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BLOOD GAS INTERPRETATION

I always use the ROME mnemonic:


Respiratory opposite (pH and CO2 go opposite directions in resp disorders)
Metabolic equal (pH and HCO3 go same direction in metabolic disorders)

Respiratory disorder if pH is up and PCO2 is down or if pH down and PCO2 is up


Metabolic disorder if pH and HCO3 are both up or if pH and HCO3 are both down
Compensating if PCO2 and HCO3 both up or if pH and HCO3 both are down
Mixed if PCO2 up and HCO3 down or if PCO2 down and HCO3 is up
http://web.indstate.edu/mary/abgdemo.html
http://realnurseed.com/abg.htm
http://www.stableprogram.org/components.html

the left side is the metabolic range. the right side


is the respiratory range. the middle is the ph value. by taking a ruler and lining up
the numbers, you can tell immediately what you have.
step one, you look at ph. if it's in normal range, whatever is going on has been
corrected. anything outside that range is uncompensated.

step two, line up the ruler on the correct metabolic and respiratory values (with the
middle on the ph number). now this might sound incredibly basic but it had never
clicked with me before that if one side is up, the other side will be down. like a
teeter-totter. maybe it was just because i had never visualized the process. but once
i saw it, i understood it in a way i hadn't been able to before.

Why do we look at Base Excess (BE)?


o Base excess is the amount of base needed to return the pH to a
normal value
o Normal range = (-)2 (+)2, with zero (0) being the middle
ground
o Used mostly to distinguish metabolic alkalosis from acidosis
o Too much base excess (over +2) may indicate loss of gastric
fluids as in vomiting, whereas a base deficit of -5 or lower may
indicate a lactic acid problem or diabetic ketoacidosis
o Used mostly to test for consistency in diagnosing metabolic
problems

Arterial Blood Gas Review


Courtesy of The Respiratory Care Services of
St. Charles Hospital Oregon, Ohio 43616

(1)

(2)

(3)

pH 7.34

pH 7.34

pH 7.59

pCO2 33.9

pCO2 40.3

pCO2 49.0

HCO3 18.2

HCO3 21.4

HCO3 48.2

B.E. -6.2

B.E. -3.6

B.E. +21.6

pO2 85.2

pO2 41.0

pO2 58.7

(4)

(5)

(6)

pH 7.17

pH 7.07

pH 7.25

pCO2 69.3

pCO2 11.4

pCO2 74.3

HCO3 21.0

HCO3 3.1

HCO3 12.4

B.E. -5.5

B.E. -26.3

B.E. -13.4

pO2 40.9

pO2 115.1

pO2 29.1

(7)

(8)

(9)

ABGsIts All in the Family


Newly Revised, Updated, & Peer Reviewed:
November 20, 2009
By Cyndi Cramer, BA, RN, OCN, PCRN
RealNurseEd.com
Revised and Updated by: Jackie Gilbert, BA, MS, BS, PCRN
and Tracy Thomas. BSN, CCRN, PCRN
Peer Reviewed by:
Lacey Lewis, RN, PCRN and Paul Pearson, RN, PCRN
and Kimatha Wolfley, RN
3.0 Contact Hour Self Learning Module
Objectives:
1. Identify the components of the ABG and their normal ranges
2. Interpret ABG values and determine the acid base abnormality given
3. Identify the major causes of acid base abnormalities
4. Describe symptoms associated with acid base abnormalities
5. Describe interventions to correct acid base abnormalities
6. Identify the acceptable O2 level per ABG and Pulse Oximetry
7. Identify four causes of low PaO2

I. The Background Stuf


The body tries to maintain homeostasis with the Acid Base balance
using acids and bases contained within the body. Each acid and base
counter balances with each other (the alkaline part of your ABG). The
body enzymes cannot work outside of the balance. The ABG is an
arterial Blood measurement of this acid base status.
The Respiratory System (Acid); CO2 is a volatile acid
1. If you increase your respiratory rate (hyperventilation) you "blow
off" CO2 (acid) therefore decreasing your CO2 acidgiving you
ALKALOSIS
2. If you decrease your respiratory rate (hypoventilation) you retain
CO2 (acid) therefore increasing your CO2 (acid)giving you
ACIDOSIS

