Oxygenation/Acid-Base Balance

Question 1

What supports normal function of respiratory system?

Answer 1

Integrity of airway system
Properly functioning alveolar system
Properly functioning cardiovascular & hematologic system

Question 2

Nasal cannula

Answer 2

Max is 6 L/min 44-55%
COPD = no more than 1-3 L/min

Check for skin breakdown behind ears

Question 3

Simple mask

Answer 3

5-8 L/min; 40-60%
Check placement frequently; pt can feel claustrophobic

Nasal cannula during mealtime

Question 4

Partial rebreather mask

Answer 4

8-11 L/min; 50-75%

Set flow rate so that the mask remains 2/3 full during inspiration; check for kinks/twists

Question 5

Non-rebreather mask

Answer 5

10-15 L/min; 80-95%
Set flow rate so that reservoir bag collapses slightly during inspiration
Make sure valves and rubber flaps operating properly

Question 6

Venturi mask

Answer 6

4-10 L/min; 20-40%

Careful monitoring to verify FiO2 rate has been ordered and air intake valves aren’t blocked

Question 7

Normal Range for pH

Answer 7

7.35-7.45

Question 8

Normal Range for PaCO2

Answer 8

35-45

Question 9

Normal Range for HCO3

Answer 9

22-26

Question 10

Respiratory acidosis

Answer 10

<7.35 pH
>45 PaCO2
HCO3 22-26

Lungs unable to remove CO2 causing acid accumulation in blood due to alveolar hypoventilation

*buffered by HCO3 to reduce CO2

Question 11

Causes of respiratory acidosis

Answer 11

Pneumonia
Airway obstruction
Atelectasis
COPD

Question 12

Respiratory alkalosis

Answer 12

> 7.45 pH
<35 PaCO2
HCO3 normal

Loses CO2 due to alveolar hyperventilation

*buffered by increased HCO3 and retaining more hydrogen

Question 13

Causes of respiratory alkalosis

Answer 13

High anxiety
Hyperventilation
High fever
Early sepsis

Question 14

Metabolic acidosis

Answer 14

<7.35 pH
PaCO2 normal
<22 HCO3

From excessive loss of HCO3 from GI tract causing loss of buffering ions; increase H+ and low plasma HCO3 from gain of hydrogen or loss of HCO3

Question 15

Causes of metabolic acidosis

Answer 15

Ketacidosis
Alcoholism
Renal failure
Diarrhea

Question 16

Metabolic alkalosis

Answer 16

> 7.45 pH
PaCO2 normal
22 HCO3

High plasma HCO3 [] form gain of HCO3 or loss of H+

Question 17

Causes of metabolic alkalosis

Answer 17

Vomiting
Gastric
Suctioning
Hypokalemia
Excess antacids

Question 18

Non-pharmacological breathing strategies

Answer 18

Deep breathing
Incentive spirometry
Pursed lip breathing
Diaphragmatic breathing
ICOUGH

Question 19

Deep breathing

Answer 19

Make each breath deep enough to move the bottom ribs through nose and out mouth

Do hourly while awake or 4x daily

Question 20

Incentive spirometry

Answer 20

Encourages lung inflation
Prevents atelectasis
Clears secretions
Every 5-10 mins per 1-2 hours
10x hour during wake period

Question 21

Pursed-lip breathing

Answer 21

Breath in 3s, breath out 7s & repeat
Prolongs expiration, prevents collapse of airways
Improved air exchange and decreased dyspnea

Question 22

Diaphragmatic breathing

Answer 22

Place one hand on stomach and other on middle of chest and breathe in slowly, letting abdomen protrude and breathe out through pursed lips, controlling ab muscles
Reduces RR, increases alveolar ventilation

Repeat for 1 minute, rest for 2 mins; several times a day

Question 23

ICOUGH

Answer 23

I = incentive spirometer
C = cough & breathe deeply
O = oral care
U = understand (patient/staff edu)
G = get out of bed 3x daily
H = head of bed elevated