Ns128 Wk 10 Abgs

Front 1

Normal PO2

Back 1

80-100

Front 2

normal O2 sat

Back 2

93-100

Front 3

normal pH

Back 3

7.35-7.45

Front 4

normal PCO2:

Back 4

35-45

Front 5

normal HCO3

Back 5

22-26

Front 6

pH levels that are compatible with life

Back 6

6.8 - 7.8

Front 7

Any pH less than 7.35 is:

Back 7

acidosis

Front 8

Any pH higher than 7.45 is:

Back 8

alkalosis

Front 9

Pco2 aka:

Back 9

PCO2, pCO2, PaCO2, Paco2

Front 10

PCO2 is it an acid or base?

Back 10

acid

Front 11

Which component (respiratory or metabolic) does PCO2 represent?

Back 11

respiratory

Front 12

Any PCO2 greater than 45 is?

Back 12

acidic/acidosis

Front 13

Any PCO2 less than 35 is?

Back 13

alkalotic

Front 14

HCO3 aka

Back 14

bicarbonate

Front 15

HCO3 is an acid/base?

Back 15

base ... aka alkalotic

Front 16

Which component (respiratory or metabolic) does HCO3 represent?

Back 16

metabolic

Front 17

any HCO3 above 26 is?

Back 17

alkalotic/alkalosis

Front 18

any HCO3 below 22 is?

Back 18

acidic/acidosis

Front 19

Steps to determine if it is respiratory/metabolic acidosis/alkalosis; fully compensate/uncompensated, partially compensated?

Back 19

1. Look at PO2 first. is it between 80-100? If not, that is the most important thing.

2. Next to pH, PcO2, and HCO3 write whether each is low, normal, or high

3. Next to pH, PCO2, and HCO3 write whether it is normal, acid, or alk.

4. Looking at PCO2 and HCO3, which is the same(alk or acid) as pH?That's the system causing the problem.

5. Now look at the remaining value (PCO2 or HCO3). Is it doing the opposite of pH and the problem system? If so, it is partially compensated. Is it in the normal range? Then it is uncompensated.

6. Regardless of all other values, if pH is normal, it is fully compensated.

Front 20

3 types of compensation?

Back 20

- fully compensated

-partially compensated

- uncompensate

Front 21

partially compensated

Back 21

- have an abnormal pH

- the opposite system will be out of range opposite to the problem

Front 22

fully compensated

Back 22

- abg's have a normal pH

Front 23

uncompensated abgs:

Back 23

- no change in the opposite system

Front 24

How to draw/care for a pt with ABG draw:

Back 24

1. allow 20-30 mins after suctioning or other respiratory procedure before drawing

2. document the client's temp before drawing

3. Have ice ready for the sample

4. record if pt is breathing room air or O2

5. instruct pt to breath normally, not hyperventilated (blow off CO2)

6. post-draw, hold pressure for 5 minutes; 10 mins if on anticoags

Front 25

Acids are substances having:

Back 25

one or more H+ that can be liberated into solution.

Front 26

Bases are substances that:

Back 26

can accept or bind H+ in a solution.

Front 27

3 regulators of acid/base balance

Back 27

1. - chemical buffers- to neutralize

2. respiratory - works quickly/in minutes

3. urinary/metabolism- works slowly/hours-days

Front 28

The strongest stimulus to breathe is

Back 28

an increase of carbon dioxide in the blood (Hypercapnia)

Front 29

What electrolyte will be off in acidosis? hypo or hyper? Why?

Back 29

- Hyperkalemia

- in acidosis, cells take up H+, and blood takes up K+ resulting in hyperkalemia

Front 30

alkalosis and H+ and K+

Back 30

- results in hypokalemia

- in alkalosis, cells take up K+ and blood takes up H+, resulting in hypokalemia

Front 31

Without regard to which system is off, what will a low pH result in and what will its affect on the CNS be?

Back 31

- Low ph=acidosis

and depresses CNS

Front 32

without regard to which system is off, what will a high pH result in and what will be its affect on the CNS be?

Back 32

- high pH=alkalosis= excitability of CNS= tetany and convulsions

Front 33

Hypoventilation increases which one O2 or CO2

Back 33

CO2

Front 34

High CO2 increases or decreases pH?