The Renal System (Base); the kidneys rid the body of the nonvolatile
acids H+ (hydrogen ions) and maintain a constant bicarb (HCO3).
Bicarbonate is the bodys base
1. You have Acidosis when you have excess H+ and decreased
HCO3- causing a decrease in pH.
The Kidneys try to adjust for this by excreting H+ and retaining
HCO3- base.
The Respiratory System will try to compensate by increasing
ventilation to blow off CO2 (acid) and therefore decrease the
Acidosis.
2. You have Alkalosis when H+ decreases and you have excess (or
increased) HCO3- base.
The kidneys excrete HCO3- (base) and retain H+ to
compensate.
The respiratory system tries to compensate with
hypoventilation to retain
CO2 (acid)
To decrease the alkalosis
Compensation
1. The respiratory system can effect a change in 15-30 minutes

2. The renal system takes several hours to days to have an effect.

II. The Big Four


RESPIRATORY ACIDOSIS: pH < 7.35 (Normal: 7.35 - 7.45) CO2 > 45
(Normal: 35 45)
1. Causes: Hypoventilation

a. Depression of the Respiratory Center (sedatives, narcotics, drug


overdose, CVA, cardiac arrest, MI)
b. Respiratory muscle paralysis (spinal cord injury, Guillian-Barre,
paralytics)
c. Chest wall disorders (flail chest, pneumothorax)
d. Disorders of the lung parenchyma (CHF, COPD, pneumonia, aspiration,
ARDS)
e. Alteration in the function of the abdominal system (distension)
2. Signs and Symptoms
a. CNS depression (decreased LOC)
b. Muscle twitching which can progress to convulsions
c. Dysrhythmias, tachycardia, diaphoresis (related to hypoxia secondary to
hypoventilation)
d. Palpitations
e. Flushed skin
f. Serum electrolyte abnormalities including elevated K+ (potassium leaves
the cell to replace the H+ buffers leaving the cell)
3. Treatment
a. Physically stimulate the patient to improve ventilation
b. Vigorous pulmonary toilet (chest PT, coughing and deep breathing,
inspirometer, respiratory treatments with bronchodilators)
c. Mechanical ventilation (to increase the respiratory rate and tidal volume)
d. Reversal of sedatives and narcotics

e. Antibiotics for infections


f. Diuretics for fluid overload
(NOTE: beware of NaHCO3- sodium bicarbonatecan compensate and cause
metabolic alkalosis. Also, if patient has been hypoxic and this is a lactic
acidosis; NaHCO3- can be dangerous)
Respiratory Alkalosis: pH > 7.45 (Normal: 7.35 - 7.45) CO2 < 35
(Normal: 35 45)
Causes: Alveolar Hyperventilation
a. Psychogenic (fear, pain, anxiety)
b. CNS stimulation (brain injury, ETOH, early salicylate poisoning,
brain tumor)
c. Hypermetabolic states (fever, thyrotoxicosis)
d. Hypoxia (high altitude, pneumonia, heart failure, pulmonary
embolism)
e. Mechanical overventilation (ventilator rate too fast)
Signs and Symptoms
a. Heachache
b. Vertigo
c. Paresthesias (numb fingers /toes, circumoral, carpal pedal
spasms and tetany)
d. Tinnitus (ringing in the ears)
e. Electrolyte abnormalities (decreased Ca+, K+)
Treatment (treat the underlying cause)
a. Sedatives or analgesics
b. Correction of hypoxia (possible diuretics, mechanical ventilation
to also decrease respiratory rate and decrease the tidal volume)
NOTE: patients with brain injury may need hyperventilation

