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Module 7 (Critical Care) > ABG > Flashcards

ABG Flashcards

1
Q

What is normal pH?

A

7.35-7.45

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2
Q

What pH is considered perfect?

A

7.4

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3
Q

Acidic pH

A

< 7.35

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4
Q

Base/Alkalosis pH

A

> 7.45

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5
Q

PaCO2 normal

A

35-45

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6
Q

PaCO2 BASE/ALKALOSIS

A

< 35

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7
Q

PaCO2 Acidic

A

> 45

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8
Q

HCO3 normal

A

22-26

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9
Q

HCO3 Acidic

A

<22

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10
Q

HCP3 Alkalosis/Base

A

> 26

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11
Q

PaO2 normal

A

80-100

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12
Q

PaO2
- mild hypoxemia

A

70-79

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13
Q

PaO2
- moderate hypoxemia

A

60-69

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14
Q

PaO2
- severe hypoxemia

A

<60

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15
Q

SaO2 normal

A

> 95 %

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16
Q

What are the steps to Analyzing ABG?

A

1) Determine Acidosis or Alkalosis using pH level
2) Determine respiratory effect on the body using PaCO2
3) Determine metabolic effect on the body using HCO3
4) Determine compensation
5) Determine oxygenation

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17
Q

Homeostasis is the

A

acid/base balance

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17
Q

How do you determine compensation in an ABG?

A

Take the unused value and interpret if it is abnormal or in the normal range.
If the value is within the normal range
If the value is abnormal, then compensation is occuring
Partial compensation = abnormal pH
Full compensation = normal pH

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18
Q

DM ABG

A

Metabolic acidosis
esp. DKA (3Ps, Kussmaul’s breathing as compensation)
- give insulin drip and fluids

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19
Q

COPD ABG

A

respiratory acidosis
- pursed lip breathing to breath out CO2

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20
Q

Is acid/base balance a disease?

A

no it is never alone and is caused by something

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21
Q

When do you trust the SpO2 monitor due to its unreliability?

A

When observing the patient and the s/s or lack of s/s corroborate with each other

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22
Q

ABG is used to determine what

A

oxygenation status
acid-base balance (compensation)

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23
Q

ABG is used along with what to determine oxygenation?

A

pulse ox

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24
Q

What systems are used to help compensate acid/base imbalance?

A

Buffer system
Respiratory
Renal

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25
Q

Buffer system

A

if the other is out of balance the other system will respond by lowering or raising their molecules

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26
Q

Respiratory system on acid/base balance

A

lungs help breathe faster or slower based on what you need

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27
Q

Renal system on acid/base balance

A

take 2-3 days to help and get out the bad stuff

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28
Q

PaO2

A

partial oxygenation in the arterial blood

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29
Q

SaO2

A

tissue oxygenation perfusion

30
Q

PaCO2

A

partial pressure of CO2 in the arterial line (ACID)

31
Q

pH measures

A

H+ ion concentration

32
Q

CO2 is the what component of our blood gas

A

acid

33
Q

What is the fastest way of changing our pH?

A

CO2 - respiratory
12-24 hours

34
Q

What do the lungs do to compensate for acidosis?

A

RR and depth will increase
- CO2 “blow off”

35
Q

What do the lungs do to compensate for alkalosis?

A

RR and depth will decrease
- CO2 retained

36
Q

The renal system is what component of our blood gas?

A

base

37
Q

How long does the renal system take to respond to an imbalance?

A

hours to days (2-3 days)

38
Q

Which system has the quickest response time to an acid/base imbalance?

A

Respiratory system

39
Q

What do the kidneys do to compensate for acidosis?

A

H+ ions will be excreted and HCO3- will be retained

40
Q

What do the kidneys do to compensate for alkalosis?

A

H+ ions will be retained and HCO3- will be excreted

41
Q

ROME

A

Respiratory Opposite
Metabolic Equal

42
Q

Respiratory Alkalosis
pH and PaCO2 LEVELS

A

pH high
CO2 low

43
Q

Respiratory Acidosis
pH and PaCO2 LEVELS

A

pH low
CO2 high

44
Q

Metabolic Acidosis
pH and HCO3 LEVELS

A

pH low
HCO3 low

45
Q

Metabolic Alkalosis
pH and HCO3 LEVELS

A

pH high
HCO3 high

46
Q

CO2 forms what when dissolved in the blood

A

carbonic acid
high CO2 lowers pH

47
Q

CO2 level if hyperventilattion

A

<35 alkalosis

48
Q

CO2 level if hypoventilation

A

> 45 acidosis

49
Q

What causes respiratory acidosis?

A

Head trauma
over sedation
NM disorders
COPD
Pain from Rib fx
Respiratory arrest/problems (pneumonia - fluid in lungs alveoli sticky/ atelectasis/ ashtma)

50
Q

What causes respiratory alkalosis?

A

Pregnancy and labor
pulmonary emboli
acute asthma
nervousness, anxiety, fear
high altitude
Hyperventilation and mechanical ventilation

51
Q

Respiratory Acidosis S/S

A

hypoventilation - hypoxia
rapid, shallow RR
low BP with vasodilation
dyspnea
HA
Hyperkalemia
- dysrhythmias
drowsy, dizzy, disorientation
muscle weakness, hyperreflexia

52
Q

What is happening in respiratory acidosis?

