NP235 ABG (Study guide with complete solutions)2022

ABG Interpretation •The level of the CO2 is controlled by breathing so any abnormal values in carbon dioxide levels are considered to be a respiratory problem •The level of HCO3 in the blood is controlled by the renal system so any abnormal values in the Bicarbonate levels are considered to be a metabolic problem pH •The relative concentration of hydrogen in arterial blood The chief component of acid-base balance Normal Range is 7.35-7.45 (Acidosis) 7.35 7.40 7.45 (Alkalosis) 01:08 01:41 PaCO2 •Partial pressure of carbon dioxide CO2 functions as acid reserve Normal range is 35- 45 mmHg CO2 levels typically stimulate respiration pCO2 (Alkalosis) 35 40 45 (acidosis) Bicarbonate (HCO3) •Indicator for the base reserve •Reflects the kidneys and/ or metabolic function •HCO3 (Acidosis) 22 24 26 (Alkalosis) PaO2 •Partial pressure of oxygen ▪Does not play an active role in acid/base balance ▪Normal for adults 60 years is 80-100mmHg ▪After the age of 60, normal PaO2 levels are slightly lower due to decreasing lung compliance Normal 80-100mmHg Mild 60-80mmHg Moderate 40-60mmHg Severe 40mmHg Oxygen Saturation (SaO2) •Percent of hemoglobin which is bound to oxygen •Normal is 94-100% Normal Values Low End. High End •pH ( acidic) 7.35. 7.45 (alkalotic) •pCO2 (alkalotic)35 45 (acidic) •pO2 80mmHg 100 mmHg •HCO3 ( acidic) 22 26 (alkalotic) Is is Metabolic or Respiratory? •For Metabolic disorders remember the Ph changes in the same direction as the HC03 •For Respiratory disorders remember the Ph changes in the opposite direction as the Co2. Metabolic Acidosis: Serum pH/Serum HC03 decreased ; the PaCo2 decreases to compensate. Metabolic Alkalosis: Serum pH/Serum HC03 increased ; the PaCo2 increases to compensate. Respiratory Acidosis: Serum pH decreased / PaCo2 increased ; the HC03 increases to compensate Respiratory Alkalosis: Serum pH increased / PaCo2 decreased ; HC03 decreases to compensate. Hypoxemia: •Low oxygen content in arterial blood (seen on the ABGs) Hypoxia: •Inadequate oxygen at the tissue or cellular level (clinical judgement) •Clinical signs/symptoms: -Tachycardia -Cyanosis -Hyperventilation -Restlessness, uncoordinated activities -hypertension Hypercarbia Increase Co2 Clinical signs/symptoms: ▪Lethargy, confusion, progressing coma ▪Depression of reflexes, tremors ▪Reversal of sleep pattern, headaches ▪Full bounding pulses with a warm periphery Respiratory Acidosis Causes •COPD •Over sedation •Neuromuscular disorder •Hypoventilation with mechanical ventilation Interventions •Assess the pt. for changes in mental status, lethargy, restlessness or confusion •Auscultate breath sounds to determine consolidation or bronchospasm •Monitor respirations and serial ABG's •Cough and deep breath •Frequent repositioning •Suctioning if necessary •Mechanical ventilation/aerosol therapy Respiratory Alkalosis Causes •Hypoxia •Anxiety •Pulmonary Emboli •Pregnancy •Hyperventilation with mechanical ventilation •Brain injury •CHF •Asthma •Severe anemia Interventions •Monitor respirations and ABG's •Administer pain medication, as indicated to prevent hyperventilation •Teach the patient to recognize the onset of hyperventilation Metabolic Acidosis Causes •Ketoacidosis- diabetic or alcoholic •Poisonings •Lactic acidosis •Renal failure •Diarrhea •Vomiting Interventions •Monitor intake and Output •Monitor UA specific gravity •Assess frequent dysrhythmias •Protect pt. from trauma or injury (seizure precautions) •Monitor ABG's •Monitor electrolytes