c. Antipyretics for fever


d. Treat hyperthyroidism
e. Breathe into a paper bag for hyperventilation
Metabolic Acidosis pH < 7.35 (Normal: 7.35 - 7.45) HCO3- < 22
(normal: 22 26)
Causes: Increased H+, excess loss of HCO3a. Overproduction of organic acids (starvation, ketoacidosis,
increased catabolism)
b. Impaired renal excretion of acid (renal failure)
c. Abnormal loss of HCO3- (diarrhea, biliary fistula, Diamox)
d. Ingestion of acid (salicylate overdose, oral anti-freeze)
Signs and Symptoms
a. CNS depression (confusion to coma)
b. Cardiac Dysrhythmias (elevated T wave, wide QRS to ventricular
standstill)
c. Electrolyte abnormalities (elevated K+, Cl-, Ca2+)
d. Flushed skin (arteriolar dilitation)
e. Nausea
Treatment (Treat the underlying cause)
a. NaHCO3- (sodium bicarbonate) based on ABGs only and with
caution
b. IV fluids and insulin for DKA
c. Dialysis for renal failure
d. Antibiotics, increased nutrition for tissue catabolism
e. Increased cardiac output and tissue perfusion for low CO states
f. Rehydrate, monitor I and O

g. Treat dysrhythmias, support hemodynamic and respiratory status

Metabolic Alkalosis pH > 7.45 (Normal: 7.35 - 7.45) HCO3- > 26


Causes: Loss of H+ or increased HCO3a. Loss of K+ (diarrhea, vomiting)
b. Ingestion of large amounts of bicarbonate (antacids,
resuscitation)
c. Prolonged use of diuretics (distal tubule lose ability to reabsorb
Na+ and Cl- therefore NaCl); Ammonia is in the urine and then
binds with H+
Signs and Symptoms: similar to the disease process
a. Diaphoresis
b. Nausea and Vomiting
c. Increase neuromuscular excitability (Ca2+ binds with protein)
d. Shallow breathing (respiratory compensation)
e. EKG changes (increased QT, sinus tachycardia)
f. May also see confusion progressing to lethargy to coma
g. Electrolyte abnormality (decreased Ca2+), normal or decreased
K+, increased base excess on the ABG
Treatment: Treat the underlying cause
a. Replace potassium (KCl) losses in 0.9% NaCl (rehydrates and
increases HCO3- excretion)
b. Diamox (acetazolamide, increases HCO3-excretion)
c. Monitor neuro status, re-orient, seizure precaution, monitor I and
O

III. The Land of the ABG**


(**based upon a concept by Laura Gasparis Vonfrolio, RN, PhD)
Once upon a time there was a land known as ABG
Everyone there was related with only a limited number of names for the
population.
They were also very polite and had their own etiquette for learning each
others names.
Now I would like to introduce you to your patient. Lets figure out what her
name is.
All of the people in the land of ABG have a first name, a middle name, and a
last name.
You just have to look at them one name at a time.

The Last Name


1. First, look at her pH (normal is 7.35 - 7.45)
2. If her pH is < 7.35; her name is ACIDOSIS
3. If her pH is > 7.45; her last name is ALKALOSIS
(NOTE: To have an absolutely perfect last name; her pH needs to be 7.40. So,
keep in mind that if her pH is 7.35 - 7.39 shes thinking about marrying into
the ACIDOSIS family. If her pH is 7.41 - 7.45 shes thinking about marrying
into the ALKALOSIS family)
The First Name
Now that you know your patients last name, you would like to also learn her
first name.
1. Look at her pH again.
2. If it is 7.35 - 7.45 (normal) then her first name is
COMPENSATED.
3. If the pH is < 7.35 or > 7.45 then her first name is
UNCOMPENSATED.
The Middle Name
Now that you know your patients first and last name, you would like to know
her
middle name.
Name Alert: These people are all related and you have many patients with
the same
first and last name. A middle name will give you more information.
First you need to look at the CO2 and HCO3-. Remember : normal CO2 35 45; and
HCO3- 22 - 26.
1. The middle name will either be Respiratory or Metabolic.
2. If the CO2 is < 35 or > 45 her middle name is RESPIRATORY.

3. If the HCO3- is < 22 or > 26; her middle name is METABOLIC.


The Family Feud
1. pH and HCO3- are "kissin cousins" they like to go in the same direction
2. CO2 is the "black sheep" pH runs the opposite direction when it sees him
coming.
THEREFORE:
3. Decreased pH with decreased HCO3-: ACIDOSIS
4. Increased pH with increased HCO3-: ALKALOSIS
5. Decreased pH with increased CO2-: ACIDOSIS
6. Increased pH with decreased CO2-: ALKALOSIS

Lets Practice
The following ABGs were all given to you by your respiratory therapist.
EXAMPLE ONE:
pH = 7.60; CO2 = 30; HCO3- =22
What is her last name?
What is her first name?
What is her middle name?
You have now been introduced to UNCOMPENSATED RESPIRATORY ALKALOSIS
EXAMPLE TWO:
pH = 7.35; CO2- = 50; HCO3- = 25
What is her last name?
What is her first name?
What is her middle name?
You have now been introduced to COMPENSATED REPIRATORY ACIDOSIS
EXAMPLE THREE:
pH = 7.55; CO2- = 40; HCO3- = 30

What is her last name?