A

build up of CO2 in the blood due to shallow RR

53
Q

Tx for Respiratory Acidosis causes

A

Asthma (AIMS)
- O2 6L if not helping then move on to simple mask 6L, then NRB 10L then mechanical ventilators)
TCDB and IS - tighten airway and get fluid off
elevated HOB
Sodium Bicarbonate
Tx the cause

54
Q

Respiratory Alkalosis S/S

A

seizures
rapid, deep RR
hyperventilation
tachycardia
low/normal BP
hypokalemia
numb and tingling of extremities
lethargy and confusion
light headedness
N/V

55
Q

Respiratory Alkalosis Tx

A

cause
- Anxiety: Benzos and Ativan

56
Q

HCO3 acidosis level

A

<22

57
Q

HCO3 alkalosis level

A

> 26

58
Q

The “seesaw effect” refers to

A

Respiratory effect

59
Q

The “elevator” effect refers to

A

Metabolic effects

60
Q

Metabolic Acidosis causes

A

DKA , hypermetabolism
Renal insufficiency/failure
Incomplete metabolism of carbs (lactic acidosis)
Salicylate intoxication
Severe diarrhea, fistulas
Malnutrition, liver failure
High fat diet

61
Q

Metabolic Alkalosis causes

A

excessive vomiting
ingestion of excess sodium bicarb
prolonged gastric lavage/ suctioning
administer of potent diuretics

62
Q

Metabolic Acidosis S/S

A

HA
low BP
Hyperkalemia
muscle twitching
warm, flushed skin (vasodilation)
N/V
low muscle tone/reflexes
(confusion, increase drowsiness)
Kussmaul respirations (compensatory hyperventilation)

63
Q

Tx for metabolic acidosis from DKA

A

insulin drips and fluid
check glucose every hour
O2
possible Bicarbonate

64
Q

Metabolic alkalosis s/s

A

restlessness followed by lethargy
dysrhythmias (tachycardia)
compensatory hypoventilation
confusion (low LOC, dizzy, irritable)
N/V/D
tremors, muscle cramps, tingling of fingers and toes
hypokalemia

65
Q

How can you prevent/tx of metabolic alkalosis

A

suction on INT
fluid/electrolyte imbalance
hemodialysis

66
Q

A 55 year-old is recovering from an exploratory laparotomy in the PACU. The nurse notices the patient’s RR is 7/ minute, demonstrates shallow breathing and has no response to stimuli. The nurse assesses the ABC’s and obtains a STAT ABG.

pH = 7.15
PaCO2 = 68
HCO3 = 22 mEq/L
PaO2 = 68 mmHg

A

Uncompensated Respiratory Acidosis with Moderate Hypoxemia

67
Q

A 79 year-old is admitted to the emergency room with nausea, vomiting and abdominal pain that has developed diarrhea after eating a 3 week old sandwich.

pH= 7.55
PaCO2 = 48
HCO3 = 47.2
PaO2 = 57.7

A

Partially Compensated Metabolic Alkalosis with Severe Hypoxemia

68
Q

A 65 year-old is admitted to the emergency room with inability to urinate and admits to taking an unknown number of aspirin over the last 24-hour period because of a severe headache. Vital signs are: T=98.5, Pulse= 92, RR=30 and deep. Routine blood test and ABG reveals:

pH= 7.37
PaCO2= 30
HCO3 = 17
PaO2 = 80

A

Fully Compensated Metabolic Acidosis with Normal Oxygenation

69
Q

Mrs. Puffer is a 35-year-old single mother. She reports to the ED in the early morning with shortness of breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks. Her temperature is 102.2, blood pressure 110/76, heart rate 108, respirations 32, rapid and shallow. Breath sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.
ABG results are:
pH= 7.44
PaCO2= 28
HCO3= 21
PaO2= 54

What does the S/S and ABG show?
How can you tx this patient?

A

Respiratory Alkalosis
Fully compensated
Severe hypoxemia

  • Tx pneumonia with TCDB, IS, O2, antibiotics, sodium bicarbonate, albuterol
70
Q

Mr. Worried is a 52-year-old widower. He is retired and living alone. He enters the ED complaining of shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies diabetes; blood sugar is normal. There are no EKG changes. He has no significant respiratory or cardiac history. He takes several antianxiety medications. He says he has had anxiety attacks before. While being worked up for chest pain an ABG is done and results are:
pH= 7.48
PaCO2= 28
HCO3= 22
PaO2= 85

What does the S/S and ABG show?
How can you tx this patient?

A

Respiratory Acidosis
Fully compensated
Normal oxygenation

Anxiety attack - Ativan

71
Q

You are the critical care nurse about to receive Mr. Sweet, a 24-year-old being admitted for DKA (diabetic ketoacidosis). In report you learn that his blood glucose on arrival was 780. He received 10 unites of regular insulin IV X2 doses in the ED.
ABG results are:
pH= 7.33
PaCO2= 25
HCO3=12
PaO2= 89

What does the S/S and ABG show?
How can you tx this patient?

A

Metabolic Acidosis
Partially compensated
Normal oxygenation

72
Q

Mrs. Dobins was found pulseless and not breathing this morning. After a couple minutes of CPR she has a pulse of 50 bpm and starts breathing on her own; but remains unresponsive with no gag reflex. A blood gas is obtained and the results include:
pH = 6.89
CO2 = 70
p02 = 42
HC03 = 13
Pa02 = 50%

What does the S/S and ABG show?
How can you tx this patient?

A

Respiratory Acidosis
Partially compensated
Severe hypoxemia

73
Q

You find Mr. Simmons to be in respiratory distress. He was admitted with shortness of breath and productive cough X1 week and has been diagnosed with pneumonia. He has a history of Type-I diabetes mellitus and his blood glucose is 583 and he is now febrile. His ABG shows:
pH = 7.00
C02 = 59
p02 = 86
HC03 = 14
Sa02 = 91%

What does the S/S and ABG show?
How can you tx this patient?

A

Respiratory Acidosis
Partially compensated
Normal oxygenation

Module 7 (Critical Care) (22 decks)

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