TOPIC 3 - respiratory diagnostics and ABG's

Question 1

risk factors for respiratory acidosis

Answer 1

Neuromuscular disorders
CNS depression
Hypoventilation
Decreased respiratory rate

Question 2

signs and symptoms of respiratory acidosis

Answer 2

Kussmaul breathing
Chest pain
Nausea /vomiting
Abdominal pain
General muscle weakness

Question 3

interventions for respiratory acidosis

Answer 3

Bronchodilators
Assisted ventilation
Respiratory stimulants

Question 4

risk factors for metabolic acidosis

Answer 4

Diabetic ketoacidosis
Lactic acidosis
Resp., renal, or heart failure
Diarrhea, laxatives

Question 5

signs and symptoms of metabolic acidosis

Answer 5

Vertigo
Neuro changes
Dyspnea
Tachypnea
Hyperpnea

Question 6

interventions for metabolic acidosis

Answer 6

Monitor vitals
Monitor respiratory status
Monitor blood gases
Correct cause
Give bicarbonate

Question 7

risk factors for respiratory alkalosis

Answer 7

Extended periods of hyperventilation
Extreme anxiety
Fever

Question 8

signs and symptoms of respiratory alkalosis

Answer 8

Lightheadedness
Agitation

Question 9

interventions for respiratory alkalosis

Answer 9

Encourage patient to take slow deep breaths
Decrease patient anxiety
Monitor ABG

Question 10

risk factors for metabolic alkalosis

Answer 10

Vomiting
NG suctioning
Hypokalemia
Excess antacids/bicarb
Steroids

Question 11

signs and symptoms of metabolic alkalosis

Answer 11

Lightheaded; N/V
Confusion; stupor
Muscle twitching; tremors
Numbness/tingling face or extremities
Electrolyte imbalance, dysrhythmias

Question 12

interventions for metabolic alkalosis

Answer 12

Monitor: Vitals, neuro status, I & O, ABGs,
Warn/teach about taking too many antacids

Question 13

normal pH range

Answer 13

7.35-7.45

Question 14

normal paCO2 range

Answer 14

35-45

Question 15

normal HCO3 range

Answer 15

22-26

Question 16

acidic vs basic values

Answer 16

below 7.35 pH - acidic
above 45 paCO2 - acidic
below 22 HCO3 - acidic

above 7.45 pH - basic
below 35 paCO2 - basic
above 26 HCO3 - basic

Question 17

when pH is up and paCO2 is down

Answer 17

respiratory alkalosis

Question 18

when pH is down and paCO2 is up

Answer 18

respiratory acidosis

Question 19

when pH is up and HCO3 is up

Answer 19

metabolic alkalosis

Question 20

when pH is down and HCO3 is down

Answer 20

metabolic acidosis

Question 21

diagnostic studies for respiratory symptoms

Answer 21

-blood serum - Hgb, Hct, ABG’s
-pulse ox
-CO2 monitor (end tidal capnography)
-sputum studies for C&S - identify infecting organism, cell type, diagnosis, course for antibiotic treatment
-skin test - test for allergic reaction or TB exposure

Question 22

radiology tests for respiratory system

Answer 22

chest x ray - AP and lateral view to diagnose and evaluate change in respiratory system
CT - diagnosis of lesion (done when x ray is difficult to detect)
MRI - diagnosis of lesions (when difficult to assess CT) and for distinguishing vascular vs nonvascular structures
ventilation perfusion - ventilation without perfusion would suggest pulmonary embolus, diminished or absent radioactivity = lack of perfusion or airflow
angiogram - visualize pulmonary vasculature and locate obstruction
PET - distinguish benign and malignant pulmonary nodules

Question 23

CBC with diff

Answer 23

leukocytosis occurs in majority of patients with bacterial pneumonia
WBC is greater than 15000

Question 24

ABGs obtained to assess for

Answer 24

hypoxemia (paO2 less than 80)
hypercapnia (paCO2 greater than 45)
acidosis (ph less than 7.35

Question 25

death can occur in what kind of change in pH

Answer 25

below 6.9 or higher than 7.8

Question 26

compensatory mechanisms

Answer 26

respiratory (CO2) and renal (metabolic) maintain homeostasis

Question 27

COPD patients are more likely to display what kind of ABG imbalance

Answer 27

respiratory acidosis because of damage to alveoli, decreased oxygen, and higher circulating levels of CO2

Question 28

people with impaired renal function are likely to display what kind of ABG imbalance

Answer 28

metabolic acidosis because of retaining metabolic waste products

Question 29

retaining CO2 results in

Answer 29

respiratory acidosis

Question 30

excreting CO2 results in

Answer 30

respiratory alkalosis

Question 31

retaining HCO3 results in

Answer 31

metabolic alkalosis

Question 32

excreting HCO3 results in

Answer 32

metabolic acidosis

Question 33

causes of respiratory acidosis

Answer 33

Hypoventilation Respiratory failure Asthma attacks, COPD Chest injury/trauma (broken ribs) Pulmonary edema Medications Obstructive sleep apnea

Question 34

causes of respiratory alkalosis

Answer 34

Hyperventilation Hypoxemia from acute pulmonary disorders Pain Anxiety/Fear Salicylate or Nicotine overdose Increased metabolism (fever, high altitudes)

Question 35

causes of metabolic acidosis

Answer 35

inadequate intake of calories diabetes type 1 cardiac arrest sepsis (lactic acid accumulation) trauma seizures renal failure severe diarrhea, laxative use

Question 36

causes of metabolic alkalosis

Answer 36

Vomiting, gastric suction Extracellular fluid deficit Dehydration Circulatory shock Loop or thiazide diuretic use Hypokalemia Ingestion of baking soda (bicarbonate product)