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Complex Care Exam 1 > ABGs > Flashcards

ABGs Flashcards

1
Q

Purpose of ABG Interpretation

A
  • Assessment of oxygenation status of blood
  • Assessment of ventilation/gas exchange
  • Assessment of acid/base balance
  • Evaluation of treatments used to correct acid/base imbalances
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2
Q

Measurement of Oxygenation

A
  • PaO2
  • A measure of the partial pressure (P) of oxygen dissolved in arterial blood plasma
  • Normal Range: 80-100mmHg
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3
Q

Measurement of Ventilation

A
  • pH
  • PaCO2
  • HCO3
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4
Q

pH

A
  • The pH is the hydrogen ion. (H+) concentration of plasma
  • Normal Range: 7.35-7.45
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5
Q

PaCO2

A
  • A measure of the partial pressure of carbon dioxide dissovled in arterial blood plasma
  • LUNGS
  • Normal Range: 35-45mmHg
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6
Q

HCO3

A
  • Bicarbonate (HCO3) is the acid-base component tht reflects kidney function
  • HCO3 lvl is reduced or incrd in the plasma by renal mechanisms
  • KIDNEYS
  • Normal Range: 22-26mEq/L
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7
Q

Acidosis

A

pH < 7.35

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8
Q

Alkalosis

A

pH > 7.45

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9
Q

Respiratory Acidosis

A
  • pH < 7.35
  • PaCO2 incrd, > 45mmHg
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10
Q

Metabolic Acidosis

A
  • pH < 7.35
  • HCO3 dcrd, < 22mEq/L
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11
Q

Respiratory Alkalosis

A
  • pH > 7.45
  • PaCO2 dcrd, < 35mmHg
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12
Q

Metabolic Alkalosis

A
  • pH > 7.45
  • HCO3 incrd, > 26mEq/L
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13
Q

PaO2 - Mild Hypoxemia

A

60-79%

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14
Q

PaO2 - Moderate Hypoxemia

A

40-59%

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15
Q

PaO2 - Severe Hypoxemia

A

<40%

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16
Q

Base Range

A
  • Base excess & base deficit reflect the nonrespiratory contribution to acid-base balance
  • Normal Range: -2mEq/L to +2mEq/L
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17
Q

High Base

A
  • Base excess (> +2mEq/L)
  • Indicates tht there is a higher than normal amnt of HCO3 in the blood, may be due to a primary metabolic alkalosis or a compensated respiratory acidosis
  • The base excess is another surrogate marker of metabolic acidosis or alkalosis
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18
Q

Low Base

A
  • Base deficit (< -2mEq/L)
  • Indicates tht there is a lower than normal amnt of HCO3 in the blood, suggesting either a primary metabolic acidosis or a compensated respiratory alkalosis
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19
Q

Compensatory Responses

A
  • Responses by the lungs (Co2) and kidney (HCO3) to metabolic and respiratory disturbances
    > respiratory compensation is rapid
    > metabolic compensation is slow
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20
Q

Uncompensated

A
  • pH = abnormal
    > less than 7.35 or greater than 7.45
  • PaCO2 &/or HCO3 = abnormal
  • Body does not have enough time to return pH back to normal
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21
Q

Compensated

A
  • pH = “normal”
    > determine which side of 7.40 is closer to
  • PaCO2 & HCO3 = abnormal
  • Body had enough time to restore pH back to normal
22
Q

Partial Compensation

A
  • pH = abnormal
  • PaCO2 = abnormal
  • HCO3 = abnormal
  • Body is attempting to return pH to normal
23
Q

Respiratory Acidosis - Uncompensated

A
  • pH low (acidic)
  • PaCO2 high (acidic)
  • HCO3 normal
24
Q

Respiratory Acidosis - Partially Compensated

A
  • pH low (acidic)
  • PaCO2 incrd (acidic)
  • HCO3 incrd (basic)
25
Q

Respiratory Acidosis - Compensated

A
  • pH normal
  • PaCO2 incrd (acidic)
  • HCO3 incrd (basic)
26
Q

Respiratory Acidosis - Causes

A
  • Airway obstruction
  • CNS depression
    > hypoventilation, opioids
  • Brain stem injury
  • Sleep apnea
  • Neuromuscular impairment
  • Ventilatory restriction
    > asthma, COPD
  • Incrd CO2 production
    > shivering, rigors, seizures, malignant hyperthermia, hypermetabolism, incrd intake of carbs
  • Incorrect ventilator settings
27
Q

Respiratory Acidosis - Treatment

A
  • Treat underlying cause
  • Oxygen
  • Mechanical ventilation
  • Suction
  • Bronchodilators
28
Q

