RPT 223 Module 1

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what is the best indicator of tissue oxygenation?

PvO2

what are clinical signs of inadequate cardiac output?

fatigue, hypotension, metabolic acidosis, bradycardia, and pulmonary edema

pH: 7.40 PaCO2: 62 PaO2: 89 HCO3: 38 FiO2: .58

fully compensated respiratory acidosis with corrected hypoxemia

respiratory alkalosis

high pH, low CO2

what are some causes of hypoxemia?

hypoventilation (drug overdose), v/q mismatch (COPD), pulmonary shunting (ARDS), diffusion defect (pulmonary fibrosis), and low PiO2 (altitude sickness)

what would cause tissue hypoxia w/normal arterial oxygentation?

inadequate cardiac output

what is the direct effect of an increase PaCO2 on HCO-3?

increase

an decrease of pH on the oxyhemoglobin dissociation curve will shift in what direction?

left

respiratory acidosis

low pH, high CO2

a mixed metabolic acidosis and respiratory alkaosis are likely when the pH and HCO-3 are low and the PaO2 is

lower than the predicted

associated w/ABG sampling, air in the sample will have what effect?

lowers Pco2 and high Po2, raises pH and low Po2

associated w/ABG sampling, excess liquid heparin will have what effect?

lowers Pco2 and high Po2, raises pH and low Po2

an 80 yo pt has a PaO2 of 71mmHg. how would you describe this finding?

mild hypoxemia

given the following ABG results, interpret the acid base status: pH 7.42, PaCO2 56mmHg, HCO-3 35mmol/L

mixed metabolic alkalosis and respiratory acidosis

given the following ABG results, interpret the PaO2 status: pH 7.21, PaO2 53mmHg, PaCO2 67mmHg, HCO-3 26mmol/L, BE +2mmol/L.

moderate hypoxemia

thermal injury from TC monitors can be avoided by?

monitoring sensor temperature and rotating the site

pH: 7.42 PaCO2: 37 PaO2: 92 HCO3: 23 FiO2: .21

normal ABG & normal oxygenation

a 17 yow is brought into ED vitals are: pulse 100bpm, RR 4 bpm, and BP 100/65. the pt was at a party where he was discovered by his friends to be slumped in a chair and unresponsive. ABG results show: pH 7.24, PaCO2 68mmHg, HCO-3 28mmol/L, BE +1mmol/L. the pts acid base status is classified as what?

uncompensated respiratory acidosis

postanalytic error

problem occurring after sample analysis that can alter the accuracy of blood gas results

Preanalytic error

problem occurring before sample analysis that can alter the accuracy of blood gas results

a pt. breathing 40% O2 has a markedly higher than normal P(A-a)O2, which doesnt improve when the O2 concentration is increased to 50%. what is the most likely cause of her hypoxemia?

pulmonary shunting

What is the preferred site for an ABG method?

radial

associated w/ABG sampling, venous blood or venous samplying will have what effect?

raises Pco2 , lowers pH and can greatly lower Po2

associated w/ABG sampling, metabolic effects will have what effect?

raises Pco2, lowers pH and Po2

given the following ABG results, interpret the acid base status: pH 7.21, PaO2 53mmHg, PaCO2 67mmHg, HCO-3 26mmol/L, BE +2mmol/L.

uncompensated respiratory acidosis

pH: 7.25 PaCO2: 57 PaO2: 74 HCO3: 24 FiO2: .32

respiratory acidosis with uncorrected mild hypoxemia

the Pco2 is measured by what electrode in blood gas analyzer?

severinghaus

what infection control precaution would you apply when obtaining ABG?

standard precautions plus face shield

For respiratory acidosis to be paritally compensated what has to occur?

the HCO3 would be high and the pH would be close to normal or normal

For respiratory acidosis to be fully compensated what has to occur?

the HCO3 would be high and the pH would not be normal

For respiratory alkalosis to be paritally compensated what has to occur?

the HCO3 would be low and the pH would be close to normal

For respiratory alkalosis to be fully compensated what has to occur?

the HCO3 would be low and the pH would be normal

For metabolic acidosis to be paritally compensated what has to occur?

the PaCO2 would be low and the pH would be close to normal

For metabolic acidosis to be fully compensated what has to occur?

the PaCO2 would be low and the pH would be normal

For metabolic alkalosis to be paritally compensated what has to occur?

the PaCO2 would rise and the pH close to normal

For metabolic alkalosis to be fully compensated what has to occur?

the PaCO2 would rise and the pH would be normal

continuous noninvasive assessment of pt. oxygenation can be provided by?

trancutaneous Po2 and pulse oximetry

True or False: the pH electrode uses a separate reference electrode

true

True or False: when you have a mixed acid base balance you would not see a compensation.

true

a pt has the following ABG results: pH 7.33, PaCO2 35mmHg, HCO-3 18mmol/L, BE -7mmol/L. bases on these findings the pt has what?

uncompensated metabolic acidosis

pH: 7.48 PaCO2: 30 PaO2: 88 HCO3: 23 FiO2: .21

uncompensated resp. alkalosis with correct hypoxemia

pH: 7.51 PaCO2: 40 PaO2: 78 HCO3: 31 FiO2: .35

uncompensated resp. alkalosis with uncorrected mild hypoxemia

a pulmonary shunt value of what indicates a potentially life threatening clinical situation?

