UPNS 232 Comprehensive Notes

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ABG

Ph
 7.35-7.45 Is normal
 > alka
 <acid
 diarrhea, vomiting, fasting= acidic
 alka- too many diuretics, K is low.

PaO2
 80-100 normal
 hyperventilation, too much O2= >100
 <80 high altitudes, resp depression, poisoning
 wont measure heme. Pulse ox wont match up
SaO2
 pulse ox!
 Normal is 95% and 100%
 <95, anemic. COPD, etc
pCO2
 normal is 35-45
 higher end is acidotic
 this is the amount of CO2 in the blood
 this is respiratory acidosis
 causes of increased pCO2 is decreased resps
o emphysema, pneumonia
 <35, alkalosis
o caused by hyperventilation
hCO3
 meausres bicarb
 normal is 22-26
 this is metabolic
 metabolic alkalosis- caused by giving too much sodium bicarb (treating acidosis, over
medicating)
 metabolic acidosis- patient has severe diarrhea, pancreatitis
patient hx
 patients taking diuretics and antacids can throw off metabolic

respiratory acidosis
 pH <7.35 and pCO2 Is > 45
 hypoventilation. Poor gas exchange
 pt has pulm emboli, not deeo breathing bc pain, not good gas exchange.

,  1 broad cause- retention of CO2 bc bad gas exchange
 S/S
o Dyspnea, resp distress, shallow resps, confusion/restless, headache, lethargy,
muscle weakness
o Can supplement w O2, PROBABLY won’t help
 Need to resolve pneumonia or problem to allow gas exchange
Resp alkalosis
 Ph greater than .45 and PaCO2 is less than 35
 Hyperventilation
 Fear, anxiety, pregnancy, CNS issues
 S/s
o Numbness, tingling, lightheadedness, agitation, confusion, positive trausseus
(inflated BP cuff, hand inverts) and chovtek sign (touch face and muscle twitch).
dysrhythmias, increased HR, thread peripheral pulse. Increased RR
 Treatment- resolve underlying issue
 Pt will get tired after hyperventilation, might need ventilator. Remember body is
compensating for condition by increasing RR
Metabolic acidosis
 Ph <.35 and bicarb <22
 Respiratory opposite, metabolic equal ROME
o Met acid- both are low
 Caused by either deficient in base or excess of acid
o Renal failure, DKA, anaerobic metabolism, starvation, aspirin OD
 S/S
o Headache, confusion, kussmaul resp (deep and rapid resps) N/V
 Treat underlying cause- ex: diarrhea
o Rehydrate, antidiarrheal meds
o DKA- treat w insulin
o Can administer bicarb- be careful w it. Can send them into opposite
Nursing priorities
 Know and treat underlying cause
 Check ABG’s often
Metabolic alkalosis
 >7.45 bicarb >26
 increase in base or decrease in acids
 causes: too many tums, too much bicarb- dialysis patients. Make dose adjustments
 loss of aids- prolonged vomiting, gastric suction, hypochloremia, excess thiazide diuretics
(HTCZ), high aldosterone
 S/S
o Resp depression, dizzy, lethargy, seizures, muscle twitching/weakness/cramps,
N/V
 Difficult to treat
Steps to solve

, ROME

 Increased pH, Decreased C02 = Respiratory Alkalosis
 Decreased pH, Increased C02 = Respiratory Acidosis
 Increased pH, Increased HC03 = Metabolic Alkalosis
 Decreased pH, Decreased HC03 = Metabolic Acidosis
Step one
 pH 7.30 (7.35-7.45) ACID
 pCO2 55 (35-45) ACID = Lungs
 HCO3 26 (22-26) NORMAL = Kidneys
 Match the two abnormalities: Respiratory (lung problem) + Acidosis = Respiratory
Acidosis.

**Ph not in normal range= uncompensated or partially compensated
when pH is normal (fully compensated), use the 7.40 rule
 < .40 = acid
 >.40= alka

Ex:
pH 7.38 (7.40) normal but NOW ACIDOSIS
PaCO2 56 (35-45) ACIDOSIS = Lungs
HCO3 35 (22-26) ALKALOSIS
Match the two abnormalities: Respiratory (lungs) + Acidosis = Respiratory Acidosis
 remember ROME. Resp opposite. pH is low, PaCO2 is high
this patient is in normal range, compensated resp acidosis

**examples in pptx

partially is all 3 are abnormal!


1/18/19

care of the pt w hematological problems
hgb- gas carry capacity RBC
hct- packed cell volume of rbcs expressed as a % of the total blood volume
reticulocyte- measure of immature RBC (bone marrow activity)
iron- amount of iron combined w proteins in serum: accurate indicator of status of iron storage
and use
Serum Ferritin: Major iron storage protein; normally present in blood in concentrations directly
related to iron storage

, Total Iron-Binding Capacity (TIBC): Measurement of all proteins available for binding iron;
transferrin represents the largest quantity of iron-binding proteins; therefore TIBC is an indirect
measure of transferrin; evaluation of the amount of extra iron that can be carried

Myelosuppression-
 neutropenia, leukopenia, anemia, thrombocytopenia, pancytopenia

neutropenia/leukopenia
 very low neutrophil count
 neutrophils fight stuff off
 worry about immunosuppression and infection
o at rx for these
 rx factors
o age (elderly)
o renal and liver function
o Nutrition!!!
 Deficiencies
o bone marrow
o medications
 chemo
o prior chemotherapy and/or radiation
o environmental (nosocomial)
o organisms (bacterial, viral, fungal)
o nosocomial infections/
 leukopenia is more broad
 manifestations: can tell if patients have neutropenia if
o cough, fever, urinary retention, rash
o usually can tell they’re not getting better, do lab work
 need a thourough assessment every shift.
o Neuro
o Circ
o Skin
o Mucus/ mouth
o ETC
Absolute neutrophil count
 **most reliable
 Grade 0 = ANC WNL
 Grade 1 = >1500 and <2000
 Grade 2 = >1000 and <1500
 Grade 3 = >500 and < 1000
 Grade 4 = <500
o Grade 4 is really bad. Put them in precautions, worried about infections
Interventions if neutropenic