Respiratory Acidosis - Signs & Symptoms

A
  • R/T cause
  • Confusion, lethargy, dyspnea, pale or cyanotic skin, mental cloudiness, restlessness, HTN, weakness, headache, incrd resp effort w/ nasal flaring/yawning, use of neck & upper body muscles
  • Dcrd resp rate/hypoventilation
    > associated w/ dcrd function of resp center as in head trauma, oversedation, general anesthesia, metabolic alkalosis
  • Adventitious breath sounds (crackles, wheezes); stridor, crowing
29
Q

Respiratory Alkalosis - Uncompensated

A
  • pH high (basic)
  • PaCO2 dcrd (basic)
  • HCO3 normal
30
Q

Respiratory Alkalosis - Partially Compensated

A
  • pH low (basic)
  • PaCO2 incrd (basic)
  • HCO3 incrd (acidic)
31
Q

Respiratory Alkalosis - Compensated

A
  • pH normal
  • PaCO2 dcrd (basic)
  • HCO3 dcrd (acidic)
32
Q

Respiratory Alkalosis - Causes

A
  • Hypoxemia or hypoxia
    > lung disease, profound anemia, low FiO2
  • Incorrect ventilator settings
  • CNS stimulation
    > fever, pain, fear, anxiety, CVA, cerebral edema, brain trauma/tumor, CNS infection
  • Pulmonary embolism
33
Q

Respiratory Alkalosis - Treatment

A
  • Treat the underlying cause
  • Mechanical ventilation
  • Buffers
  • Have the pt rebreathe air tht has been exhaled
    > put on a non-rebreather on w/o oxygen
34
Q

Respiratory Alkalosis - Signs & Symptoms

A
  • Deep rapid breathing (40+ bpm)
  • CNS & neuromuscular disturbances: lightheadedness, agitation, circumoral & peripheral paresthesias, carpopedal spasms, twitching & muscle weakness, N/V, muscle twitching
35
Q

Metabolic Acidosis - Uncompensated

A
  • pH low (acidic)
  • PaCO2 normal
  • HCO3 dcrd (acidic)
36
Q

Metabolic Acidosis - Partially Compensated

A
  • pH low (acidic)
  • PaCO2 dcrd (basic)
  • HCO3 dcrd (acidic)
37
Q

Metabolic Acidosis - Compensated

A
  • pH normal
  • PaCO2 dcrd (basic)
  • HCO3 dcrd (basic)
38
Q

Metabolic Acidosis - Causes

A
  • Hypoxia
  • Lactic acidosis
  • Ketoacidosis
  • Renal failure
    > uremic acidosis
  • GI loss of HCO3
    > diarrhea
  • Renal loss of HCO3
    > renal tubular acidosis, diamox
  • Poison
    > salucylate intoxication, methanol, ethylene glycol
  • Overconsumption of alcohol
  • Rhabdomyolysis
39
Q

Metabolic Acidosis - Treatment

A
  • Treat the underlying cause
  • Buffers
40
Q

Metabolic Acidosis - Signs & Symptoms

A
  • Headache
  • Drowsiness & confusion
  • Weakness
  • Incrd resp rate & depth
  • N/V
  • Diminished cardiac output w/ pH < 7
    > results in hypotension, cold clammy skin, & cardiac arrhythmias
41
Q

Metabolic Alkalosis - Uncompensated

A
  • pH high (basic)
  • PaCO2 normal
  • HCO3 incrd (basic)
42
Q

Metabolic Alkalosis - Partially Compensated

A
  • pH high (basic)
  • PaCO2 high (acidic)
  • HCO3 high (basic)
43
Q

Metabolic Alkalosis - Compensated

A
  • pH normal
  • PaCO2 high (acidic)
  • HCO3 high (basic)
44
Q

Metabolic Alkalosis - Causes: GI Loss of H+

A
  • Nasogastric suctioning
  • Gastric lavage
  • Prolonged vomiting
45
Q

Metabolic Alkalosis - Causes: Renal Loss of H+

A
  • Loop & thiazide diuretics
  • Edematous states
    > heart failure, cirrhosis, nephrotic syndrome
  • Hyperaldosteronism
  • Hypercortisolism
  • Excess ACTH
  • Exogenous steroids
  • Hyperreninemia
  • Severe hypokalemia
  • Renal artery stenosis
  • Bicarbonate administration
  • Hypokalemia
46
Q

Metabolic Alkalosis - Causes: Retention/Addition of Bicarbonate

A

Excessive quantities of antacids

47
Q

Metabolic Alkalosis - Treatment

A
  • Treat underlying cause
  • KCL
  • Volume
  • Arginine monohydrochloride
  • HCL
48
Q

Metabolic Acidosis Examples

A
  • DKA
  • Renal failure
49
Q

Metabolic Alkalosis Examples

A
  • Chronic indigestion & use antacids daily
    > antacids are alkalotic
  • Long term nasogastric suctioning
50
Q

Narcotic Overdose

A

Respiratory acidosis
narcotics depress resp system

51
Q

Anxiety Attack

A

Respiratory alkalosis
hyperventilation = breathing off too much CO2

Complex Care Exam 1 (6 decks)

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