35%

PaCO2

35-45 mmHg

moderate hypoxemia

40-59

mild hypoxemia

60-79

pH

7.35-7.45

PaO2

80-100 mmHg

normal rang of anion gap

9-14 mEq/L

metHb

<1.5%

metabolic acidosis

<22 mEq/L

CoHb

<3%

serve hypoxemia

<40

what are common causes of metabolic acidosis?

Diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, hyperalimentation, ingestion of acids, loss of base, and pancreatic fistula

anion gap

Difference between the concentrations of serum cations and anions, used to help differentiate among causes of metabolic acidosis

BE

(+)(-) 2mmol/L

metabolic alkalosis

>26 mEq/L

SaO2

>95%

to evaluate a pts acid base status, you would recommend what?

ABG

Mixed acidosis

Low pH High PaCO2 Low HCO3-

anemia

total Hb content is low

under ideal conditions of temperature, pressure and relative humidity analyzers are within what percentage?

1%

for the test of collateral circulation in an Allen's test, "pinking up" of the hand is normal if it occurs within?

10 to 15 seconds

Hb

12-18 g/dL

CaO2

16-20 ml/dl

HCO-2

22-26 mmol/L

an arterial pressure site normally should be compressed for a minimum of what after puncture?

3 to 5 minutes

what is the normal value of an anatomic shunt of the lung?

3%

what is the best indicator of metabolic acid base status?

BE

to measure actual blood O2 saturation, you would recommend?

CO- oximetry

what is the best used to assess arterial oxygenation?

CaO2

what parameters is the respiratory component of acid base status?

PaCO2

hypocapnia

PaCO2 below 35mmHg, occurs when alveolar ventilation exceeds CO2 production (hyperventilation)

hypercapnia

PaCo2 above 45mmHg, occurs when the level of alveolar ventilation is nor sufficient to remove CO2 production (hypoventilation)

the blood gas results from a pt. breathing a confirmed O2 concentration of 30% indicate a PaO2 of 250mmHg, based on this datum, it can be concluded that the

PaO2 is in error and should be remeasured

During metabloic acidosis if the PaCo is not low then there is what defect as well?

Respiratory

Calibration

exposing a measurement device to two or more know levels of measurements to confirm proper zeroing, gain, and linerarity

hyperoxemia

abnormally high PaO2 value

right decrease in HbO2 of the oxyhemoglobin dissociation curve causes?

acidosis, hypercapnia, and fever

iatrogenic alkalosis

alkalosis caused by medical intervention; most often a respiratory alkalosis caused by overly aggressive mechanical ventilation

Left increase in HbO2 of the oxyhemoglobin dissociation curve causes?

alkalosis, hypocapnia, and hypothermia

before an ABG sample is obtained the clotting parameters should be evaluated because?

bleeding time may be prolonged if they are abnormal

Before an ABG is obtained, the patient's clotting parameters should be evaluated because:

bleeding time maybe prolonged if they are abnormal

What is the primary method of transporting O2 in the blood?

bound to Hb

given the following ABG results, interpret the acid base status: pH 7.14, PaCO2 55mmHg, HCO-3 18.

combined respiratory and metabolic acidosis

given the following ABG result interpret the acid base status: pH 7.45, PaCO2 25mmHg, HCO-3 17mmol/L, BE -6mmol/L.

compensated respiratory alkalosis

a shift to the right in the oxyhemoglobin dissociation cureve has what effect on the affinity of Hb for O2?

decrease

hypoxia

decrease in tissue oxygenation

Abnormal Hb

dyschemoglobin

Analytic errors

error occurring the analysis or measurement phase of laboratory test

What are some indications for an ABG sampling?

evaluate ventilation, acid base, assess the pts. response to therapy, monitor the severity and progression of a disease

what is often the first clinical sign that suggest the presence of hypoxemia?

exertional dyspnea

the negative log of the hydrogen ion concentration is defined as

pH

Henderson-Hasselbalch equation

pH = 6.1 + log [HCO3-]/(.03*Pco2)

mixed alkalosis

pH high PaCO2 low HCO3 high

alkalemia or alkalosis

pH higher than 7.45

acidemia or acidosis

pH lower than 7.35

pH: 7.12 PaCO2: 60 PaO2: 48 HCO3: 29 FiO2: .4

partially compensated resp. acidosis with uncorrected moderate hypoxemia

pH: 7.51 PaCO2: 27 PaO2: 116 HCO3: 21 FiO2: .50

partially compensated respiratory alkalosis with over-corrected hypoxemia

pH: 7.46 PaCO2: 49 PaO2: 47 HCO3: 34 FiO2: .25

partially uncompensated metablic alkalosis with uncorrected moderate hypoxemia

a 35 yo 54 kg woman w CHF enters ER w/SOB. An ABG sample shows: pH 7.51, PaCO2 30mmHg, HCO-3 23mmol/L, Be +1mmol/L. these results indicated what?

uncompensated respiratory alkalosis

what is the most common physiologic cause of hypoxemia in pts w/ lung disease?

v/q mismatch

hyperventilation

ventilation greater than necessary to meet metabolic needs, <35mmHg (respiratory alkalemia)

hypoventilation

ventilation less than necessary to meet metabolic needs, >45mmHg (respiratory acidemia)

dead space ventilation

ventilation that doesnt participate in gas exchange


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