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RRCCPA Clinical Medicine I > Pulmonology Labs/ABGs- Schoenwald final exam > Flashcards

Pulmonology Labs/ABGs- Schoenwald final exam Flashcards

1
Q

What is the main function of arterial blood gases?

A

Maintenance of normal pH required for normal organ function

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2
Q

Arterial blood gases (ABGs) measure arterial pH, pO2, pCO2, bicarbonate and __ saturation

A

O2

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3
Q

Name the primary buffer system of the body

A

Carbonic acid/bicarbonate system

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4
Q

CO2=

A

acid

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5
Q

CO2 concentration is regulated by the ______

A

lungs

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6
Q

Bicarb=

A

base

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7
Q

Bicarbonate concentration is regulated by the _____

A

kidneys

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8
Q

Equation of Life

A

HCO3¯+H+«—-»H2CO3«—-»CO2+H2O

Bicarb + hydrogen–> carbonic acid–>Co2 and water (note arrows can go either direction

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9
Q

Equation of life is controlled by which organs?

A

lungs and kidney

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10
Q

Pathology in the lungs and kidneys is associated with _____ disorders

A

acid/base

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11
Q

Lungs excrete ____

A

CO2

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12
Q

Increased blood CO2 levels=

A

respiratory acidosis

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13
Q

Decreased blood CO2 levels=

A

respiratory alkalosis

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14
Q

Increased blood bicarbonate=

A

metabolic alkalosis

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15
Q

Decreased blood bicarbonate=

A

metabolic acidosis

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16
Q

When should you order ABGs?

A

on critically ill patients

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17
Q

ABGs help monitor _______ patients

A

ventilated

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18
Q

Normal pH range

A

7.36-7.44

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19
Q

A pH above 7.45 is ______

A

alkalotic

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20
Q

normal pCO2 range

A

35-45 mmHg

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21
Q

pCO2 provides info about ___

A

lung function & CO2 excretion

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22
Q

pCO2 represents the ____ part of the equation of life

A

acid. It’s a measurement of ventilation

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23
Q

elevated pCO2 level implies ______ ventilation

A

inadequate

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24
Q

Describe normal blood carriage

A

10% plasma

90% RBCs

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25
Q

Venous blood has higher levels of _____

A

pCO2

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26
Q

Normal pO2 range

A

80-100 mmHg

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27
Q

pO2 provides info on…

A

oxygenation of blood

28
Q

normal pO2 provides _____ _____ delivery to tissues

A

adequate O2

29
Q

What level of pO2 suggests significant reduction in hgb saturation and impaired O2 delivery?

A

levels <60

30
Q

What causes decreased pO2 due to poor O2 gas diffusion?

A

pneumonia, CHF

31
Q

pO2 is low in ______ blood

32
Q

Normal Bicarb range

A

22-26 mEg/L

33
Q

Total ____ value is actually the bicarb measurement

A

CO2 (from electrolyte panel)

34
Q

Some labs report the base deficit which represents the amount of:

A

buffering anions in the blood (HCO3+hgb, phosphate, proteins

35
Q

Negative base excess=

A

metabolic acidosis

36
Q

Positive base excess=

A

metabolic alkalosis or compensation to respiratory acidosis

37
Q

Causes of Respiratory Alkalosis (list 3)

A
  • Hyperventilation
  • Anxiety
  • Overventilation of patients on ventilators
38
Q

Respiratory alkalosis:
pH?
pCO2?

A

pH would be increased (>7.45) and pCO2 would be decreased

39
Q

Causes (or conditions associated with) Respiratory acidosis

A
  • COPD
  • Asthma
  • Drug overdose
  • Pneumonia-due to poor gas exchange
  • Hypoventilation
40
Q

Respiratory Acidosis:
pH?
pCO2?

A 
pH= low, 
pCO2= increased
41
Q

Metabolic alkalosis is caused by a loss of ______

A

gastric acid (i.e. vomiting), or from diuretic usage

42
Q

Metabolic alkalosis

A

pH is elevated, HCO3 is slightly increased

43
Q

Which conditions are associated with metabolic acidosis?

A
  • Diabetics-ketoacidosis
  • Starvation
  • Alcoholics
  • Lactic acidosis
44
Q

Metabolic Acidosis:
pH?
HCO3?

