Mark Klimek NOTES Review ABG INTERPRETATION

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Mark Klimek Review ABG INTERPRETATION The Rule of the Bs ● pH and Bicarb (HCO3) are BOTH in the same direction = MetaBolic ● pH and BICARB (HCO3) in DIFFERENT directions = Respiratory ● pH ... ↑ = Alkalosis (>7.45) ● pH ↓ = Acidosis (<7.35) Normal Values ● pH: 7.35 - 7.45 ● Bicarb (HCO3): 22-26 Signs & Symptoms As the pH goes so goes my patient except for potassium (and MACKussmaul) ● Alkalosis → if the pH goes ↑ the patient’s body goes ↑ = irritable systems; hyper/elevated/tachy o HTN, hyperreflexia, tachypnea, tachycardia, restless, diarrhea, Borborygmi (↑ bowel sounds); HYPOkalemia o Seize and Aspirate  Suction at the bedside ● Acidosis → if the pH goes ↓ the patient’s body goes ↓ = systems shut down o hypoTN, bradycardia ( block), hyporeflexia, lethargy (obtunded), constipation, anorexia, paralytic ileus; HYPERkalemia o Respiratory Arrest  ambu-bag at the bedside o Kussmaul breaths (deep, rapid, labored) ■ Think MacKussmaul  M = metabolic  AC = acidosis ■ only happens with Metabolic Acidosis b/c body trying to get rid of excess CO2 ● Compensatory respiratory mechanism NOT a S/Sx Causes • Lung scenario = Respiratory o Over-ventilating (alkalosis)  ventilating ≠respiratory rate o Under-ventilating (acidosis) o Ventilation = gas exchange (SaO2)  ↑ RR but ↓ SaO2 = under-ventilating  ↓ RR ↑ SaO2 = over-ventilating o Underventilation, overventilation, emphysema, downing, breathing = Respiratory  If a Pt has emphysema - even if they are breathing fast - and Sa02 is 78%, they are in respiratory acidosis (not alkalosis) b/c its all about the ventilation, not the RR • NOT a Lung scenario = Metabolic o Alkalosis = if gastric vomiting or suctioning (b/c losing acid)  GI surgery w/ NG tube with suctioning for 3 days; hyperemesis gravidarum  EXCEPT if pt has prolonged vomiting & NOW dehydrated = metabolic acidosis o Acidosis  hyperemesis gravidarum w/ dehydration, acute renal failure, infantile diarrhea Compensation: pH normal  compensated imbalance VENTILATOR ALARMS (Day 1 Part 1 - 1:10:00) High Pressure Alarms = increased resistance to airflow • Too much pressure in the system (the machine has to push too hard to get air into lungs) o Causes: Obstructions ■ Something is kinked (unkink it) ■ Water condensation in dependent loops (empty it!) Page 1 of 36 When you don’t know what to pick choose: METABLOIC ACIDOSIS1.Physiological 2. Safety 3. Comfort (Pain) 4. Psychological 5. Social 6. Spiritual Mark Klimek Review ■ Pt has mucus that is blocking the airflow (reposition patient, cough, deep breathe, then only suction as last resort! ● Check in that order ■ Nursing Action: Remove kink, empty condensation, get rid of mucus ● If Mucus - Reposition Pt, cough, deep breath 1st - Only suction as last resort! Low Pressure Alarms = not enough pressure in the system • Not delivering the breath we want! o Causes: Disconnections ■ Main tubing disconnected ■ Oxygen sensor tubing disconnected (FiO2 sensor) ■ Nursing Action: Reconnect ● Respiratory Alkalosis = means ventilator settings may be TOO HIGH. (Overventilation) ● Respiratory Acidosis = means ventilator settings may be TOO LOW. (Underventilation) o ex. weaning a PT off ventilator → should not be under-ventilated, they need the ventilator; if they are over-ventilating then they can be weaned ABUSE [Show More]

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