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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.
(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)
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
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
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
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)
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
pH
pH
pH
pH
pH
pH
pH
pH
pH
=
=
=
=
=
=
=
=
=
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).
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;
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!!
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
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
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
85%
92%
Anemia
Carbon monoxide poisoning
All of the above
Metabolic acidosis
Metabolic alkalosis
Metabolic acidosis
Metabolic alkalosis
Metabolic acidosis
Metabolic alkalosis
State
Name:
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.
8. Organization/readability of program
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
no