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Med Surg > ABGs / Problems With Oxygenation > Flashcards

ABGs / Problems With Oxygenation Flashcards

1
Q

Normal pH

A

7.35-7.45

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2
Q

What is compensation?

A

Body’s means of returning pH to normal (buffering)

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3
Q

3 systems that compensation is regulated by, and how quickly do these occur?

A

Chemical: immediate
Respiratory: within minutes to hours
Kidney: hours to days

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4
Q

When monitoring ABGs, what is being assessed?

A

Tissue oxygenation
Alveolar ventilation
Acid-base balance

Goal of analysis = treat primary problem

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5
Q

Normal PaCO2

A

34-45 mm Hg

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6
Q

What is it called if PaCO2 < 35

A

Respiratory alkalosis

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7
Q

What is it called if PaCO2 > 45

A

Respiratory acidosis

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8
Q

What does the bicarbonate determine?

A

Metabolic problem

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9
Q

Normal HCO3

A

22-26 mEq/L

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10
Q

What does it mean if HCO3 is < 22?

A

Metabolic acidosis

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11
Q

what does it mean if HCO3 is > 26?

A

Metabolic alkalosis

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12
Q

What does ROME stand for?

A

Respiratory
Opposite
Metabolic
Equal

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13
Q

What is respiratory acidosis caused by?

A

Hypoventilation (opioids)
Respiratory failure
COPD

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14
Q

How is respiratory acidosis compensated for?

A

Kidneys conserve HCO3- and secrete H+ into urine

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15
Q

What is respiratory alkalosis caused by?

A

Hypoxemia from acute pulmonary disorders
Hyperventilation (can be from pain, anxiety, DKA, head injury

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16
Q

How is respiratory alkalosis compensated for?

A

Expect kidneys to compensate, but compensation is rare

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17
Q

What is metabolic acidosis caused by?

A

Excess acid from:
Ketoacidosis (DKA)
Lactic acid accumulation (shock, seizures, Metformin, aspirin)

OR

Bicarbonate deficit from:
Severe diarrhea (loss from lower GI)
Kidney disease (end stage ~uremia)

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18
Q

How is metabolic acidosis compensated for?

A

Increased CO2 secretion by lungs (Kussmaul respirations)
Kidneys excrete acid

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19
Q

What is metabolic alkalosis caused by?

A

Bicarbonate excess caused by:
Ingestion of antacids
Pancreatic secretion of HCO3-

OR

Loss of acids from:
Prolonged vomiting or gastric suction (loss from upper GI)

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20
Q

How is metabolic alkalosis compensated for?

A

Renal excretion of HCO3-
Decreased respiratory rate to increase plasma CO2 (limited help)

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21
Q

If someone is about to have their ABCs taken, what precautions do you need to take?

A

No changes to O2 therapy 15 minutes before
So if someone has order to change O2 flow rate,
1 - change O2
2 - wait 15 min before getting ABG

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22
Q

What does a CT of the chest look at?

A

Scans lungs in layers

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23
Q

Nursing considerations when a pt has a CT or chest ordered

A

Look to see if it’s ordered with or without contrast dye (sometimes both)
If with dye, check to see if pt is allergic to contrast/iodine/shellfish
Teach pt they will feel warm and flushed with injection
Encourage hydration before and after to flush out contrast
After CT: monitor renal function

24
Q

Nursing considerations for a pt having an MRI

A

Screen for metal (including implantable devices, surgical hardware)
Remove all metal (jewelry, hearing aids)
Address claustrophobia (sedation may be necessary)

25
Q

What does a V/Q scan consist of?

A

Ventilation - inhale moisture of O2 with radioisotopes
Perfusion - IV injection of radioisotope

26
Q

Why is a V/Q scan performed?

A

Usually to check for pulmonary embolism

27
Q

Nursing considerations for V/Q scans

A

Pt must be able to follow commands, be able to lie still
Pt must have IV access
No prep, takes about an hour

28
Q

What does an SpO2 monitor check for?

A

Oxygenation

29
Q

Normal oxygen

A

94-99%

30
Q

Oxygenation that needs prompt treatment

A

Below 91%

31
Q

oxygenation that is life threatening

A

Below 70%

32
Q

What should be done if SpO2 shows a questionable reading

A

Repeat

33
Q

What is SaO2?

A

Same as SpO2, measured by ABGs

34
Q

What does Capnography monitor?

A

Ventilation
(Detects resp depression before SpO2)

35
Q

What is a normal Capnography range?

A

35-45 mm Hg

36
Q

Why would someone have a high EtCO2?

A

(High Capnography reading)
Partially obstructed airway
Hypoventilation

37
Q

What do pulmonary function tests measure?

A

Lung volumes and airflow

38
Q

What is a thoracentesis?

A

Aspiration of pleural fluid
(Needle into chest wall to obtain specimens, remove pleural fluid, or instill medication)

39
Q

What needs to be done after every thoracentesis?

A

Chest Xray

40
Q

Nursing actions after a thoracentesis

A

Encourage deep breaths
Auscultate breath sounds
Ensure CXR obtained
Dressing to site

41
Q

Possible complications after a thoracentesis

A

Hypoxia
Infection
Pneumothorax
(Possible chest tube)

42
Q

What is a bronchoscopy?

A

Direct visualization of bronchi through scope via nose or mouth

43
Q

Nursing management for a bronchoscopy

A

NPO 6-12 hours before (sedation)
NPO until gag reflex returns after (recovery from sedation)
Monitor for complications:
- hemorrhage
- pneumothorax
- infection

44
Q

How is a transbronchial biopsy done?

A

Can be performed during bronchoscopy

45
Q

How is a transthoracic biopsy done?

A

Percutaneously (requires CXR post procedure to assess for pneumothorax)

46
Q

How is a VATS biopsy done?

A

(Video-assisted thoracoscopic surgery)
Scope with camera inserted through a trocar
(Chest tube needed post procedure)

47
Q

How is an open biopsy done?

A

Surgical procedure
(Chest tube needed after)

48
Q

How would you know if your pt had a pneumothorax?

A

Pain on affected side (at end of inspiration and expiration)
Decreased lung sounds on affected side
Trachea shift to unaffected side
Dyspnea
Fast RR, HR
New cough
Cyanosis

49
Q

Treatment for a pneumothorax

A

O2
Raise HOB
Call HCP

50
Q

Why would a pt have a chest tube?

A

Pneumothorax (air)
Hemothorax (blood)
Pleural effusion (fluid)

51
Q

Where are chest tubes placed?

A

Into the pleural space, not the lung
To remove air: upper chest, near apex
To remove blood/drainage: further down chest

52
Q

Nursing actions for pt with a chest tube

A

*#1 = good resp assessment / changes (check chest tube connection)
Assess CT insertion site dressing and monitor
Monitor drainage
Monitor bubbling in chamber
Check suction - matches order
Maintain drainage system lower than chest
Mark drainage level at end of shift

53
Q

What does a gram stain culture test for?

A

Gram positive/negative bacteria

54
Q

What does an acid-fast bacillus test for?

A

Indicated possible TB

55
Q

What does a culture & sensitivity (C&S) test for?

A

Allows growth and isolation of microorganisms
Determines appropriate medication

56
Q

What does cytology test for?

A

ID abnormal cells (to look for malignancies)

Med Surg (12 decks)

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