A

pH= low

HCO3=low

45
Q

MUDPILES

A 
M-Methanol
U-Uremia
D-Diabetic Ketoacidosis
P-Propylene glycol
I-INH or Iron
L-Lactic Acid
E-Ethanol
S-Salicylates

–>Anion gap metabolic acidosis (AGMA) is a common scenario in critically ill patients. Common causes are often implied by the acronym, MUDPILES

46
Q 
Electrolyte panel (list the normal ranges):
Na (norm \_\_\_\_\_ meq/l)
K (norm \_\_\_\_\_\_\_ meq/l)
CL (norm \_\_\_\_\_ meq/l)
CO2 (\_\_\_\_\_ meq/l)
A

Na: 135-145
K: 3.5-4.5
CL: 98-106
CO2: 23-30

47
Q

_____ is the main regulator of water and sodium

48
Q

Electrolyte panel can be used to measure the _____

49
Q

Normal anion gap range

A

3-11 mEq/L

50
Q

The anion gap= the difference b/w cations and ____ in the extracellular space

51
Q

Anion gap equation

A

Na- (Cl+CO2)

52
Q

A higher anion gap (above 11) is indicative of..

A

If increased, indicates increase in negatively charged, weak acids
=metabolic acidosis

53
Q

Important for body to remain ______ _______- ie numbers of positive and electric charges should be equal

A

electrically neutral

54
Q

Interpreting ABGs (4 steps)

A
  1. Look at the pH
    is the primary problem acidosis (low) or alkalosis (high)
  2. Check the CO2 (respiratory indicator)
    is it less than 35 (alkalosis) or more than 45 (acidosis)
  3. Check the HCO3 (metabolic indicator)
    is it less than 22 (acidosis) or more than 26 (alkalosis)
  4. Which is primary disorder (Resp. or Metabolic)?
    If the pH is low (acidosis), then look to see if CO2 or HCO3 is acidosis (which ever is acidosis will be primary).
    If the pH is high (alkalosis), then look to see if CO2 or HCO3 is alkalosis (which ever is alkalosis is the primary).

The one that matches the pH (acidosis or alkalosis), is the primary disorder.

55
Q

Normal pH range=
Normal PCO2 range=
Normal HCO3 range=

A

pH –> 7.35-7.45
PCO2–> 35-45
HCO3 –> 22-26

56
Q

pH of 7.9=

57
Q

pH of 7.3=

A

slight acidosis

58
Q

PCO2 of 29=

59
Q

HCO3 of 33=

60
Q

The Respiratory system and Renal systems _______ for each other

A

compensate (attempt to return the pH to normal)

61
Q

ABG’s show that compensation is present when:

A

the pH returns to normal or near normal

62
Q

If the nonprimary system is in the normal range (CO2 35 to 45) (HCO3 22-26), then:

A

that system is not compensating for the primary.

For example:
In respiratory acidosis (pH<7.35, CO2>45), if the HCO3 is >26, then the kidneys are compensating by retaining bicarbonate.
If HCO3 is normal, then not compensating.

63
Q

When obtaining ABGs, -Ensure ______ vs venous collection

64
Q

Common sites to obtain ABGS

A

Brachial and radial arteries

65
Q

What is the Allen test used to evaluate?

A

Used for evaluation of collateral circulation of radial artery

66
Q

Allen test– this is NOT on Schoenwald’s slides! This sums up what the test measures and how it’s performed

A

Allen test:
Instruct the patient to clench his or her fist; if the patient is unable to do this, close the person’s hand tightly.
Using your fingers, apply occlusive pressure to both the ulnar and radial arteries, to obstruct blood flow to the hand.
While applying occlusive pressure to both arteries, have the patient relax his or her hand, and check whether the palm and fingers have blanched. If this is not the case, you have not completely occluded the arteries with your fingers.
Release the occlusive pressure on the ulnar artery only to determine whether the modified Allen test is positive or negative.

Positive modified Allen test – If the hand flushes within 5-15 seconds it indicates that the ulnar artery has good blood flow; this normal flushing of the hand is considered to be a positive test.
Negative modified Allen test: – If the hand does not flush within 5-15 seconds, it indicates that ulnar circulation is inadequate or nonexistent; in this situation, the radial artery supplying arterial blood to that hand should not be punctured.

RRCCPA Clinical Medicine I (49 decks)

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