ABG Flashcards
pH
7.35-7.45
PaCo2
45-35
HCO3
21-28
Resp Rate
Acidosis: RR and Depth inc
Alkalosis: RR and Depth dec
Compensation
Occurs in the kidneys; takes hours/days
Potassium
Acidosis leads to Hyperkalemia
Alkalosis leads to Hypokalemia
Resp Acidosis
pH: <7.35
PaCo2: >45
Causes: Asthma; Atelectasis; Brain Trauma; Bronchiectasis; Bronchitits; CNS Depressants; Emphysema; Hypoventilation; Pneumonia; Pulmonary Edema; Pumonary Emboli
Interventions: Monitor for resp distress; admin 02; Place in semi-Fowler’s; COPD is risk factor; Monitor Potassium level
Resp Alkalosis
pH: >7.45
PaCo2: <35
Causes: Fever; Hyperventilation; Hypoxia; Hysteria; Overventilation by mechanical vents; Pain
Interventions: Monitor for resp distress; provide emotional support and reassurance; Assist with breathing techniques and breathing aids as prescribed (hold breath, rebreathing mask, CO2 breaths aka breath in a paper bag); monitor vents; monitor K and Ca levels; Ca gluconate for tetany
Met Acidosis
pH: <7.35
HCO3: <21
Inadequate insulin for DM1 => DKA aka Met Acid
Causes: DM or DKA; Excessive ingestion of acetylsalicylic acid (aspirin); High-fat diet; Insufficient met of carbs; Malnutrition; Renal insufficiency or failure; Sever diarrhea
Interventions: Monitor for signs of resp distress, LOC changes, and CNS depression; I/O; fluid/electorlyte replacement; safety and seizure precautions; monitor K closely (as met acid resolves, K levels dec)
DKA Interventions: Give Insulin; monitor circulatory collapse caused by polyuria (extracellular vol deficit may require fluid and electrolyte replacement)
Kidney Disease Interventions: Dialysis to remove protwin and waste products; diet low in protein and high in calories dec the amount of protein waste products (this lessens the acidosis)
Met Alkalosis
pH: >7.45
HCO3: >28
Causes: Diuretics; Excessive vomiting or gastrointestinal suctioning; Hyperaldosteronism; Ingestion and/or infusion of excess sodium bicarbonate; Massive transfusion of whole blood
Interventions: Monitor for signs of resp distress, K, and Ca levels; Safety precautions; Med and IV fluids to promote kidney excretion of bicarb; K replacement; Tx underlying cause
Acidosis S/S
Both- Drowsiness; Disorientation; Dizziness; Headache; Confusion; Coma; Dec bp; Dysrhythmia (r/t hyperkalemia from compensation); Warm, flushed skin (r/t peripheral vasodilation)
Resp Acid- Seizure; Hypoventilation with hypoxia (lungs are unable to compensate when there is a resp problem)
Met Acid- Nausea; Vomiting; Diarrhea; Abdominal Pain; Deep, rapid resp (Compensatory action by the lungs)
Alkalosis S/S
Both- Lethargy; Lightheadedness; Confusion; Drowsiness; Dizziness; Nervousness; Tachycardia; Dysrhythmia (r/t hypokalemia from compensation)
Resp Alk- Nausea; Vomiting; Epigastric Pain; Tetany; Numbness; Tingling of Extremities; Hyperreflexia; Seizure; Hyperventilation (lungs are unable to compensate when there is a resp problem)
Met Alk- Aorexia; Nausea; Vomiting; Tremors; Hypertonic Muscles; Muscle Cramps; Tetany; Tingling of Extremities; Seizure; Hypoventilation (compensatory action by the lungs)
Allen’s Test
- Performed before obtaining an ABG from radial artery
- determines the presence of collateral circulation and adequacy of the Ulnar artery
- Apply pressure over both the radial and ulnar arteries simultaneously
- Have patient open and close hand repeatedly. Hand should blanch
- Release Ulnar artery
- Hand should repink in 6-7 sec
- Document
- If >6-7 sec: Ulnar artery is insufficient. Choose alt site (brachial or femoral artery)
ABG Collection
RN or higher; Heparinized syringe; Provide emotional support during; hold pressure 5 mins post draw (10 mins if on anticoagulants); Record patient temp; record supplemental O2; trans on ice to lab
Respiratory Imbalance
Opposite relationship between pH and PaCO2
(R-Acid: pH Decreased, PaCO2 Increased.
R-Alk: pH Increased, PaCO2 Decreased)