What is her first name?
What is her middle name?
You have now been introduced to UNCOMPENSATED METABOLIC ACIDOSIS
EXAMPLE FOUR:
pH = 7.35; CO2- = 45; HCO3- = 21
What is her last name?
What is her first name?
What is her middle name?
You have now been introduced to COMPENSATED METABOLIC ACIDOSIS
Now practice doing some yourself:

Note: PaCO2 (partial pressure of carbon dioxide) tells us the adequacy


of the ventilation; also can be read as your CO2 level due to its direct
relation.

A. Choose from the below answer key to answer these questions:


Answer Key:
a. Compensated respiratory acidosis
b. Compensated metabolic alkalosis
c. Compensated metabolic acidosis
d. Uncompensated metabolic acidosis
e. Compensated respiratory alkalosis
f. Compensated metabolic alkalosis
g. Compensated respiratory acidosis
h. Uncompensated metabolic alkalosis
i. Compensated respiratory acidosis
j. Uncompensated respiratory alkalosis
1. pH = 7.31 PaCO2 = 48 HCO3- = 24

pH
pH
pH
pH
pH
pH
pH
pH
pH

=
=
=
=
=
=
=
=
=

7.47
7.20
7.50
7.23
7.50
7.40
7.49
7.35
7.60

PaCO2= 45 HCO3- = 33
PaCO2 = 36 HCO3- = 14
PaCO2 = 29 HCO3- = 22
PaCO2 = 59 HCO3- = 22
PaCO2 = 38 HCO3- = 30
PaCO2 = 41 HCO3- = 25.5
PaCO2 = 44 HCO3- = 34
PaCO2 = 40 HCO3- = 23
PaCO2 = 33 HCO3- =23

Now try some harder ones:

In these problems, both the CO2 and the HCO3 are abnormal. Choose
the middle name that is the same as the pH. (You cant have a middle
name in the Land of ABG unless you get married and can share a last
name)

A. Choose from the below answer key for these questions:


Answer Key:
a. Compensated respiratory acidosis
b. Compensated metabolic alkalosis
c. Compensated metabolic acidosis
d. Uncompensated metabolic acidosis
e. Compensated respiratory alkalosis
f. Compensated metabolic alkalosis
g. Compensated respiratory acidosis
h. Uncompensated metabolic alkalosis
i. Compensated respiratory acidosis
j. Uncompensated respiratory alkalosis
1. pH = 7.36 PaCO2 = 56 HCO3- = 26

pH
pH
pH
pH
pH
pH
pH
pH
pH

=
=
=
=
=
=
=
=
=

7.43
7.35
7.19
7.44
7.42
7.36
7.48
7.35
7.60

PaCO2
PaCO2
PaCO2
PaCO2
PaCO2
PaCO2
PaCO2
PaCO2
PaCO2

=
=
=
=
=
=
=
=
=

32
31
45
47
35
26
37
38
33

HCO3- = 29
HCO3- = 18.1
HCO3- = 18.1
HCO3- = 26
HCO3 = 27
HCO3 - =26
HCO3- = 29
HCO3- = 26
HCO3- = 26

The prefix to the name:


You have been introduced to the married name of the ABG now you are
to be introduced to the full married name of the ABG. (Like Ms. or Mrs.)
1. Partially: This describes when you have abnormalities in both systems
and your pH is abnormal. This shows that one system has tried to
compensate for the other but is not yet successful.
2. Completely: This describes when abnormalities in both systems occur
and your pH is normal. This shows that one system has been able to
compensate for the other

3. Now, we can describe the FULL MARRIED NAME.

Now, let's try some combined disorders:


1. pH = 7.09 PaCO2 = 50 HCO3- = 30

pH
pH
pH
pH
pH
pH
pH
pH
pH

=
=
=
=
=
=
=
=
=

7.21 PaCO2 = 55 HCO3- = 28


7.67 PaCO2 = 60 HCO3- = 45
7.45 PaCO2 = 33 HCO3- = 20
7.01 PaCO2 = 20 HCO3- = 10
6.9 PaCO2 = 65 HCO3- = 19
7.35 PaCO2 = 48 HCO3- = 30
7.48 PaCO2 = 25 HCO3- =12
7.12 PaCO2 = 30 HCO3- = 10
7.58 PaCO2 = 22 HCO3- = 20

V. O2 STANDS ALONE
Did you notice that I havent mentioned O2?
The O2 number has nothing to do with your acid-base ABG interpretation!
What does the PaO2 mean?
o The O2 tells us if the patient has hypoxemia (decreased oxygen
in the blood).

o Normal PaO2 = 80-100 (hypoxemia = PaO2 < 80)


o PaO2 assesses perfusion (gas exchange)
o PaCO2 assesses the adequacy of ventilation (breathing pattern)
o The PaO2 is very important in determining your patients oxygen
status and needs but it is not necessary in determining the BIG
FOUR.
What is saturation?
o SaO2 (oxygen saturation) measures the percent of oxygen bound
to hemoglobin. This tells whether the patient has hypoxia
(decrease O2 in the tissue).
o Normal SaO2 = greater than 95%
o Acceptable SaO2 will vary between MD, but PaO2 dramatically
drops when it is less than 92%.
o This is a noninvasive measurement via pulse oximetry and can
be less accurate due to hypoxemia, hypotension, hypovolemia,
or vasoactives.
Note: In Carbon Monoxide Poisoning, the Hgb is
saturated with Carbon Monoxide. Although the
patient is hypoxemic, it is because there is no room
on the Hgb for O2 to be carried the Saturation looks
good because it cant distinguish between the two.
What are some causes of low PaO2?
o Hypoxic-Hypoxia there is just not enough of a supply of O2
(COPD, pneumonia, ARDS, suffocation)
o Anemic-Hypoxia there is plenty of O2, but not enough Hgb to
carry it to the tissue.
o Stagnant-Hypoxia there may be enough O2 coming in and
enough Hgb to carry it, but the circulation is stagnant due to a
decreased Cardiac Output (CO). The O2 is not being adequately
carried to the tissue.

o Histotoxic-Hypoxia poisoning like Carbon Monoxide or Cyanide.


Either the blood cant carry the O2 or the cells cant receive the
O2 from the blood.
Why do we look at Base Excess (BE)?
o Base excess is the amount of base needed to return the pH to a
normal value
o Normal range = (-)2 (+)2, with zero (0) being the middle
ground
o Used mostly to distinguish metabolic alkalosis from acidosis
o Too much base excess (over +2) may indicate loss of gastric
fluids as in vomiting, whereas a base deficit of -5 or lower may
indicate a lactic acid problem or diabetic ketoacidosis
o Used mostly to test for consistency in diagnosing metabolic
problems
Can we only be PARTIALLY compensated?
o The body has attempted to compensate with either the lungs or
kidneys, but has not fully compensated to return the pH to
normal.
o pH balance will still be abnormal, either acidotic or alkalotic
state.

LETS PRACTICE:
1. pH 7.34, PCO2 34, HCO3- 18.6, BE -6, PO2 86%
2. pH 7.58, PCO2 48, HCO3 48, BE +22, PO2 59%
3. pH 7.29, PCO2 78, HCO3- 36, BE +7, PO2 32%
4. pH 7.45, PCO2 28, HCO3- 20, BE -3, PO2 66%
5. pH 7.30, PCO2 31, PO2 77, HCO3- 18;

For Additional Practice Problems, Click Here:

VI. If you are ready for contact hoursyou have to


take the test. You can practice first here: Practice Test
which will open a new window. When you are done just close
the new window.
VII. Or, to go directly to the post test below just scroll down.
Note: I MUST have your license number & state if you want
the CE + you will need to fill out the evaluation to keep the
state of Florida happy!!
VII. Check out the "CHEAT SHEET"
If you would like a cheat sheet as a reminder for ABGsjust print this out:

CLICK HERE
REFERENCES
Corning, HS & Bryant, SL. Mosbys Respiratory Care PDQ. Mosby,
2005.
Hennessey, I & Japp, A. Arterial blood gases made easy. Churchill
Livingstone, 1st edition. 2007.
Hogan, MA & Wane, D. Fluids, electrolytes, and acid base balance.
Pearson Education, Inc., 1st edition. 2003.
Malley, WJ. Clinical blood gases: Assessment & Intervention.
Saunders, 2nd edition. 2004.

