Arterial Blood Gas Interpretation Acid pH (Conc. of H+ ions) PaCO2 (respiratory) <7.35 Normal 7.35-7.45 Alkaline >7.

45

>45 (Hypoventilation) <22

35-45

<35 (Hyperventilation) >26

HCO3 (Metabolic)
1.

22-26

Write down pH (reflects regulation of H+ ions), PaCO2 (reflects alveolar ventilation respiratory component), HCO3 (kidneys, metabolic component) values

2. Determine if each value is Acid, Base or Normal. 3. Circle the letters that are the same 4. To for compensation, determine whether the uncircled variable is moving in the opposite direction

Absent - the value that doesnt match the acid base status of the pH is normal Partial - both the value that doesnt match the acid-base status of the pH and the pH itself are above or below normal Complete - the value that doesnt match the acid base status of the pH is above or below normal but the pH is normal

. Acid Base Disturbances and Nursing interventions A. Respiratory Acidosis - ( pH, CO2) caused by: hypoventilation, obstruction, CAL, Pulmonary Edema, OD 1. Aggressive chest PT, positioning, coughing, deep breathing and aerosol therapy or suctioning to stimulate coughing. 2. Assess for changes in mental status, lung sounds, respirations and serial ABGs to assess oxygenation and effects of interventions. B. Respiratory Alkalosis -(pH, PaCO2) - caused by hyperventilation due to anxiety, pain, fever, PE 1. Administer pain medication to prevent hyperventilation. 2. Teach patient to recognize hyperventilation and to breathe regularly and deeply. 3. Breathing into a paper bag will increase the amount of CO2 retained, would we really do this in ICU?? C. Metabolic Acidosis -(pH, HCO3) caused by diabetic ketoacidosis, diarrhea, renal failure, shock, sepsis) 1. Monitor I & Os and electrolytes. Correlate I & Os with weights, vital signs and skin color, turgor and temperature. 2. Prevent infection. 3. Monitor for arrhythmias 4. Protect from injury. (seizures, and trauma) 5. Monitor serial ABG results D. Metabolic Alkalosis -(pH, HCO3) caused by loss of gastric secretions, overuse of antacids, potassium-wasting diuretics 1. Monitor VS 2. Monitor I & Os and electrolytes 3. Protect the patient from injury ABG PRACTICE pH 7.35 PaCO2 64 mmHg HCO3 33 mEq/L pH 7.48 PaCO2 51 mmHg HCO3 29 pH 7.26 PaCO2 42 mmHg HCO3 17 mEq/L pH 7.26 PaCO2 52 mmHg HCO3 34