flapping, body
problems. · Clients with bulimia are aware that their eating wear a hospital gown each time they are weighed; twisting, or head banging
· Treatment: behavior is pathologic and go great lengths to hide it they may attempt to place objects in their clothing · May improve as child acquires language skills
o Focusing on weight restoration from others. to give the appearance of weight gain. · Short term impatient therapy is used when behaviors
o Nutritional rehabilitation · Clients with a co-morbid personality disorder tend to o In bulimia, the clients should sit at a table in a such as head banging or tantrums are out of control
o Rehydration have poorer outcomes than those without. kitchen or dining room. o Haldol or Risperadol may be effective (prn, of
· Most are treated on an outpatient basis o Write out a grocery list, it is easier to follow a course)
Correction of electrolyte imbalances · Antidepressants are more effective than the placebos in nutritious eating plan · Goals of treatment:
o Severely malnourished individuals may require reducing binge eating o Reduce behavioral symptoms
TPN, tube feedings, or hyperalimentation to · Clients are often focused on pleasing others and have a Ineffective coping o Promotes learning and development
receive adequate nutritional intake. history of impulsive behavior such as substance abuse · The client will eliminate use of compensatory behaviors o Language skills development
o Access to the bathroom is supervised to prevent and shoplifting as well as anxiety, depression, and such as excessive exercise and use of laxatives and
purging as clients begin to eat more food. personality disorders.