Morton, PG, Fontaine, DK, Hudak, CM, Gallo, BM. Critical care
nursing: A holistic approach. Lippincott, Williams, and Wilkins, 8 th
edition. 2005.
Oakes, D. Arterial blood gas pocket guide. Respiratorybooks.com.
2009.
Springhouse. Respiratory care made incredibly easy. Lippincott,
Williams & Wilkins. 2004.
Post Test
You have to take this post test, fill in your name, license number and state,
and do the evaluation to make the state of Florida happy and you will get
your CE which will come in the body of a return e-mail within the
next few days!!

"ABG ITS ALL IN THE FAMILY" Post Test


1. Mr. M is a 65-year old male admitted with a decreased level of
consciousness (LOC). He has a history of chronic bronchitis and heart failure.
His vital signs are: Temp-102, HR-104, RR-28 and shallow, BP-90/60. ABG
results are as follows:
pH 7.2
PCO2 75 mmHg
HCO3- 26 mEq/L
What is the acid base disturbance?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

2. Is this Compensated or Uncompensated?


Compensated
Uncompensated

3. What are some causes of this disorder?


Vomiting, diarrhea, prolonged diuretics
Pain, fever, hyperventilation
Pneumonia, hypoventilation, pneumothorax
Renal failure, ASA overdose, starvation, ketoacidosis

4. What are the interventions for this disorder?


IV fluids (IVF), insulin, NaHCO3 based on ABGs only
Vigorous pulmonary toilet, antibiotics, diuretics, mechanical ventilation
Sedatives or analgesics, breathe into paper bag, mechanical ventilation
to decrease rate.
Potassium replacement, Diamox
5. Mrs. G., who has congestive heart failure (CHF), has been having diarrhea
for three days. You have noticed some LOC changes and she is breathing
shallowly. The doctor orders ABGs:
pH 7.44
PCO2 50 mmHg
HCO3- 31 mEq/L
What is the acid base disturbance?
Respiratory acidosis

Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

6. Is this compensated or uncompensated?


Compensated
Uncompensated

7. What are some causes of this disorder?


Vomiting, diarrhea, prolonged diuretics
Pain, fever, hyperventilation
Pneumonia, hypoventilation, pneumothorax
Renal failure, ASA overdose, starvation, ketoacidosis

8. What are the interventions for this disorder?


IVF & insulin, NaHCO3- based on ABGs only
Vigorous pulmonary toilet, antibiotics, diuretics, mechanical ventilation
Sedatives or analgesics, breathe into paper bag, mechanical ventilation

to decrease rate
K+ replacement, Diamox

9. Ms. P., a 22-year old female, is admitted with an acute onset of fever,
chills, and Rt. upper quadrant pain.
Her vital signs are: T=99.6, P=125, RR=32, BP=140/84.
Her ABG results are:
pH 7.53
PaCO2 30 mmHg
HCO3- 22 mEq/L
What is the acid base disturbance?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

10. Is this Compensated or Uncompensated?


Compensated
Uncompensated

11. What are some causes of this disorder?


Vomiting, diarrhea, prolonged diuretics
Pain, fever, hyperventilation

Pneumonia, hypoventilation, pneumothorax


Renal failure, ASA overdose, starvation, ketoacidosis

12. What are the interventions for this disorder?


IVF & insulin, NAHCO3- based on ABGs only
Vigorous pulmonary toilet, antibiotics, diuretics, mechanical ventilation
Sedatives or analgesics, breathe into paper bag, mechanical ventilation
to decrease rate.
K+ replacement, Diamox

