NSG 107 -3b Review for ABGS

NSG 107 -3b Review for ABGS

NSG 107 -3b Review for ABGS

Review for ABGS

The two broad types of acid–base imbalance are acidosis and alkalosis. When the serum pH level falls below 7.35, the patient has acidosis; when the serum pH level climbs above 7.45 the patient has alkalosis.

Normal Ph 7.35-7.45

pH levels are inversely proportionate to hydrogen ion concentration

When hydrogen concentration increases, pH decreases (acidosis) <7.35

When hydrogen concentration decreases, pH increases (alkalosis) <7.45

There are three major buffer systems that are responsible for regulating blood pH: …

Kidneys responsible for …

Lungs start the process while kidneys turn on; then kidneys take over

Bicarbonate (HCO3) …

Lungs=In acidosis, the pH decreases; compensation occurs by increasing respiratory rate and depth to exhale acids. In alkalosis, the pH increases; compensation occurs by decreasing the respiratory rate and depth to retain acids

Bicarb= in acidosis, Kidneys attempt to compensate by retaining bicarbonate and excreting excess hydrogen ions in urine; in alkalosis Kidneys attempt to compensate by excreting excess bicarbonate in urine and Retain H+

The femoral, brachial, and radial arteries are most often used to obtain the ABG sample. Allen’s test is done to test the adequacy of the ulnar circulation before drawing an ABG. This is necessary to ensure that the client has adequate circulation to the hand in case the radial artery becomes occluded. Failure to assess collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture.

Respiratory acidosis when…

Lungs not able to get rid of excess carbon dioxide, respirations become more depressed and shallow as muscle weakness worsens. mental status is altered, progressing from confusion and lethargy to stupor and coma if not treated.

Treatment focuses on improving ventilation and lowering PaCO2; …

Antibiotics (to treat infection), diuretics (to reduce excess fluid affecting the heart and lungs), corticosteroids (to reduce inflammation), mechanical ventilation (in severe cases).

Symptoms: headache, anxiety, blurred vision, restlessness, confusion, drowsiness, dizziness, fatigue, lethargy, delirium or confusion, shortness of breath, coma, muscle paralysis; otherwise rate is rapid/shallow, increased respiratory effort with nasal flaring/yawning, use of neck and upper body muscles, Adventitious breath sounds (crackles, wheezes); stridor, crowing

…

Causes: …

Interventions- …

Metabolic Acidosis- …

Causes= …

S/S: Look for signs and symptoms of hyperkalemia, including abdominal cramping, diarrhea, muscle weakness, and ECG changes, hypotension, progressive CNS depression, including lethargy, dull headache, confusion, stupor, and coma; Kussmaul’s respirations w/ a fruity breath odor, warm, dry skin, flaccid paralysis, tingling and numbness in the extremities, bradycardia, arrhythmias, diminished muscle tone and deep tendon reflexes, anorexia, nausea, and vomiting, a tall T wave, a prolonged PR interval, and a wide QRS complex.

Lactic acidosis can cause or worsen metabolic acidosis and can occur secondary to shock, heart failure, pulmonary disease, hepatic disorders, seizures, or strenuous exercise. Hyperpnea and Kussmaul’s respirations attempt to compensate as lungs try to exhale excess CO_2.

Treatment: …

With diabetes mellitus and diabetic ketoacidosis: …

Interventions in renal failure – …

Metabolic Alkalosis- …

Causes- …

S/S The signs and symptoms of metabolic alkalosis are commonly associated with an underlying condition. Characteristic hypokalemic or hypocalcemic ECG changes may occur, as well as signs of hypotension. Cyanosis, paresthesia, weakness, seizures, coma, slow, shallow respirations as hypoventilation, neuromuscular excitability, which causes muscle twitching, weakness, and tetany. The patient develops hyperactive reflexes. He may also experience numbness and tingling of the fingers, toes, and mouth area. Neurologic symptoms include apathy and confusion. Seizures, stupor, and coma may result if severe, if hypokalemia affects the GI tract, the patient is likely to experience anorexia, nausea, and vomiting. If it affects the genitourinary (GU) tract— that is, if the kidneys are affected— polyuria may result and even death if untreated.

Treatment- …

EXTRA TIPS

Watch Nurse Karma

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Use ROME handouts and TIC TAC METHOD

https://nurseslabs.com/8-step-guide-abg-analysis-tic-tac-toe-method/

Finding compensated, partially compensated, or uncompensated ABG problems:

• When PaCO₂ is high, but pH is normal instead of being acidic, and if HCO₃ levels are also increased, then it means that the compensatory mechanism has retained more HCO₃ to maintain the pH.
• When PaCO₂ and HCO₃ values are high but pH is acidic, then it indicates partial compensation. It means that the compensatory mechanism tried but failed to bring the pH to normal.
• If pH is abnormal and if the value of either PaCO₂ or HCO₃ is abnormal, it indicates that the system is uncompensated. This is probably because of either respiratory or metabolic acidosis.