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Med Surg Sem 3 > ABGs Exam > Flashcards

ABGs Exam Flashcards

1
Q

Excess CO2 retention leads to

A

Respiratory acidosis

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2
Q

Excess CO2 excretion leads to

A

Respiratory alkalosis

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3
Q

HCO3 loss with acid retention leads to

A

Metabolic acidosis

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4
Q

HCO3 retention with acid loss leads to

A

Metabolic alkalosis

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5
Q

(x) reflects the adequacy of the lung ventilation and CO2 elimination

A

PaCO2

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6
Q

(x) reflects the body’s ability to pick up O2 from the lungs

A

PaO2

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7
Q

(x) reflects the metabolic parameter, reflects the kidney’s ability to retain and excrete HCO3

A

bicarbonate metabolic parameter

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8
Q

The key regulating pH is

A

H+ concentration

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9
Q

in alkalosis, pH is (x) and H+ is (x)

A

pH is high, H+ is low

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10
Q

in acidosis, pH is (x) and H+ is (x)

A

pH is low, H+ is high

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11
Q

acid-base relationship is (x)

A

Inverse

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12
Q

Normal pH range

A

7.35-7.45

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13
Q

pH < 7.2 leads to

A

acidosis

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14
Q

pH < 7.0 leads to

A

death

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15
Q

how does the body regulate pH

A

through compensatory mechanisms: buffers, respiratory and renal system

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16
Q

1 compensatory mechanism is

A

the buffers

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17
Q

at 24hrs, (x) compensatory mechanism kick in

A

the respiratory system

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18
Q

The final defense compensatory mechanism is

A

the renal system; it’s the most dependable regulator of pH

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19
Q

7 components of ABGs

A

pH, PaCO2, PaO2, SaO2, HCO3, Base Excess, anion gap

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20
Q

How are ABG imbalances dx?

A

7 components of ABGs, CBC, renal funciton, UA, Drug screening, CXR, Pulmonary function, electrolytes (K+, Na+)

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21
Q

The common causes of high anion gap

A

DKA, Shock, renal failure, severe dehydration, severe malnutrition, alcoholism, salicylates (ASA), rhabdomyolysis (e.g. statins)

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22
Q

The common causes of a low anion gap

A

Hyperkalemia, hypermagnesium, lithium intoxication, hyercalcemia

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23
Q

What values do I need to know for the test?

A

pH 7.35-7.45; PaCO2 35-45 mEq/L; HCO3 22-26 mEq/L; PaO2 80-100 mEq/L; Base excess +/- 2 mEq/L; Anion gap 8-14 mEq/L

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24
Q

The metabolic parameter of ABGs

A

HCO3

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25
Q

The respiratory parameter of ABGs

A

PaCO2

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26
Q

Respiratory Acidosis is when

A

When ventilation is depressed, carbod dioxide is retained, causing hypercapnia (High H2CO3), which lowers pH to below 7.35

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27
Q

Respiratory acidosis could cause

A

restlessness, lethargy, muscle twitching, tremors, convulsions, and coma.

28
Q

Hypercapnia when the lungs work too fast

A

pneumonia, pulmonary edema, emphysema, bronchitis, COPD, pain

29
Q

Hypercapnia when the lungs work to slow

A

oversedation (o/d or anesthesia), brainstem trauma, immobility, respiratory muscle paralysis, atelectasis, obesity/kyphosis, pain

30
Q

in chronic conditions like emphysema, the skin color becomes

A

pink, instead of cyanotic as a result of the vasodilation caused by acidosis

31
Q

s/s of respiratory acidosis

A

hypoventilation, leading to hypoxia; rapid slow respirations, low BP with vasodilation; dyspnea, HA, Hyperkalemia, leading to dysrhythmia; drowsiness, dizziness, disorientation; muscle weakness, hypereflexia

32
Q

tx of respiratory acidsosis

A

based on underlying cause; supplemental O2; bronchodilator; ventilation support; pulmonary hygiene; removal of a foreign body; abx

33
Q

Respiratory happens when

A

deep and rapid respirations (tachypnea) will cause too much of CO2

34
Q

Nursing concern with respiratory alkalosis

A

Check ABGs, K+, and Ca+ levels; slow down the respirations; keep pt hydrated; a rebreather bag

35
Q

Causes of respiratory alkalosis

A

hyperventilation with EXTREME anxiety/fear (this is most common); pulmonary dz (pu edema); ventilator settings too high or too fast; high altitudes; salicylate intoxication; hypoxia; hypermetabolic states; fear; CNS causes (e.g. hemorrhage or stroke); fever; sepsis; brain injury/tumor

36
Q

s/s of respiratory alkalosis

A

seizures; deep rapid breathing; hyperventilation; tachycardia; decreased or normal BP; hypokalemia; numbness and tingling of extremeties; lethargy; light headedness; n/v; mechanical ventilation

37
Q

tx of respiratory alkalosis

A

focuses on measures to increase PaCO2; correcting the underlying d/o; breathing into a paperbag or cupped hands; pain management; fever reduction; O2 administration; monitor VS and ABGs; ***this is RARELy life threatening

38
Q

Pt dx status asthmaticus p/w RR 22, BP 140/90, P 110, T 98.4; ABG pH 7.26, PaCO2 80 mmHg, HCO3 24 mEq/L

A

pH acidic; PaCO2 high acidic; HCO3 WNL. This pt has uncompensated respiratory acidosis.