13. Mrs. D is a 45-year old female admitted with a history of diabetes.


She has a temperature of 101.8, P=110, RR=30, BP=90/70.
Labs are drawn and reveal a glucose of 780 mg/dl, positive ketones, and the
following ABGs:
pH 7.25
PaCO2 35 mm Hg
HCO3- 18 mEq/L
What is the acid base disturbance?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

14. Is this Compensated or Uncompensated?


Compensated
Uncompensated

15. What are some causes of this disorder?


Vomiting, diarrhea, prolonged diuretics
Pain, fever, hyperventilation
Pneumonia, hypoventilation, pneumothorax
Renal failure, ASA overdose, starvation, ketoacidosis

16. What are the interventions for this disorder?


IVF & insulin, NAHCO3- based on ABGs only
Vigorous pulmonary toilet, antibiotics, diuretics, mechanical ventilation
Sedatives or analgesics, breathe into a paper bag, mech. vent. to
decrease rate
K+ replacement, Diamox

17. Mr. J calls you to his room with a complaint of shortness of breath.
His SaO2 is 89% on room air.
He has rhonchi in all lobes and a temperature of 101,
P=122, RR=36, BP=160/92.
RT draws ABGs with the following results:

pH 7.33
PaCO2 72 mmHg
HCO3- 24
What is the acid base disturbance?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

18. Is this Compensated or Uncompensated?


Compensated
Uncompensated

19. Is his PaO2 normal?


No
Yes

20. Under what SaO2 does the PaO2 significantly decrease?


70%
95%

85%
92%

21. The PaO2 measures?


Hypoxia
Anemia
Hypoxemia
Azotemia

22. How can you tell that your ABG is compensated?


The CO2 is 35 - 45
The HCO3- is 22 - 26
The pH is 7.35 - 7.45
The O2 is > 90

23. What are some causes of low PaO2?


Low supply of O2
Decreased cardiac output

Anemia
Carbon monoxide poisoning
All of the above

24. Interpret the following ABGs:


pH 7.47, CO2 30, HCO3- 24
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis

25. Is this Compensated or Uncompensated?


Compensated
Uncompensated

26. pH 7.30, CO2 75, HCO3- 22:


Respiratory Acidosis
Respiratory alkalosis

Metabolic acidosis
Metabolic alkalosis

27. Is this Compensated or Uncompensated?


Compensated
Uncompensated

28. pH 7.36, CO2 32, HCO3- 20


Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
Metabolic acidosis

29. Is this Compensated or Uncompensated?


Compensated
Uncompensated

30. pH 7.48, CO2 46, HCO3- 28


Respiratory acidosis
Respiratory alkalosis

Metabolic acidosis
Metabolic alkalosis

31. Is this Compensated or Uncompensated?


Compensated
Uncompensated

32. pH 7.38, CO2 50, HCO3- 27


Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis

33. Is this Compensated or Uncompensated?


Compensated
Uncompensated

34. pH 7.50, CO2 35, HCO3- 32


Respiratory acidosis
Respiratory alkalosis

Metabolic acidosis
Metabolic alkalosis

35. Is this Compensated or Uncompensated?


Compensated
Uncompensated

Participant Self-Learning Program Evaluation


The information below is required before contact hours can be given.
Program Title:

"ABGs--It's All In The Family"


Date: (month / day / year)

Nursing License Number:

State

Name:

Complete E-mail address ( example: nurse@aol.com ) :

Your feedback is valued and will assist in improving this program. Please
explain ratings of 2 or 1.
Ratings: 5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor
1. Objectives of program were clear.

2. Objectives were met.

3. Time allotted was adequate

4. Authors Knowledge of subject matter

5. Efficient Method of Instruction

6. Provided for material review

7. Program expectations satisfied

8. Organization/readability of program

9. Test correlated with objectives

10. Would you recommend this Self-Learning Program to another student?


yes
no

11. One contact hour should take approximately 50-60 minutes to complete.
If you read all the material, did the practice problems, and took both tests Do you
feel this program was in the 3 hour range?
yes
no

11a. If not - please explain.

12. What could have improved the program?

13. Any suggestions for future Self-Learning Programs?

14. Would you utilize another Self-Learning experience by this instructor?


yes

no

14a. Why or why not?

15. Any other comments?

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