ABGs
what does a respiratory center depressant cause?
respiratory acidosis
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects:
respiratory alkalosis
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?
respiratory alkalosis
HCO3 normal
22-26
O2 saturation normal
above 94%
The nurse knows which is the normal serum value for potassium?
3.5-5.0 mEq/L (3.5-5.0 mmol/L).
metabolic acidosis
-base bicarbonate deficit- low pH bicarb <22 *DUE to renal failure -common causes: DKA, severe diarrhea, renal failure, shock, salicylate OD S/S: HA, confusion, drowsy, increased RR/depth, low BP, low cardiac output, dysrhythmias, pt may be asymptomatic until bicarb is under 15, kussmaul RR (compensatory hyperventilation), N/V/D, muscle twitching, vasodilation (warm, flushed skin). HYPERkalemia goal: correct underlying problem (renal usually) and correct imbalance (bicarb may be administered) *serum calcium levels may be low with chronic - must be corrected before treating acidosis (if not -> tetany (inv. muscle contractions)) tx: dialysis anion gap: difference between sum
metabolic alkalosis
-base bicarbonate excess- high pH high bicarb >26 *due to vomiting or gastric suction (long term diuretic use) -common causes: pyloric stenosis, excessive use of antacids, bicarb during CPR S/S: HYPOkalemia, S/S related to decreased calcium, respiratory depression, tachycardia goal: correct underlying condition, supply chloride to allow excretion of excess bicarb, restore fluid volume with sodium chloride solutions restlessness followed by lethargy, tachycardia, compensatory hypoventilation, confusion, N/V/D, tremors, tingling of fingers/toes, muscle cramps
respiratory acidosis
-carbonic acid excess- low pH PaCO2 >45 *always due to respiratory problem with inadequate exertion of CO2 ~common causes: acute pulmonary edema/aspiration, atelectasis, pneumothorax, sedative OD/ sleep apnea with morbid obesity/ acute respiratory distress syndrome/ diseases that impair respiratory muscles (MD, MS, myasthenia gravis, Guillian-Barre)/ improper mechinical ventilator settings body may compensate and pt may be asymptomatic (sudden increased pulse, RR, BP/mental changes/feeling of fullness in head) potential increased ICP goal: improving ventilation (vent, cpap, bipap, incentive spirometry, semi fowlers) hyperventilation, rapid/shallow respirations/low BP with vasodilation/dyspnea/HA/ HYPERkalemia/ dysrhythmias (increased K+)/ drowsy, dizzy, disoriented/ muscle weakness, hyperreflexia retention of CO2 by lungs
what is the most common buffer system in the body?
1. bicarbonate carbonic acid (then lungs, kidneys)
PaCO2 normal
45-35
pH normal
7.35-7.45
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be
7.50
PaO2 normal
80-100 (arterial)
HYPOkalemia
Alkalosis Shallow respirations irritability confusion/drowsy weakness/fatigue arrhythmias (irr. rate/tachy) lethargy thready pulse decreased intestinal mobility N/V ileus
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
Arterial blood gas (ABG) analysis
The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
Bicarbonate
what does potassium supplements cause?
GI distress (diarrhea/ulcers)
pH is an indicator of..
H+ ions in blood (high H+ = acid, low = alkaline)
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increases arterial pH
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Instruct the client to breathe into a paper bag.
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?
Metabolic acidosis
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
Prepare to assist with ventilation.
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH?
The lungs are not able to blow off carbon dioxide.
The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
bicarb
homeostasis
body strives to keep pH within normal range
When a client's ventilation is impaired, the body retains which substance?
carbon dioxide
pH 6.8 or 7.8 =
death
where do they get ABG blood?
from the wrist (arterial blood)
acidosis
hyperkalemia
alkalosis
hypokalemia
A client with a history of anxiety experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should:
instruct the client to breathe into a paper bag.
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.48
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
metabolic alkalosis
what does diuretics cause?
metabolic alkalosis
what does steroids cause?
metabolic alkalosis
what does calcium carbonate medications cause (tums)?
metabolic alkalosis (N/V)
HYPERkalemia
muscle twitches, cramps, paresthesia irritability, anxiety low BP EKG changes (peaked T, wide QRS, flat P, prolonged P-R, depressed ST) dysrhythmias, irregular rhythym abd. cramping diarrhea
what does NSAIDs cause?
nephrotoxicity
what does antibiotics, such as vancomycin, cause?
nephrotoxicity
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH, 7.25; PaCO2 50 mm Hg
Which electrolyte is a major cation in body fluid?
potassium
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
respiratory acidosis