ABG Interpretation
Which system compensates for respiratory acidosis/alkalosis, and how quickly does it occur?
The renal system will compensate, but it takes 2-3 days for a full effect to occur. The kidneys conserve or release bicarbonate while also retaining or eliminating hydrogen ions.
A 75-year-old COPD patient is sitting upright, using accessory muscles, and has an SpO₂ of 88%. What is your first action?
Apply oxygen and encourage pursed-lip breathing.
Identify what part of the EKG strip is highlighted.
P wave, which denotes atrial depolarization.
What should be your nursing action if the patient’s oxygen saturation drops below 88%?
Assess the patient and raise the HOB. If the saturation remains low, apply oxygen per provider orders.
Next steps may include coaching breaths, or putting the patient in tripod positioning to ease their work of breathing.
What is the primary use of a corticosteroid in a patient with a COPD exacerbation?
Decreasing inflammation in the lungs and airway, which allows air to flow through for gas exchange.
What is a bicarbonate level that would indicate respiratory alkalosis?
Over 26 mEq/L.
A post-op abdominal surgery patient refuses to cough because of pain. What interventions should the nurse use to prevent pneumonia?
Have them splint the incision with a pillow to reduce pain, administer pain medications, and encourage coughing/deep breathing.
Identify the heart rate of this 6 second strip.
80 BPM
What oxygen delivery device can supply a patient with oxygen, but is not helpful if a patient is a mouth breather?
How many liters of oxygen can this supply the patient?
Nasal cannula
Flow rate of 1-6 L of oxygen
What type of medicated inhaler is used for quick relief in an asthma attack?
Short-Acting Beta Agonist
Give an example of one!
Your patient is exhibiting signs of respiratory acidosis. What are two ways that you would expect them to compensate? Choose one lab value and one physical manifestation.
Bicarbonate would be above 26 mEq/L for renal compensation.
Tachypnea/hyperventilation to breath off excess CO2.
You have a patient who comes to the ER with decreased breath sounds bilaterally, cyanosis to the fingers and toes, and an AP:T diameter of over 1:3. He is sitting in a tripod position. What would you expect his diagnosis to be based on the manifestations?
COPD
Anterior-Posterior to Transverse diameter, or a barrel chest, is a telltale sign of COPD, especially when combined with the cyanosis and patient positioning.
What is occurring at the QRS complex?
Ventricular depolarization & Atrial repolarization.
What is the name for a group of nursing interventions that are often paired with antibiotics in pneumonia patients to aid in clearing secretions?
Pulmonary toilet.
It includes incentive spirometry, coughing and deep breathing.
Why should a nurse encourage a patient to rinse their mouth after the use of an inhaled steroid?
To prevent the risk of developing oral thrush.
Mary Barker, 34, comes to the ED with acute shortness of breath and chest pain. She smokes one pack of cigarettes a day and recently started taking birth control pills. Her blood pressure is 140/80 mmHg, her pulse is 110 beats/minute, and her respiratory rate is 44 breaths/minute. Her ABG values are as follows:
pH: 7.50
PaCO2: 29
This patient has uncompensated respiratory alkalosis.
A patient with COPD and a pulse ox. reading of 86% is placed on 6L of oxygen by nasal cannula. Instead of the O2 sat improving, the patient becomes confused, disoriented, and and incredibly short of breath. What is happening and why?
Administering oxygen at such a high flow rate has essentially killed this patient's hypoxic drive, which would typically stimulate ventilation. As a result, more CO2 is being trapped in the lungs, and the body isn't sending the proper signal to breath it out quickly enough, resulting in hypoventilation.
Identify what the name of this rhythm is.
Atrial Fibrillation - You can tell because the rhythm is irregular, and there are no distinguishable P waves present for every QRS.
What techniques does chest physiotherapy use?
It uses percussion of different areas around the chest to drain specific portions of secretions, as well as vibration and postural drainage positioning.
A patient with COPD is experiencing difficulty breathing due to excessive secretions and airway inflammation. What combination of medications would you expect to be ordered to treat these simultaneously?
Bronchodilators (like a SABA) to open up the airway and reduce inflammation, and mucolytics to thin out secretions and make them easier to cough out.
J.S is brought to the ED for an overdose of a tricyclic antidepressant. He’s unconscious and has a respiratory rate of 5 to 8 breaths/minute. His ABG values are as follows:
pH of 7.25
PaCO2 of 61 mmHg
HCO3 of 26 mEq/L
What is the patient experiencing based on their ABG and symptoms? What is the compensation?
This patient is experiencing respiratory acidosis, but without any compensation, indicated by the bicarbonate still being in a normal range and the pH being acidotic.
A patient with COPD has an O2 saturation of 92%. What would you as a nurse do after seeing this reading?
No interventions are needed, continue to monitor!
What is happening in this picture?
The patient is likely moving in some way.
What is the rationale behind placing a patient with respiratory distress in semi/high fowler's position?
This position allows for more effective and comfortable expansion of the chest and lungs, promoting easier breathing.
You see that a provider has ordered Labetalol for a patient who uses Albuterol to control their asthma. Why might you question this order?
Labetalol is a beta blocker, which can block the effects of Albuterol (a beta agonist), leading to uncontrolled asthma and potentially worsened bronchospasms.