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Medsurge ABGs
Medsurge ABGs - EX#2
| Question | Answer |
|---|---|
| Lab values for normal pH | 7.35-7.45 |
| Normal PaCO2 levels | 35-45 |
| Normal HCO3 levels | 22-26 |
| Normal PaO2 levels | 80-100 |
| O2 saturation SaO2 | 95-100 |
| pH 7.35, PaO2 60, PaCO2 50, HCO3 30 | Compensated Respiratory Acidosis |
| pH 7.50, PaO2 75, PaCO2 40, HCO3 32 | Uncompensated Metabolic Alkalosis |
| pH 7.6, PaO2 80, PaCO2 30, HCO3 24 | Uncompensated Respiratory Alkalosis |
| 7.3, PaO2 75, PaCO2 32, HCO3 19 | Partially Compensated Metabolic Acidosis |
| pH 7.45, PaO2 75, PaCO2 28, HCO3 20 | Compensated Respiratory Alkalosis |
| 7.28, PaO2 78, PaCO2 39, HCO3 18 | Uncompensated Metabolic Acidosis |
| pH 7.45, PaO2 80, PaCO2 50, HCO3 30 | Compensated Metabolic Alkalosis |
| pH 7.23, PaO2 77, PaCO2 50, HCO3 28 | Partially Compensated Respiratory Acidosis |
| What is acid-base balance? | refers to the homeostasis of the hydrogen ion (H+) concentration in body fluids |
| Fatal pH blood levels are less than ____ and more than ___. | less than 6.8 and more than 7.8 |
| Arterial blood gas analysis is recommended for oxygen saturations less than | 80%; pulse oximetry is considered accurate for O2 saturations above 80% |
| Renal buffers | most effective, but slowest-acting buffering system |
| If the body is in Alkalosis, what does the renal system do? | The kidneys excrete HCO3-, and reabsorb H+, making the urine more alkalotic which will decrease the pH |
| If the body is in Acidosis, what does the renal system do? | The kidneys excrete H+ and reabsorb HCO3- which decreases the pH; urine becomes acidic, HCO3- and pH increases |
| The first line of defense against a change in pH is what? | Chemical buffers! The three buffers are bicarbonate buffers, phosphate buffers, and protein buffers |
| If the body is in Metabolic acidosis, how does the resp system compensate? | Increased rate and depth of respirations which results in a greater elimination of CO2 |
| If the body is in Metabolic alkalosis, how does the resp system compensate? | Decreased rate and depth of respirations which results in increased CO2 retention and increased carbonic acid accumulation |
| In metabolic acidosis related to hyperglycemia, what electrolyte is exchanged for H+? | Potassium! |
| In the Allen test, which artery do you release after the hand experiences blanching? | Ulnar! |
| When the body is in a state of alkalosis, what is the role of the renal buffers? A. ↑ Excretion of water B. ↓ Excretion of water C. ↑ Excretion of HCO3– D. ↓ Excretion of HCO3– | C. ↑ Excretion of HCO3– |
| Causes of respiratory acidosis | Central nervous system depression (head trauma, oversedation, anesthesia, high spinal cord injury) • Pneumothorax • Hypoventilation • Bronchial obstruction and atelectasis |
| Causes of respiratory acidosis | • Severe pulmonary infections • Heart failure with pulmonary edema (congestive heart failure) • Massive pulmonary embolus • Myasthenia gravis • Multiple sclerosis |
| Nursing interventions for respiratory acidosis | maintain airway; monitor ABGs and vital signs, especially RR and depth; administer O2; assist with intubation if necessary; monitoring potassium levels; administration of sedatives cautiously; and providing reassurance and teaching as needed. |
| Treatments for respiratory acidosis | Bronchodilators, Medications to treat hyperkalemia, Antibiotics to treat infection, Chest physiotherapy, Removal of a foreign body from the airway, if indicated, Chest tube insertion |
| Clinical manifestations of respiratory acidosis | Dyspnea Restlessness Headache Tachycardia Confusion Lethargy Dysrhythmias Respiratory distress Drowsiness Decreased responsiveness |
| Causes of respiratory alkalosis | Anxiety and nervousness, Fear and pain, Fever and gram-neg septicemia, Hyperventilation, Lung conditions such as pneumonia, pulmonary embolisms and edema, Thyrotoxicosis, CNS lesions, Salicylate intoxication/overdose, Hepatic failure, Pregnancy |
| Lab values: pH 7.56, paCo2 20, HCO3 20 A. respiratory alkalosis, uncompensated B. respiratory alkalosis, uncompensated C. respiratory alkalosis, partially compensated D. metabolic alkalosis, partially compensated | C. respiratory alkalosis, partially compensated |
| Lab values: pH 7.23, paCo2 37, HCO3 18 A. respiratory alkalosis, partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, uncompensated D. metabolic alkalosis, partially compensated | The answer is C: metabolic acidosis, uncompensated |
| Lab values: pH 7.31, paCo2 34, HCO3 21 A. respiratory alkalosis, partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is C: metabolic acidosis, partially compensated |
| Lab values: pH 7.50, paCo2 32, HCO3 24 A. respiratory alkalosis, partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is B: respiratory alkalosis, uncompensated |
| Lab values: pH 7.46, paCo2 36, HCO3 32 A. respiratory alkalosis, partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, uncompensated | The answer is D: metabolic alkalosis, uncompensated |
