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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
The respiratory parameter of ABGs
PaCO2
26
Respiratory Acidosis is when
When ventilation is depressed, carbod dioxide is retained, causing hypercapnia (High H2CO3), which lowers pH to below 7.35
27
Respiratory acidosis could cause
restlessness, lethargy, muscle twitching, tremors, convulsions, and coma.
28
Hypercapnia when the lungs work too fast
pneumonia, pulmonary edema, emphysema, bronchitis, COPD, pain
29
Hypercapnia when the lungs work to slow
oversedation (o/d or anesthesia), brainstem trauma, immobility, respiratory muscle paralysis, atelectasis, obesity/kyphosis, pain
30
in chronic conditions like emphysema, the skin color becomes
pink, instead of cyanotic as a result of the vasodilation caused by acidosis
31
s/s of respiratory acidosis
hypoventilation, leading to hypoxia; rapid slow respirations, low BP with vasodilation; dyspnea, HA, Hyperkalemia, leading to dysrhythmia; drowsiness, dizziness, disorientation; muscle weakness, hypereflexia
32
tx of respiratory acidsosis
based on underlying cause; supplemental O2; bronchodilator; ventilation support; pulmonary hygiene; removal of a foreign body; abx
33
Respiratory happens when
deep and rapid respirations (tachypnea) will cause too much of CO2
34
Nursing concern with respiratory alkalosis
Check ABGs, K+, and Ca+ levels; slow down the respirations; keep pt hydrated; a rebreather bag
35
Causes of respiratory alkalosis
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
s/s of respiratory alkalosis
seizures; deep rapid breathing; hyperventilation; tachycardia; decreased or normal BP; hypokalemia; numbness and tingling of extremeties; lethargy; light headedness; n/v; mechanical ventilation
37
tx of respiratory alkalosis
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
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
pH acidic; PaCO2 high acidic; HCO3 WNL. This pt has uncompensated respiratory acidosis.
39
High pH, High HCO3, High Base excess leads to
Metabolic alkalosis
40
Metabolic acidosis is when
when acid accumulates in the body or when bicarbonate is lost from body fluid, a bicarbonate deficit results and metabolic acidosis occurs
41
Causes of metabolic acidosis
DKA, shock, severe diarrhea, impaired kidney function
42
Metabolic acidosis will cause changes in the (x) systems
neurologic, respiratory systems, gastrointestinal, and cardiac systems.
43
Nursing concern with metabolic acidosis
watch the K+; it will go up fast.
44
s/s of metabolic acidosis
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
compensation abg mneumonic
ROME; RO respiratory opposite (ph and PaCO2 inverse relationship); ME metabolic equal (pH and HCO3 direct relationship)
46
hyperkalemia is the most common EKG change with metabolic acidosis. T wave looks like
"tented or pinched" shape to the T waves; this is dangerous; this is called a Peaked T wave
47
if K+ > 8.0 mEq/L, do what collaboration
dialysis via permacath (which is in place for 1 mon).
48
Tx of metabolic acidosis
correct the underlying problem; restore F/E; IV sodium bicarb; dialysis; rehydrate (do I&Os); increase CO (to increase pefusion); insulin
49
metabolic alkalosis is when
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
causes of metabolic alkalosis
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
s/s of metabolic alkalosis
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
EKG changes with metabolic alkalosis
ST depression (NSTEMI) with prominent U wave and prolonged depolariation; prolonged QT wave
53
tx of metabolic alkalosis
KCL, Diamox osmotic diuretic
54
Nursing consideration with metabolic alkalosis
monitor neuro status; observe for seizure; re-orient; I&Os
55
Mixed Acid Base d/o is when
more than one d/o influence ABG values; can have any combination except respiratory alkalosis and respiratory acidosis at the same time.
56
Partial compensation is when you have
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
Complete/fully compensated ABG imbalance is when
abnormalities in both systems occur and your pH is NORMAL. This shows that one system has been able to compensate for the other.
58
Steps to interpreting ABGs
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
PaO2 tells us what
hypoxemia
60
normal PaO2 is
80-100 mmHg
61
PaO2 assess what?
perfusion
62
PaCO2 assess what?
adequacy of ventilation
63
SaO2 measures what
the percentage of O2 bound to Hgb
64
Normal SaO2 is
> 95%; but follow MD orders because it depends on pt condition
65
how do we measure SaO2
noninvasive measurement via pulse oximetry

Med Surg Sem 3 (1 decks)

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