abg's
steps to interpret abg's
- 1st- ph - 2nd- eval paco2 and hco3 in rel to ph - if paco2 is <40 the primary prob is resp alkalosis > hyperventilation - if bicarb/hco3 is >24 primary prob is met alk> body has too much bicarb - if paco2 is >40 primary prob is resp acid- pt hypocenter - if hco3 is <24 is met alk- bicarb level drops - compensation??
resp acidosis tx
- aimed at improving ventilation - uc > would bronchodilators, antibiotics, hydration, pulm hygiene, anticoag's, mech vent help??
mech to keep ph w/in range
- buffer sys keep ph w/in range > kid regulate bicarb in ecf (slow processes) > lungs- regulate co2, carbonic acid in ecf
treatment of met alk
- correct uc - restore fluid vol w/ nacl solutions - cl allows excretions of excess bicarb - monitor I/o
resp alk
- high ph > 7.45 - paco2 <35 - ALWAYS DUE to hyperventilation - cl man- lightheadedness, inability to concentrate, numbness/tingling (hypocalcemia) - t/x- correct cause of hyperventilation (blows off co2)
metabolic alkalosis
- high ph >7.45 - high bicarb > 26 - mostly due to vomiting/ gastric SUCTION (loss of acid), long term diuretic use - hypokalemia can prod alkalosis - clinical man- symp (dizziness), r/t dec ca/hypokalemia, resp dep (co2 retains), tachycardia - kid conserve k so h excretion is inc or k out of cells into extracellular fluid
electorlyte issues w/ met acidosis
- hyperkalemia- k shifts out of cells - hypokalemia- k shifts back into cells as acidosis is corrected - hypocalcemia- chronic met acidosis > must be corrected before treating > acidosis inhibits ca reabs in kid> inc ca loss in urine
metabolic acidosis
- low ph <7.35 - low bicarb < 22 - body prod too much acid or kid can't remove it (due to renal failure) -cl man- h/a, confusion, drowsiness, inc resp rate (hypervent dec co2), dec bp/cardio output, shock - t/x- correct uc> administer bicarb
resp acidosis
- low ph <7.35 - paco2- >42 - always due to resp prob w/ inadeq excretion of co2 - clinical man- inc pulse/resp rate, confusion, dec loc
chronic resp acidosis
- paco2 chronically inc - body can compensate and be asymptomatic - if greater than 50, resp center becomes insensitive to co2 as resp stim - leads to- hypoxemia is primary drive for resp and dev co2 narcosis - oxy is only admin w/ extreme caution
how do you know if compensation has occurred?
- ph is corrected
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
B is right> inc ph, dec h ion > Excessive bicarb drugs, loss of h >>> suctioning
A client recovering from an acute asthma attack 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: insert a nasogastric tube (NG) as ordered. administer acetaminophen (Tylenol) as ordered. instruct the client to breathe into a paper bag. administer antibiotics as ordered.
C > asthma attack w/ resp alk to inc co2 and ease anxiety Ng tube is for met acidosis or toxic sub's Fever may cause met but not resp alk > Tylenol
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 rise in pH? The lungs are unable to breathe in sufficient oxygen. The lungs are unable to exchange oxygen and carbon dioxide. The lungs have ineffective cilia from years of smoking. The lungs are not able to blow off carbon dioxide.
D is right ans- resp acidosis and will have inc h ions - Copd can breathe in oxy
A nurse reviews the arterial blood gases and noted a pH of 7.50, a PC02 of 30 mm Hg, and a HC03 of 25 mEq/L. These values indicate? A. Metabolic acidosis, uncompensated B. Respiratory acidosis, uncompensated C. Respiratory alkalosis, uncompensated D. Metabolic acidosis, partially compensated
c -Resp alk ph and pco2, uncomp ph is out of range 7/35-7/45 and co2 is outside of range
norm bg's
ph- 7.35-7.45 paco2- 35-45 mm Hg po2- >80mmHg hco3- 22-26 base excess/def +/-2 mEq/L oxy sat >94%