ABGs

ARTERIAL BLOOD GASES

Why Is It Done?
Check for severe breathing problems
Check for lung diseases (asthma, CF,COPD) Determine how well treatment for lung disease is

working Determine if the patient needs extra O2 Determine if the patient needs help breathing (mechanical ventilation)

Why is It Done?
Determine if the patient is receiving the correct amount of O2 while in the hospital
Measure the acid-base level in the blood of those who have heart failure, kidney failure, uncontrolled DM, sleep disorders, severe infections, or after an OD

What Is An ABG?
Sample of arterial blood (in order to measure O2 and CO2 before they enter body tissues)
WHY? Because if a sample of venous blood is obtained, the oxygen is already used up and the carbon dioxide has been produced! You want to obtain a sample BEFORE its tainted

What Does An ABG measure?

Measures acidity (pH) and by default, measures

alkalinity Measures levels of oxygen (O2) and carbon dioxide (CO2) Provides information on how well lungs are able to move O2 INTO blood Provides information on how well lungs able to remove CO2 FROM blood

Whats Happening???

As blood passes through lungs O2 moves into blood While CO2 moves out of blood into lungs

Whats it all mean, Basil?

PaO2 - 80-100

measures pressure of oxygen dissolved in the blood and, how well O2 able to move from airspace of lungs into the blood PaCO2 - 35-45 measure how much carbon dioxide is dissolved in the blood and how well CO2 able to move out of the body

And this means???

pH 7.35-7.45

measures hydrogen ions (H+) in blood so the more H+, the lower the pH then a pH less than 7.40 is acidic or the less H+, the higher the pH then a pH more than 7.40 is called basic, or alkalitic So therefore blood is slightly basic?!?!?

And this?
HCO3 22-26 bicarbonate is a chemical buffer keeps pH of blood from becoming too acidic or too basic PaO2 95-100% measures amount of oxygen in blood how much of the hemoglobin in the red blood cells is carrying O2

What Should The Nurse Do?

Tell the Doctor

if the patient has any bleeding problems (anemia low Hgb) Orif the patient takes any blood thinners (ASA, Coumadin)

Take The Oxygen Off The Patient???

If ABG Ordered On Room Air
O2 needs to be OFF for 20 minutes before the test If the pt cannot breathe with it off, it does not get turned off!!! Then the resp tech will note that the ABG was done on 2L, and so on

Changes When Acidic

Increase in force of cardiac contractions Decrease in vascular response to catecholamines Diminished response to effects and actions of certain medications

Changes When Alkalotic

Interference with tissue oxygenation

Interference with normal neurological and muscular functioning

 Extreme pH - >7.8 or <6.8

Will interfere with cellular

functioning If uncorrected will lead to death

So What To Do
So how does the body self-regulate acid- base balance in order to maintain a normal pH???
It uses a buffer mechanism between the respiratory system (respiratory) and renal system (metabolic).

The Respiratory Buffer Response

A normal by-product of cellular metabolism is

CO2 CO2 is carried in the blood to the lungs This triggers the lungs to either increase or decrease the rate and depth of ventilation UNTIL the appropriate amount of CO2 has been re-established! Activation of the lungs to compensate for an imbalance starts to occur............... in 1-3 min.

The Renal Buffer Response

Kidneys excrete or retain bicarbonate (HCO3) As pH decreases, kidneys will retain HCO3

As pH rises, kidneys will excrete HCO3 through the urine

Although excellent means of regulating, acid-base

balance, system .may take hours to days to correct imbalance

Respiratory Acidosis
pH < 7.35 PaCO2 > 45

(too much ! so blow it off!!) So that means the condition keeps the respirations low Therefore increases the CO2

Pulmonary S&S
dyspnea, resp distress, shallow respirations

Nervous S&S
HA, restlessness, confusion and if CO2 extremely high, drowsiness and unresponsiveness

Cardiovascular System S&S

tachycardia and dysrhythmias Increasing ventilation will correct resp. acidosis or, manual ventilation with a bag valve mask (BMV) if patient is unstable

What To Do?
Once stable, rapidly treat causes Pneumothorax? Pain? CNS depression due to meds? If unable to resolve, mechanical ventilation needed O2 alone will not correct the problem

Respiratory Alkalosis
pH >7.45 PaCO2 < 35

(they are blowing off too much CO2) So that means in this condition the respirations are fast hyperventilating
Thats why you see the paper bag treatment

Nervous System S&S

light-headedness, numbness, tingling, confusion, inability to concentrate, blurred vision

Cardiovascular System S&S

dysrhythmias, palpitations

Plus
dry mouth, diaphoresis, arm and leg spasms

What To Do?
treatment centers on resolving underlying problem
monitor for muscle fatigue acute resp. failure may follow

Metabolic Acidosis
pH <7.35 HCO3 <22

(looking at HCO3 now because its metabolic) The pH and HCO3 are going in the same direction

Nervous System S&S

HA, confusion, restlessness progressing to lethargy, then stupor

Cardiovascular System S&S dysrhythmias

and Kussmaul resp

Plus warm, flushed skin, nausea & vomiting

What To Do?
As previously mentioned, treat the cause
One common cause is hypoxia, so look for hypoxic issues look to restore tissue perfusion to hypoxic tissues If patient in DKA sodium bicarb will be ordered

Metabolic Alkalosis
HCO3

> 26 pH >7.45

pH and HCO3 are going in the same direction

 Neurological S&S
dizziness, lethargy, disorientation, seizures, and coma

Musculoskeletal S&S
weakness, muscle twitching, muscle cramps and tetany (involuntary contractions of muscles)
Plus nausea and vomiting and respirations distress

What To Do?
One of the most difficult acid-base imbalances to treat
Bicarbonate excretion through kidneys can be stimulated with drugs (Diamox) but resolution of the imbalance is slow such as

Onto Reading ABGs