Wk 2 ABGs

Question 1

Why do we use ABGs?

Answer 1

Gives us the best representation of the pH and CO2

Question 2

What is the purpose of ABGs?

Answer 2

to ASSESS acid/base status and to determine adequacy of oxygenation and ventilation

Question 3

Normal PaCO2 range

Answer 3

35-45 mmHg

Question 4

pH is essentially the balance of…

Answer 4

hydrogen ions

Question 5

PaCO2 is a __ parameter

Answer 5

respiratory (H20 + CO2 = carbonic acid)

Question 6

HCO3 is a __ parameter

Answer 6

metabolic

Question 7

Normal HCO3 range on ABG

Answer 7

22-26 mEq/L

Question 8

HCO3- is a __ value on the ABG

Answer 8

calculated

Question 9

What is HCO3- reported as on the venous chemistry panel?

Answer 9

CO2

Question 10

What is a primary event for acid/base balance?

Answer 10

The problem that initiates the acid/base balance

Question 11

4 examples of primary even for acid/base balance

Answer 11

Hyperventilation
Hypoventilation
Vomiting
Diarrhea

Question 12

What is the primary disorder?

Answer 12

The result of the primary event

Question 13

Two examples of a primary disorder?

Answer 13

Respiratory acidosis

Metabolic alkalosis

Question 14

If there is a problem with the kidneys, the lungs will compensate. What is the problem with this?

Answer 14

The lungs cannot compensate for a long period of time like the kidneys can

Question 15

What would we do for a patient with renal failure?

Answer 15

Dialysis and/or bicarb

Question 16

Metabolic imbalances are related to…

Answer 16

Bicarbonate (HCO3-)

Kidneys

Question 17

Respiratory imbalances are related to…

Answer 17

H2CO3 (carbonic acid)

Question 18

Increase or decrease in CO2, changes in ventilation

Answer 18

respiratory alkalosis or acidosis

Question 19

Changes in [H+] or bicarbonate ions

Answer 19

metabolic alkalosis or acidosis

Question 20

Acid base pneumonic ROME

Answer 20

R- Respiratory
O- Opposite
M- Metabolic
E- Equal

Question 21

If pH is up and PCO2 is down then it is…

Answer 21

respiratory alkalosis

Question 22

If pH is down and PCO2 is up then it is…

Answer 22

respiratory acidosis

Question 23

If pH is up and HCO3 is up then it is…

Answer 23

metabolic alkalosis

Question 24

If pH is down and HCO3 is down then it is…

Answer 24

metabolic acidosis

Question 25

What is HCO3?

Answer 25

bicarbonate

Question 26

What is metabolic alkalosis?

Answer 26

Too much bicarbonate or not enough carbonic acid

Question 27

What are the ABGs of someone with metabolic alkalosis?

Answer 27

pH: >7.48 PaCO2: 35-45 (lungs not compensating yet) HCO3: >26

Question 28

What are dietary causes metabolic alkalosis

Answer 28

Taking in excess baking soda or alia-seltzer (too much base)

Question 29

What happens if you take in too much base?

Answer 29

Hydrogen shift outside the cell causing potassium to go into cell (hypokalemia)

Question 30

3 other causes of metabolic alkalosis?

Answer 30

``` Prolonged vomiting (losing HCl from stomach) NG tube (pulling out HCl from stomach) Diuretics (loop) ```

Question 31

What are neurologic symptoms of metabolic alkalosis?

Answer 31

CNS over-excitability, muscle tremors, cramps, confusion, parathesias, coma,

Question 32

What are two other symptoms of metabolic alkalosis?

Answer 32

Respiratory depression N/V/D Hypokalemia

Question 33

In respiratory alkalosis, there is a __ __ deficit

Answer 33

carbonic acid (H2CO3)

Question 34

What are the ABG levels of someone with respiratory alkalosis?

Answer 34

pH >7.45 PaCO2 <35 HCO3 22-26 (kidneys not begun to compensate yet)

Question 35

What causes respiratory alkalosis?

Answer 35

Anything that can cause an increase in breathing

Question 36

What are the symptoms of respiratory alkalosis?

Answer 36

CNS over-excitability | Tachypnea, confusion, light headedness, parathesia, hyperactive reflexes, coma, hypotension

Question 37

What causes respiratory acidosis?

Answer 37

Excess carbonic acid, hypoventilation

Question 38

Acute versus chronic respiratory acidosis

Answer 38

respiratory arrest versus COPD

Question 39

ABGs of someone with respiratory acidosis

Answer 39

pH <7.35 PaCO2 >45 HCO3 22-26 (kidneys react slow with acute)

Question 40

In a patient with COPD and respiratory acidosis, their pH will...

Answer 40

Return to normal once the kidneys have had time to compensate. HCO3 will be high.

Question 41

What are the symptoms of respiratory acidosis?

Answer 41

CNS depression including hypoventilation Headache, restlessness, confusion tachycardia, LOC, coma

Question 42

3 causes of respiratory acidosis

Answer 42

``` Cardiopulmonary arrest Head injury Narcotics Anesthesia Pulmonary disorders Uncontrolled pain (hurts to breath) Abdominal distention Airway obstruction Chest wall deformities ```

Question 43

What is metabolic acidosis?

Answer 43

Excess acids or loss of bicarb (base)

Question 44

ABGs of metabolic acidosis

Answer 44

pH <7.35 PaCO2 35-45 HCO3 <22

Question 45

Common causes of metabolic acidosis

Answer 45

``` Renal disease fistulas diabetes lactic acidosis prolonged diarrhea starvation shock cardiac arrest ```

Question 46

What type of diabetes is associated with metabolic acidosis?

Answer 46

Type 1 - DKA

Question 47

How does prolonged diarrhea cause metabolic acidosis?

Answer 47

Relative increased acid due to loss of HCO3

Question 48

How does starvation cause metabolic acidosis?

Answer 48

Using fat for energy causing ketosis

Question 49

Metabolic acidosis causes an increase in what type of acid and why?

Answer 49

Lactic acid due to lack of oxygen to the tissues

Question 50

What are the s/s of metabolic acidosis?

Answer 50

CNS over-excitability Confusion, lethargy, tremors, parathesias hypotension, hyperkalemia Kussmal respirations