39
Q

High pH, High HCO3, High Base excess leads to

A

Metabolic alkalosis

40
Q

Metabolic acidosis is when

A

when acid accumulates in the body or when bicarbonate is lost from body fluid, a bicarbonate deficit results and metabolic acidosis occurs

41
Q

Causes of metabolic acidosis

A

DKA, shock, severe diarrhea, impaired kidney function

42
Q

Metabolic acidosis will cause changes in the (x) systems

A

neurologic, respiratory systems, gastrointestinal, and cardiac systems.

43
Q

Nursing concern with metabolic acidosis

A

watch the K+; it will go up fast.

44
Q

s/s of metabolic acidosis

A

HA, lethargy, anorexia, deep rapid inspirations (kussmaul: compensatory hyperventilation), nausea, diarrhea, abd discomfort in severe acidosis; coma and dangerous ; dysrhythmias; decreased BP, hyperkalemia, muscle twitching; warm flushed skin d/t vasodilation; n/v/d; changes in LOC/confusion/drowsiness; prolonged lack of O2; ETOH; drug or chemical poisoning (e.g. Drano); liver failure; severe dehydration; RENAL DZ IS THE MOST COMMON CAUSE OF CHRONIC METABOLIC ACIDOSIS

45
Q

compensation abg mneumonic

A

ROME; RO respiratory opposite (ph and PaCO2 inverse relationship); ME metabolic equal (pH and HCO3 direct relationship)

46
Q

hyperkalemia is the most common EKG change with metabolic acidosis. T wave looks like

A

“tented or pinched” shape to the T waves; this is dangerous; this is called a Peaked T wave

47
Q

if K+ > 8.0 mEq/L, do what collaboration

A

dialysis via permacath (which is in place for 1 mon).

48
Q

Tx of metabolic acidosis

A

correct the underlying problem; restore F/E; IV sodium bicarb; dialysis; rehydrate (do I&Os); increase CO (to increase pefusion); insulin

49
Q

metabolic alkalosis is when

A

the kidney cannot control a high pH; there’s too much base and there’s a lost in H+ concentration; the lungs will compensate

50
Q

causes of metabolic alkalosis

A

steroids; excessive NGT suctioning THIS IS THE MOST COMMON CAUSE; prolonged/severe vomiting; HZTZ and other diuretic; TPN infusion; citrates from blood tranfusion; O/d of bicarbonate with CPR; low H+, Ca++, and K+; excessive NaHCO3; hypovolemia

51
Q

s/s of metabolic alkalosis

A

dysrhythmia d/t low K+; physical weakness; muscle cramping; hyperactive reflexes; tetany; convulsions; confusion; restlessness followed by lethargy; tachycardia; compensatory hypoventilation; confusion (low LOC, dizzy, irritable); n/v/d; tremors, muscle cramps, tingling of fingers and toes; hypokalemia (increase with ACE inhibitors, Spirolactone; bactrim abx?); severe dyhydration; endocrine d/o (e.g. thyrotoxicosis); drug use; cushing’s dz; multiple transfusions (careful with renal/old pts); GI surgery

52
Q

EKG changes with metabolic alkalosis

A

ST depression (NSTEMI) with prominent U wave and prolonged depolariation; prolonged QT wave

53
Q

tx of metabolic alkalosis

A

KCL, Diamox osmotic diuretic

54
Q

Nursing consideration with metabolic alkalosis

A

monitor neuro status; observe for seizure; re-orient; I&Os

55
Q

Mixed Acid Base d/o is when

A

more than one d/o influence ABG values; can have any combination except respiratory alkalosis and respiratory acidosis at the same time.

56
Q

Partial compensation is when you have

A

abnormalities in both systems and your pH is abnormal; this shows that one system has tried to compensate for the other but is not yet successful.

57
Q

Complete/fully compensated ABG imbalance is when

A

abnormalities in both systems occur and your pH is NORMAL. This shows that one system has been able to compensate for the other.

58
Q

Steps to interpreting ABGs

A

look at pH (normal is 7.35-7.45; perfect is 7.4 {deviation is movement towards acidosis or alkalosis); if pH is < 7.35 it’s acidosis; if pH is > 7.45 it’s alkalosis; look for compensation by looking at abn components and normal pH; If pH normal it’s compensated; if pH abnormal it’s uncompensated; if PaCO2 abn it’s a respiratory ABG abnormality; if HCO3 is abnormal it’s a metabolic ABG abnormality;

59
Q

PaO2 tells us what

A

hypoxemia

60
Q

normal PaO2 is

A

80-100 mmHg

61
Q

PaO2 assess what?

A

perfusion

62
Q

PaCO2 assess what?

A

adequacy of ventilation

63
Q

SaO2 measures what

A

the percentage of O2 bound to Hgb

64
Q

Normal SaO2 is

A

> 95%; but follow MD orders because it depends on pt condition

65
Q

how do we measure SaO2

A

noninvasive measurement via pulse oximetry

Med Surg Sem 3 (1 decks)

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