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MED SURG 245 Lecture STUDY GUIDE Notes LATEST
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MED SURG 245 Lecture STUDY GUIDE NotesLATEST
Mark Klimek Lecture Notes
LECTURE 1: Acid Base Balance & Ventilator
Interpreting blood gases
(remember the rules of the B’s)
If the pH and the bicarb are both in the same direction then it’s
metaBolic (Bicarb Both Bolic), if they are in different
directions then it is respiratory
If bicarb is normal and the pH is low or high then its respiratory
You will be given 8 values for arterial blood gas, always first
look at the pH and the bicarb first
You get acidosis and alkalosis from the pH
LABS: ABG’s
The normal pH is 7.35-7.45
The normal bicarb is 22-26 (the bicarb years where you make all
the decisions [22-26 years old], or 2+2+2=6)
The normal CO2 is 35-45 (same as pH)
Signs and Symptoms with ABG’s
MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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As the pH goes up so does my patient
o If the pH goes up, every system in your body
gets more irritable/hyperexcitable
As the pH goes down so does my patient
o If the pH goes down, systems in your body shut down
Except for potassium- When pH goes down, potassium goes up
If the pH goes up (alkalosis): you will find irritability,
hyperreflexia (3&4), tachypnea, tachycardia, borborygmi
(increased bowel sounds), seizure (need suctioning at the bed
side because they can seize and aspirate)
If pH goes down (acidosis): hyporeflexia, bradycardia,
lethargy, obtunded, paralytic ileus, coma, respiratory arrest
(need bag-mask ventilation bag at bedside for respiratory
arrest), +1 reflexes
MACkussmal- compensatory and respiratory pattern for
only acid base disorder: MAC- Metabolic ACidosis
MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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Respiratory Acidosis multiple choice example: What would you see
with a patient who is in respiratory acidosis?
a. +1 reflex,
b. diarrhea,
c. adynamic ileus (no movement),
d. spasm,
e. urinary retention,
f. paraxysmol atrial tachycardia,
g. second degree lovitz, type 2 heart block (impulse is being
slowed),
h. hypokalemia
LAB: REFLEXES
0&1-
hyporeflexia
2-normal
3&4- hyperreflexia
EXAMPLE: (In general what do pain meds do?
ANSWER: They sedate you, they are CNS depressants: lethargy, lucidity,
reflexes at
+1, hyporeflexia, obtundent
MED SURG 245 Lecture STUDY GUIDE Notes
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, MED SURG 245 Lecture STUDY GUIDE Notes
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Causes of Acid Base Imbalance
Don’t get signs and symptoms mixed up with causation!!!
What causes something is the opposite of what the signs and
symptoms are
o EXAMPLE: diarrhea will cause a metabolic acidosis but once
you get acidotic, it will shut your bowels down and you will
get a paralytic ileus.
The first question you should ask yourself if the scenario
involves a lung problem.
o Is it a respiratory problem? BUT remember it can still be
respiratory acidosis/alkalosis…
Next question you ask yourself…
o is the client overventilating or underventilating?
o If the patient is overventilating pick alkalosis
o If they are underventilating pick acidosis
If the client is overventilating.. it has an attachment to the
word- alkalosis (because they are both OVER)… ventilating
OVER becomes respiratory ALKALOSIS
MED SURG 245 Lecture STUDY GUIDE Notes
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