Asidosis ada 2 , yaitu : Asidosis MetabolikAsidosis metabolik adalah keasaman darah yang berlebihan, yang ditandai dengan rendahnya kadar bikarbonat dalam darah. Seiring dengan menurunnya pH darah, pernafasan menjadi lebih dalam dan lebih cepat sebagai usaha tubuh untuk menurunkan kelebihan asam dalam darah dengan cara menurunkan jumlah karbondioksida. Asidosis RespiratorikBuild up of CO2 in blood (hypercapnia) due to hypoventilation or decrease respiration rate.Infusion Fluids Types of fluids :Hypotonic solution: osmolaration is lower if compared with serum (Na+ ion concentration is lower than serum), soluble in serum, decreases the osmolaration of serum. So, the liquid attracted from inside part of out to the surrounding tissues blood vessels (principal of liquid that travels from lower osmolaration to higher osmolaration), till at the end it fills all the cells that its aiming for. It is used when the cell having dehydration such as when a patient undergoes dialysis (blood cleaning process) in diuretic therapy, and also to hyperglycemia patient (high level of sugar in blood) and diabetic ketoasidosis. For an example, NaCI 45% and dextrose 2.5%. Isotonic solution: osmolaration (level of concentration) liquid approaches the serum (liquid component of the blood), till it flows inside of the blood vessels. It gives benefits to the hypovoleamic patient (less body fluids, till causes the blood pressure decreases). Possess of the risk of overload (excessive of body fluids), especially for congestive heart failure and hypertension. Such as, Ringer-Laktat (RL) and normal saline/ physiology salt solution (NaCI 0.9%). Hypertonic solution: osmolaration will be higher than the serum, till it can pull the fluid and electrolytes from the tissues and cells inside the blood vessels. It can stabilize the blood pressure, increases urin production, decreases edema (swallowing). Utilizing contradictive with hypertonic. Such as, Dextrose 5%, NaCl 45% hypertonic, Dextrose 5%+Ringer-Lactate, Dextrose 5%+NaCl 0,9%, blood product (blood), and albumin. Division on other fluids according to the groups :Crystalloid: isotonic, so it is effective in filing certain amount of body fluid (volume expanders) inside the blood vessels in short period of time and it is useful to the patient who needs fluids urgently. Such as, Ringer-Laktat and physiology salt. Colloid: size of molecule (normally protein) big till it cant come out from the membrane capillaries and continuously will be there in the blood vessels , so its criteria is hypertonic and it can pulls the fluids from blood vessels. Such as albumin and steroid Vital SignComponents of vital sign: a. Consciousness, measured with Glasgow Coma Scale (GCS) Consciousness level: Compos Mentis : Entirely conscious, to him/herself and to other people. Be able to answer questions Apathetic : The patient does not care to the surroundings Delirium : consciousness and motoric confusion decreases Nervous, disorientation, noisy Somnolence : Sleepy, but can be awaked with a soft stimulus Give verbal response, answer the question Fall asleep again if the stimulus is stopped Spoors : In a seep sleepy condition Can be awaked with a strong stimulus Cannot give verbal response well. Coma : Loss the body weight Theres no motoric response No response to painful stimulus b. Respiration Normal respiration rate for human is 16 to 24 times per minute. If the respiration rate is less than 16 times per minute bradipneu If the respiration rate is more than 16 times per minute takipneu c. Pulse Pulse Rate : Normal 80x per minute More than 100x per minute tachycardia Less than 60x per minute bradycardia Generally measured by the palpation on the radialis artery Besides, the pulse can also measured on a. brankialis, fermonalis, a. poplitea, a. dorsalis pedis Aspects of pulse rate measurement : Frequency of pulse Pulse rhythm Pulse volume Pulse quality Quality of the wall of artery d. Blood Pressure Measurement of 2 aspects : High systolic pressure Low diastolic pressure The measurement usually conducted on the right arm, if possible. Blood pressure is the difference between systolic and diastolic pressure. The normal blood pressure is 120/80 mmHg e. Temperature Normal body temperature 36 370 Celsius The temperature can be measured at : Rectum (2-5 minutes) 0,5-10C higher than mouth temperature Mouth (10 minutes) 0,50C higher than axillary temperature Axilla (15 minutes) Mechanism of symptompsa. Anxious Non stop bleeding blood volume low Hb in red blood cell capture less oxygen oxygen in the brain less stimuli the sympatic nerves causes the anxious perception There are three aspect of anxiousness symptoms: In biology aspect, such as increase of heart rate and blood pressure, the duration of breathing will be short and fast, cold sweat including on palm of hand, lost of appetite, nausea/vomit, frequent urination, headache, cant sleep, enlargement at pupil and digestion problems. In intellectual aspect, as an example: less concentration, less attention and pretension, no interaction towards surrounding stimulation, less productivity, absent-minded, more orientation towards the past than the nowadays/future. In emotional and behavior aspect, such as: self withdraw, depression, easy to cry, hot tempered, very fast to get offended and apathy. b. Cold Sweat Non stop bleeding blood volume decreases stimuli sympatic nerves Heart beats very fast heart rate increases blood at peripheral vasoconstriction blood flow decreases strive into the sweat gland tissues sweat blood gives warmest. c. Weak Non stop bleeding blood volume decreases oxygen supply less to the tissues decreases the oxidative metabolism taking up oxygen from muscles fiber oxygen at the muscle decreases muscle cant carry out the contraction weak Weak also can be caused by less fluid in the body. d. Pale Non stop bleeding blood volume decreases stimuli sympatic nerves Heart beats very fast heart rate increases blood at peripheral vasoconstriction blood flow decreases pale HYPOVOLAEMIA Hypovolaemia is caused loss of blood volume which will cause decrease of systolic. This is stimulated by sympathetic katekolamin which caused peripheral vasoconstriction, increased the heart rate, and decreased the quality of heart rate. Tachycardia and increased heart contractility caused increased O2 need. In shock, purpose of fluid resutitation is replacement of tissue perfusion and send O2 to cells so that decreased tissue ischemic and organ failure.