Asidosis ada 2 , yaitu :

Asidosis Metabolik
Asidosis 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 Respiratorik
Build 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 Sign
Components 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 symptomps
a. 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 O 2 to
cells so that decreased tissue ischemic and organ failure.