Back 34

decreases pH

Front 35

Respiratory AcidosisAssessment findings

Back 35

•Hypoventilation

Cyanosis

•Tachycardia

•Confusion

Hyperthermia

•Dizziness

•Visual disturbances

•CNS depression

(think about it, in acidosis, everything slows down ... except you can't get enough air, so your heart beats faster to try to compensate)

Front 36

Respiratory Acidosis- Possible causes

Back 36

•Drug Overdose

- Increased CarbohydrateDiet

•Pneumothorax,

Airway Obstruction

•Chronic Obstructive Pulmonary Disease•Central Nervous System trauma, Seizures,Chills•Pulmonary Edema

•Sleep Apnea

Front 37

Resp Acidosis Interventions

Back 37

•Assess Respiratory, CNS, Cardiac, &Renal Systems

•Treat underlying problems

•Maintain Hydration

•Avoid Sedatives & Narcotics

•Watch for Hyperkalemia

•Give Bicarb as ordered to close the gapbetween low Bicarb (Base) and high CO2 - Acid

Front 38

hyperventilation decreases:

Back 38

pCO2

Front 39

Low pCO2 increases or decreases the pH?

Back 39

increases

Front 40

Respiratory AlkalosisAssessment findings

Back 40

•Numbness/tingling

•Lightheadedness

•Confusion

•Tetany

•Hypokalemia

Hypocalcemia

Front 41

Respiratory AlkalosisPossible Causes

Back 41

•Anxiety,

Pain,

Stroke•

Salicylates,

Opiates

•Fever,

Infection,

Sepsis

•Exercise, Marathons

•Hypermetabolic states

•Asthma,

pneumonia,

Pregnancy,

Hypoxia

Front 42

Respiratory Alkalosis Interventions

Back 42

•Assess resp, neuro, cardiac systems

•Treat underlying Cause

•Decrease Rate and Breathe into paper bagor use Rebreather mask.

•Psychosocial interventions, Calm, Safe,Quiet•Watch for decreased Ca+ and K+

Front 43

High Hco3 causes:

Back 43

high pH

Front 44

How does body compensate for high pH?

Back 44

hypoventilation (lungs save the CO2)

Front 45

Metabolic AlkalosisAssessment findings

Back 45

•Hypoventilation

•Apathy

•Confusion

•Paresthesia

Front 46

Metabolic AlkalosisPossible Causes

Back 46

•Vomiting or gastric drainage.

•Diuretic therapy

•Severe K+ depletion.

•Cushing’s syndrome, (Steroids)

•Bicarbonate Administration

Front 47

Metabolic Alkalosis Interventions

Back 47

•Assess neuro, resp,and cardiac systems

•Treat underlying causes and Hypokalemia•Acetazolamide (Diamox) to increase bicarbexcretion by the kidneys

•IV Lactated Ringers to close base excessgap•Seizure precautions

Front 48

•The accumulation of metabolic acids leadsto :

Back 48

a low pH.

Front 49

How does body compensate for low pH

Back 49

hyperventilation (lungs blow off CO2 to increase pH)

Front 50

Metabolic AcidosisAssessment findings

Back 50

•Lethargy/drowsiness, Comatose

•Kussmaul’s respirations

•Twitching, Increased Reflexes

•Nausea & Vomiting

•Hyperkalemia, High Ammonia

Front 51

Metabolic AcidosisPossible Causes

Back 51

•Starvation, Multi-system Shutdown

•Diabetic Ketoacidosis,

Cardiac Arrest

•Diarrhea,

Renal Disease,

uremia

•Trauma/burns,

Lactic Acid Production•

Alcohol or Salicylate intoxication

•Ileostomy, Proximal colostomy, UrinaryDiversion

•Total Parenteral Nutrition

Front 52

Metabolic Acidosis Interventions

Back 52

•Assess resp, renal, neuro, cardiac, endocrinesystems

•Treat underlying cause

•Treat hyperkalemia

•Fluid replacement

•Bicarb IV and Loop Diuretics toneutralize

• Strong Cation to close the Anion Gap

Front 53

•The Strong Cations are:

Back 53

Na+ and K+. (Positive Charge) (think of the "T" in cation as a plus sign)

Front 54

•The Strong Anions are

Back 54

Cl- and HCO3) (Negative charge)

Front 55

•The anion gap measures . .

Back 55

the difference between Positive and negatively charged ions

Front 56

acceptable numbers for the anion gap

Back 56

Best to be within 2, but normal to 10

Front 57

How do you calculate the anion gap?

Back 57

To figure the Anion Gap: •

(Na+ and K+) – (Cl- and HCO3) & unmeasured anions)

Front 58

Normal for NA

K

Cl

HCO3

Back 58

•Normal Na+ is: 135-145 & Normal K+ is: 3.5-5.0 •Normal Cl- is 95-105 & Normal HCO3 is: 26