| Lab values: pH 7.52, paCo2 48, HCO3 28 A. respiratory alkalosis, partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is D: metabolic alkalosis, partially compensated |
| Lab values: pH 7.25, paCo2 60, HCO3 27 A. respiratory acidosis partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is A: respiratory acidosis partially compensated |
| Lab values: pH 7.55, paCo2 47, HCO3 30 A. respiratory acidosis partially compensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is D: metabolic alkalosis, partially compensated |
| Lab values: pH 7.20, paCo2 49, HCO3 25 A. respiratory acidosis, uncompensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, partially compensated D. metabolic alkalosis, partially compensated | The answer is A: respiratory acidosis, uncompensated |
| Lab values: pH 7.30, paCo2 36, HCO3 16 A. respiratory acidosis, uncompensated B. respiratory alkalosis, uncompensated C. metabolic acidosis, uncompensated D. metabolic alkalosis, partially compensated | The answer is C: metabolic acidosis, uncompensated |
| Lab values: pH 7.41, paCo2 26, HCO3 17 A. respiratory alkalosis, fully compensated B. respiratory alkalosis, uncompensated C. respiratory acidosis, fully compensated D. metabolic alkalosis, partially compensated | The answer is A: respiratory alkalosis, fully compensated |
| Lab values: pH 7.39, paCo2 48, HCO3 28 A. metabolic alkalosis, fully compensated B. metabolic alkalosis, partially compensated C. respiratory acidosis, fully compensated D. respiratory alkalosis, fully compensated | The answer is C. respiratory acidosis, fully compensated |
| Lab values: pH 7.22, paCo2 49, HCO3 24 A. metabolic alkalosis, fully compensated B. metabolic acidosis, uncompensated C. respiratory acidosis, uncompensated D. respiratory alkalosis, fully compensated | The answer is C. respiratory acidosis, uncompensated |
| Lab values: pH 7.37, paCo2 33, HCO3 17 A. metabolic acidosis, fully compensated B. metabolic acidosis, partially compensated C. respiratory acidosis, fully compensated D. respiratory alkalosis, uncompensated | The answer is A. metabolic acidosis, fully compensated |
| Lab values: pH 7.22, paCo2 49, HCO3 28 A. metabolic acidosis, partially compensated B. respiratory acidosis, partially compensated C. respiratory acidosis, fully compensated D. respiratory alkalosis, fully compensated | The answer is B. respiratory acidosis, partially compensated |
| Clinical Manifestations of Respiratory Alkalosis | Hyperventilation, Light-headedness, Confusion, Decreased concentration, Paresthesias, Tetanic spasms in the extremities, Cardiac dysrhythmias, Palpitations, Sweating, Dry mouth, Blurred vision |
| Nursing Interventions for Respiratory Alkalosis | Encourage pt to take slow deep breaths, VS, provide emotional reassurance/support to decrease anxiety, assist with ADLs, provide pt a paper bag to rebreathe |
| Treatments for Respiratory Alkalosis | Treat underlying cause, reduce fever, including cooling measures and antibiotic therapy if the elevated temperature is secondary to an infectious process, eliminate causes of sepsis, give O2, provide sedative, Diuretics to treat pulmonary edema |
| Causes of Metabolic Acidosis | Accumulation of Acid: Renal failure, Ketoacidosis, Anaerobic metabolism, Starvation, Salicylate intoxication Loss of Base: Diarrhea, Intestinal fistulas |
| Clinical Manifestations of Metabolic Acidosis | Headache, Confusion, Restlessness, Lethargy, Weakness, Stupor/coma, Kussmaul respirations, Nausea and vomiting, Dysrhythmias, Warm, flushed skin, Seizures, Twitching, Peripheral vasodilation |
| Nursing interventions for Metabolic Acidosis | monitor hemodynamic status through BP, PR, RRs, and cardiac rhythm and assessing peripheral vascular status. Cautious administration of sodium bicarbonate may be indicated, along with providing patient reassurance and teaching |
| Treatments for Metabolic Acidosis | sodium bicarb replacement, parenteral fluid, insulin for DKA, antidiarrheals for bicarb loss, dialysis for CKD, and mechanical ventilation for resperatory compensation |
| Causes of Metabolic Alkalosis | Accumulation of base: Excess use of bicarbonate, Lactate administration in dialysis, Excess ingestion of antacids Loss of acids: Vomiting, Nasogastric suctioning, Hypokalemia, Hypochloremia, Diuretics, Increased levels of aldosterone |
| Clinical Manifestations of Metabolic Alkalosis | Muscle twitching and cramps, Tetany, Dizziness Lethargy, Weakness Disorientation, Convulsions, Coma, Nausea and vomiting, Depressed respirations |
| Nursing Interventions for Metabolic Alkalosis | Monitor RR, PR, cardiac rhythms, and LOC, administer IV fluids and electrolytes as needed |
| Treatments for Metabolic Alkalosis | Discontinue potassium-wasting diuretics and NG suction, administer antiemetic to treat underlying N/V. Increase renal excretion of bicarbonate w/ meds like acetazolamide if the patient is not volume compromised or hypokalemic. |
Created by:
bolenrocks
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