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Test 4 > ABG's > Flashcards

ABG's Flashcards

1
Q

Why are ABGs important?

A

ABGs help maintain the balance between acids and bases in the body to achieve homeostasis.

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2
Q

ABG’s provide insights into the blood’s makeup ____ it is distributed to tissues.

A

BEFORE

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3
Q

Normal pH

A

7.35 - 7.45
(slightly alkaline)

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4
Q

Normal PaCO2

A

35 - 45 mm Hg

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5
Q

Normal HCO3 (bicarbonate)

A

22 - 26 mEq/L

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6
Q

Normal PaO2 (partial pressure of oxygen)

A

80 - 100 mmHg

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7
Q

Normal SaO2
(% value)

A

96 - 100%
(arterial oxygen saturation)

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8
Q

HCO3 is a component of what system?

A

Metabolic

  • Acts as a buffer to neutralize excess acids, helping to regulate the pH of blood.
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9
Q

PaCO2 is a component of what system?

A

RESPIRATORY

  • indicator of how the respiratory system regulates the removal of carbon dioxide from the blood.
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10
Q

PaO2 is found in what type of blood

A

ARTERIAL blood

  • reflects the oxygen content in arterial blood, indicating how efficiently oxygen is being transported from the lungs to the bloodstream for tissue perfusion.
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11
Q

SaO2 is found in what type of blood

A

Arterial (dont mix with SpO2)

  • reflects how effectively oxygen is being transported in the blood. Important that organs receive sufficient O2.
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12
Q

Types of solutions that help maintain a stable pH in the body.

A

Buffers

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13
Q

3 examples of Buffers

A
  • bicarbonate
  • proteins
  • hemoglobin
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14
Q

System that ELIMINATES CO2 from body

A

Respiratory System

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15
Q

Increased respirations leads to

A
  • CO2 elimination from body
  • ↓ CO2 in blood

(respiratory alkalosis)

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16
Q

Decreased respirations leads to

A
  • retained CO2
  • ↑ CO2 in blood(respiratory acidosis)
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17
Q

System that excretes or retains bicarbonate (HCO3), hydrogen ions (H+), and electrolytes

A

Renal System

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18
Q

System that responds within minutes to hours.

A

Respiratory system

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19
Q

System that responds within hours to days

A

Renal System

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20
Q

What is the preferred site for obtaining an ABG sample.

A

radial or femoral artery.

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21
Q

What test will need to be performed if using the Radial artery to obtain an ABG sample?

A

Allen’s Test
* ensure adequate blood flow from both ulnar and radial artery to hand & body.

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22
Q

Steps for Allen’s Test:

A
  • Elevate hand, make a fist for 20 seconds.
  • Compress firmly on radial and ulnar arteries.
  • Pt opens hand, hand should blanche (turn white)
  • Examiner releases ONLY ulnar artery to ensure blood flow (hand turns pink again)
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23
Q

What materials and conditions are necessary for obtaining arterial blood samples?

A
  • A heparinized syringe
  • place syringe in ice
  • prompt delivery to the lab.
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24
Q

Blood sample should include what 5 pieces of information?

A
  • time drawn
  • FiO2
  • O2 delivery rate & method
    -ventilator settings
  • patient temperature
  • pulse O2 saturation
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25
Q

Method used to INTERPRET ABG’s

A

first, middle, and last name

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26
Q

First name is

A
  • Whether systemic compensation has maintained a normal pH
  • Compensate or Uncompensated?
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27
Q

Middle name is

A
  • System causing the disturbance
  • Respiratory or Metabolic?
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28
Q

Last name is

A
  • Type of disturbance
  • Acidosis or Alkalosis?
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29
Q

Interpretating ABG’s:

1st step is

A

Check for Hypoxemia - low O2 in BLOOD

  • Normal PaO2 (O2 in BLOOD) = 80-100 mmHG
30
Q

Hypoxemia is considered when PaO2 is

A

less than 80 mmHg

31
Q

Highest priority with Hypoxemia

A

Establish airway and oxygenate!!

your ABC’s- KNOW

32
Q

Interpretating ABG’s:

2nd step is to

A

Analyze pH
* Any disturbances?

33
Q

Analyzing pH will give you

A

FIRST & LAST names

34
Q

pH < 7.35

A

acidosis

35
Q

pH > 7.45

A

alkalosis

36
Q

if pH is NORMAL we call it

A

COMPENSATED
pH: 7.35-7.45

37
Q

if pH is ABNORMAL we call it

A

Uncompensated

38
Q

pH number that is considered “in the middle”

A

pH = 7.40

39
Q

pH < 7.35 =

pH > 7.45 =

A

Acidosis

Alkalosis

40
Q

3rd step is to find out Middle name by determining if

A

The PaCO2 levels are causing the problem?

or

The HCO3 levels are causing the problem?

41
Q

Middle name:

If PaCO2 < 35 we say

A

Respiratory alkalosis.

42
Q

Middle name:

If PaCO2 >45 we say

A

Respiratory acidosis.

