ABGs / Problems With Oxygenation Flashcards by Katy Peterson

Normal pH

7.35-7.45

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What is compensation?

Body’s means of returning pH to normal (buffering)

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3 systems that compensation is regulated by, and how quickly do these occur?

Chemical: immediate
Respiratory: within minutes to hours
Kidney: hours to days

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When monitoring ABGs, what is being assessed?

Tissue oxygenation
Alveolar ventilation
Acid-base balance

Goal of analysis = treat primary problem

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Normal PaCO2

34-45 mm Hg

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What is it called if PaCO2 < 35

Respiratory alkalosis

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What is it called if PaCO2 > 45

Respiratory acidosis

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What does the bicarbonate determine?

Metabolic problem

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Normal HCO3

22-26 mEq/L

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What does it mean if HCO3 is < 22?

Metabolic acidosis

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what does it mean if HCO3 is > 26?

Metabolic alkalosis

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What does ROME stand for?

Respiratory
Opposite
Metabolic
Equal

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What is respiratory acidosis caused by?

Hypoventilation (opioids)
Respiratory failure
COPD

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How is respiratory acidosis compensated for?

Kidneys conserve HCO3- and secrete H+ into urine

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What is respiratory alkalosis caused by?

Hypoxemia from acute pulmonary disorders
Hyperventilation (can be from pain, anxiety, DKA, head injury

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How is respiratory alkalosis compensated for?

Expect kidneys to compensate, but compensation is rare

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What is metabolic acidosis caused by?

Excess acid from:
Ketoacidosis (DKA)
Lactic acid accumulation (shock, seizures, Metformin, aspirin)

Bicarbonate deficit from:
Severe diarrhea (loss from lower GI)
Kidney disease (end stage ~uremia)

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How is metabolic acidosis compensated for?

Increased CO2 secretion by lungs (Kussmaul respirations)
Kidneys excrete acid

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What is metabolic alkalosis caused by?

Bicarbonate excess caused by:
Ingestion of antacids
Pancreatic secretion of HCO3-

Loss of acids from:
Prolonged vomiting or gastric suction (loss from upper GI)

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How is metabolic alkalosis compensated for?

Renal excretion of HCO3-
Decreased respiratory rate to increase plasma CO2 (limited help)

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If someone is about to have their ABCs taken, what precautions do you need to take?

No changes to O2 therapy 15 minutes before
So if someone has order to change O2 flow rate,
1 - change O2
2 - wait 15 min before getting ABG

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What does a CT of the chest look at?

Scans lungs in layers

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Nursing considerations when a pt has a CT or chest ordered

Look to see if it’s ordered with or without contrast dye (sometimes both)
If with dye, check to see if pt is allergic to contrast/iodine/shellfish
Teach pt they will feel warm and flushed with injection
Encourage hydration before and after to flush out contrast
After CT: monitor renal function

Nursing considerations for a pt having an MRI

Screen for metal (including implantable devices, surgical hardware)
Remove all metal (jewelry, hearing aids)
Address claustrophobia (sedation may be necessary)

What does a V/Q scan consist of?

Ventilation - inhale moisture of O2 with radioisotopes Perfusion - IV injection of radioisotope

Why is a V/Q scan performed?

Usually to check for pulmonary embolism

Nursing considerations for V/Q scans

Pt must be able to follow commands, be able to lie still Pt must have IV access No prep, takes about an hour

What does an SpO2 monitor check for?

Oxygenation

Normal oxygen

94-99%

Oxygenation that needs prompt treatment

Below 91%

oxygenation that is life threatening

Below 70%

What should be done if SpO2 shows a questionable reading

Repeat

What is SaO2?

Same as SpO2, measured by ABGs

What does Capnography monitor?

Ventilation (Detects resp depression before SpO2)

What is a normal Capnography range?

35-45 mm Hg

Why would someone have a high EtCO2?

(High Capnography reading) Partially obstructed airway Hypoventilation

What do pulmonary function tests measure?

Lung volumes and airflow

What is a thoracentesis?

Aspiration of pleural fluid (Needle into chest wall to obtain specimens, remove pleural fluid, or instill medication)

What needs to be done after every thoracentesis?

Chest Xray

Nursing actions after a thoracentesis

Encourage deep breaths Auscultate breath sounds Ensure CXR obtained Dressing to site

Possible complications after a thoracentesis

Hypoxia Infection Pneumothorax (Possible chest tube)

What is a bronchoscopy?

Direct visualization of bronchi through scope via nose or mouth

Nursing management for a bronchoscopy

NPO 6-12 hours before (sedation) NPO until gag reflex returns after (recovery from sedation) Monitor for complications: - hemorrhage - pneumothorax - infection

How is a transbronchial biopsy done?

Can be performed during bronchoscopy

How is a transthoracic biopsy done?

Percutaneously (requires CXR post procedure to assess for pneumothorax)

How is a VATS biopsy done?

(Video-assisted thoracoscopic surgery) Scope with camera inserted through a trocar (Chest tube needed post procedure)

How is an open biopsy done?

Surgical procedure (Chest tube needed after)

How would you know if your pt had a pneumothorax?

Pain on affected side (at end of inspiration and expiration) Decreased lung sounds on affected side Trachea shift to unaffected side Dyspnea Fast RR, HR New cough Cyanosis

Treatment for a pneumothorax

O2 Raise HOB Call HCP

Why would a pt have a chest tube?

Pneumothorax (air) Hemothorax (blood) Pleural effusion (fluid)

Where are chest tubes placed?

Into the pleural space, not the lung To remove air: upper chest, near apex To remove blood/drainage: further down chest

Nursing actions for pt with a chest tube

*#1 = good resp assessment / changes (check chest tube connection) Assess CT insertion site dressing and monitor Monitor drainage Monitor bubbling in chamber Check suction - matches order Maintain drainage system lower than chest Mark drainage level at end of shift

What does a gram stain culture test for?

Gram positive/negative bacteria

What does an acid-fast bacillus test for?

Indicated possible TB

What does a culture & sensitivity (C&S) test for?

Allows growth and isolation of microorganisms Determines appropriate medication

What does cytology test for?

ID abnormal cells (to look for malignancies)