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
...
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]
.png)
.png)