43
Q

Middle name*:

If HCO3 < 22 we call it

A

Metabolic acidosis

44
Q

Middle name:

If HCO3 >26 we call it

A

Metabolic alkalosis

45
Q

4th Step is to determine

A

ROME
(Respiratory Opposite, Metabolic Equal)

46
Q

ROME:

If pH and PaCO2 go opposite ways we call it

A

Respiratory problem

  • Respiratory acidosis: ↓ pH, ↑ PaCO2.
  • Respiratory alkalosis: ↑ pH, ↓ PaCO2.
47
Q

ROME:

If pH and HCO3 go the same way

A

Metabolic problem

  • Metabolic acidosis: ↓ pH, ↓ HCO3.
  • Metabolic alkalosis: ↑ pH, ↑ HCO3.
48
Q

Step 5 we check compensation:

In Acidosis, the kidneys increase

A

HCO3 to compensate.

49
Q

Respiratory Acidosis can occur due to:

List 6 causes

A
  • Hypoventilation
  • COPD
  • over-sedation: depress CNS leading to slow breathing
  • drug overdose
  • neuromuscular diseases (resp. muscle weakness)
  • head trauma.
50
Q

Respiratory Acidosis:

pH and PaCO2 results

A
  • pH < 7.35
  • PaCO2 > 45 (retaining CO2)
51
Q

Step 5 we check compensation:

In Alkalosis, the respiratory system retains

A

CO2 to compensate.

52
Q

Respiratory Acidosis is ALWAYS due to

A

respiratory problems unable to remove CO2

53
Q

How does the body compenssate in RESPIRATORY ACIDOSIS

A

Kidneys conserve HCO3- in the blood stream (does not excrete into urine) and excrete H+ into urine.
(H+ are acidic)

54
Q

S/S of Respiratory Acidosis

A

SUDDEN Increase of:

  • ↑ pulse
  • ↑ respiratory rate
  • ↑BP: speeds up CO2 circulation to lungs for removal
  • Mental changes: feeling of fullness in the head
55
Q

Interventions for Respiratory Acidosis

A
  • Treat the underlying cause of acidosis
  • Improve ventilation, maintain patent airway, give O2
56
Q

What causes Respiratory Alkalosis?

A

Hyperventilation from:

  • anxiety
  • pain
  • septicemia: serious bloodstream infection
  • PE: blocks O2 to be received in lungs
  • CNS lesions: affects respiratory center+
  • severe anemia: less hgb to carry O2 to body
57
Q

How does the body compensate during Respiratory Alkalosis

A

Rarely occurs because WE treat the underlying cause (hypoxemia) early and aggressively that the body doesnt have time to compensate.
* we treat hypoxemia bc pt starts to breath faster (getting rid of CO2 fast) leading to respiratory alkalosis

58
Q

S/S of Respiratory Alkalosis

A
  • Lightheadedness: low CO2 reduces blood flow to head
  • inability to concentrate: low CO2 affects brain function
  • numbness/tingling: more alkaline = affects Calcium levels & nervous system
  • sometimes loss of consciousness
59
Q

Interventions for Respiratory Alkalosis

A
  • Slow down RR
  • breathe into a paper bag- (rebreath the CO2 inside bag)
  • reassess ventilator settings
  • Treat the underlying cause.
60
Q

pH and PaCO2 results in Respiratory Alkalosis

A

pH > 7.45

PaCO2 < 35.

61
Q

What causes Metabolic Acidosis

A

Kidney injury due to:

  • Diabetic ketoacidosis- most common
  • renal failure
  • severe diarrhea
  • Anaerobic metabolism (shock)
  • severe dehydration
  • starvation
  • Salicylate ingestions-aspirin overdose
  • severe diarrhea

Remember: Vomit acid but poop base- if we poop all our base, then we become ACIDIC.

62
Q

How does the body compensate in Metabolic Acidosis

A
  • Lungs increase CO2 excretion
  • Kussmaul respirations: hyperventilation- deep and rapid to exhale CO2
    -every-time we exhale, we get rid of CO2
63
Q

S/S of Metabolic Acidosis

A
  • Headache: ’A for Acid Affects the Brain’
  • confusion
  • drowsiness
  • ↑ RR and ↑ depth
  • ↓BP: acidic blood affects heart function
  • dysrhythmias
64
Q

pH and HCO3 results in Metabolic Acidosis

A
  • pH < 7.35
  • HCO3 < 22
65
Q

What causes Metabolic Alkalosis

A
  • Prolonged vomiting
  • GI suctioning- *too high or not intermittent
  • long-term diuretic therapy (hypokalemia)
  • hypochloremia

-vomit acid, poop base

66
Q

Interventions for Metabolic Acidosis

A
  • Hydration
  • antidiarrheal
  • bicarbonate administration if needed.
  • treat underlying cause (e.g., insulin for diabetic ketoacidosis, why are they hyperventilating in the 1st place?),
67
Q

pH and HCO3 for Metabolic Alkalosis

A
  • pH > 7.45
  • HCO3 > 26
68
Q

How does the body compensate for Metabolic Alkalosis

A
  • Decreased respiratory rate to retain plasma CO2.
69
Q

S/S of Metabolic Alkalosis

A
  • Respiratory depression
  • tachycardia
  • hypokalemia
  • hypocalcemia
70
Q

Interventions for Metabolic Alkalosis

A
  • Fluid and electrolyte replacement
  • antiemetics
  • modify gastric suctioning

Test 4 (8 decks)

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