#1
what are ABG normal ranges?
ph 7.35-7.45
co2 35- 45
po2 80-100
hco3 22-26
what is hypoxemia and what is hypoxia?
hypoxemia: low o2 in the blood
hypoxia: poorly oxygenated tissues and organs
what is SpO2?
measure of the amount of oxygen-carrying hemoglobin in the blood compared to the amount not carrying oxygen, expressed as a percentage.
ABGs:
Interpret this ABG and what intervention
compensate metabolic acidosis, none it is compensated
A patient in diabetic ketoacidosis is breathing rapidly and deeply. This breathing pattern is compensatory.
Kussmaul Respirations
A patient with ARDS is placed in this position to improve oxygenation.
prone
This device delivers the highest oxygen concentration without intubation.
Non rebreather
BIpap, HFNC
The hallmark assessment finding in ARDS is worsening oxygenation despite this intervention.
supplemental O2 therapy
A patient states they have had severe diarrhea for a week. What does the nurse expect their ABG to reflect? what about their BMP?
metabolic acidosis, low electrolytes and bicarbonate
The patient is hypoventilating after receiving IV opioids. What does the RN expect to see on their ABG and what should the RN do next?
Respiratory acidosis, call the provider, narcan or bipap to assist with respiratory rate and CO2
A patient's ABG results are:
ph 7.31
PaCO2 52
PaO2 58
HCo3 25
The chest X ray shows Bilateral Pulmonary Infiltrates
Identify the acid base balance AND the respiratory condition
Respiratory Acidosis
and
ARDS
A patient’s ABG results are:
interoperate the ABG
Normal ABG
A COPD patient arrives sleepy and difficult to arouse. ABGs:
What should the RN anticipate and how would the RN interpret the ABG?
partially compensated respiratory acidosis, bipap to help release CO2, if mentation continues to decline, intubation
A patient with a panic attack is breathing 36 times/minute. ABGs show low PaCO₂. What should the nurse expect the ABG to show.
The patient is breathing fast and releasing the CO2
A severe asthma patient suddenly becomes quiet with diminished breath sounds and worsening ABGs. What should the nurse anticipate?
Intubation. diminished breath sounds will eventually become absent. the airway should be secured if breathing treatments are unsuccessful and patient is in status asthmaticus
A ventilated patient’s oxygen saturation remains low. The nurse anticipates increasing this ventilator setting to improve oxygenation.
PEEP
A patient has had prolonged vomiting for 3 days following abdominal surgery.
ABGs:
A patient with chronic kidney disease reports weakness and fatigue.
ABGs:
Describe how to interpret an ABG:
1. Look at pH first.
2. Determine respiratory or metabolic cause.
3. Assess compensation.
4. Evaluate oxygenation.
A patient abruptly stops taking prednisone after several months of therapy.
Two days later:
1. What complication is occurring?
2. Why is this happening?
3. What medication does the nurse anticipate?
Adrenal crisis
The adrenal glands are suppressed and cannot produce cortisol
IV hydrocortisone
A patient presents with:
Moon face
Buffalo hump
Purple abdominal striae
What endocrine disorder is suspected?
Cushing’s syndrome
Cortisol
Hyperglycemia
1. What electrolyte imbalance occurs in Addison’s disease?
2. What electrolyte imbalance occurs in Cushing’s syndrome?
Answer: Hypokalemia
3. What hormone is excessive in Cushing’s syndrome?
4. What hormone deficiency occurs in Addison’s disease?
5. What is the priority treatment for adrenal crisis?
1. Answer: Hyperkalemia (defiant aldosterone production)
2. Answer: Hypokalemia (excessive cortisol acting as a mineralocorticoid, which leads to renal potassium wasting)
3. Answer: Cortisol
4. Answer: Cortisol and aldosterone
5. Answer: IV corticosteroids and fluids
A patient with septic shock becomes increasingly tachypneic.
ABGs:
Metabolic acidosis
Yes, respiratory compensation is occurring
Lactic acidosis from poor tissue perfusion
A patient with Addison’s disease develops influenza.
Assessment:
Stress increases cortisol demands
Stress-dose steroid education
Increased corticosteroid dosage
A patient with Cushing’s syndrome has delayed wound healing after surgery.
Excess cortisol suppresses immune response
Assess for infection
Sepsis or poor wound healing