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ABG II Final

QuestionAnswer
A patient arrives at the emergency department with a presumed exacerbation of COPD. He is receiving oxygen by nasal cannula at 2 l/min and appears to be in moderate respiratory distress. What actions should the RT recommend? Obtain an arterial blood gas
Compensation for respiratory alkalosis occurs through which of the following? Renal excretions of HCO3-
Which two organs are primarily responsible maintain the acid-base balance of the body? Pulmonary and Renal
What is the best parameter for evaluating a patient's ventilation PaCO2
Which of the following laboratory results would be considered abnormal as they pertain to the medical history of a 35-yr. old female PT? I. AN arterial oxygen tension of 78 mmHg on .21 III. An oxyhemoglobin saturation of 88%
WHat test is useful for evaluating the blood-clotting ability of your PT? Platelet Count
What explains the lack of an increased anion gap seen in metabolic acidosis caused by HCO3- loss? For each HCO3- ion lost, a Cl- ion is reabsorbed by the kidney
Which of the following are considered the main fluid compartments of the body? I. Interstitial II. Intracellular IV. Extracellular
A PT has a Na+ level of 140 and Cl- level of 110 mmoles. The blood gas results are as the following: pH: 7.19 PaCO2: 16 mmHg HCO3-: 11 mEq/L PaO2: 61 mmHg Based on this information what is the PT anion gap? 19
A homeless man, long history of substance abuse, is being admitted to the ER for intoxication. There is some suspicion he may also have ingested antifreeze. Been treated for uremia alcohol ketoacidosis starvation. this Pt is probably in? Metabolic Acidosis with a high Anion Gap
Hypoxia is best defined as a condition in which what occurs? Tissue oxygen delivery is inadequate to meet cellular needs
A low cardiac output is an example of? Circulatory Hypoxia ( Stagnant Hypoxia)
What term is used to describe a red blood cell count that is below the normal values? Anemia
PT brought in to the ER after house fire. Might have Carbon monoxide poisoning. Which would confirm this Hemoximeter Analysis
What term is used to describe a red blood cell count that is above normal value? Polycythemia
WHy is it important to keep the PT's PaO2 greater than 60 mmHg? Level of 60 mmHg marks the beginning of the steep part of the O2 HB dissociation curve
A PaO2 of 40 mmHg is classified as ____________ hypoxemia ? Severe
Which of the following are potential causes of hypoxemia? Decrease in the arterial PO2 Decrease in the available Hb Hb saturation abnormalities (Carboxyhemoglobin )
Whihc of the following carries the majority of the oxygen to the tissues via the blood? Chemically bonded to hemoglobin
Which of the following indicates a diffusion defect? Widened A-a gradient
After obtaining an arterial blood sample what should you do? Apply pressure to the puncture site until bleeding stops Place the sample in a transport container with ice Mix the sample by rolling and inverting the syringe.
An outpatinet scheduled for an arterial blood sample enters the pulmonary lab 20 minuutes late and out of breathe, having run up fouur flights of stairs. What shouuld you do? Wait 5 minutes before taking the sample
What chart information should be checked before performing artery puncture? PT primary diagnosis and history Presence of bleeding disorders or blood-borne infections Respiratory care orders Anticoagulant or thrombolytic drug prescriptions
THe respiratory therapist documents the presence of a positive Allen test if? The palm and fingers flush pink within 10 seconds after releasing pressure on the ulnar artery
Performing CPR on Motor vehicle accident adequacy of chest compressions which artery is most appropriate for RT to palpate? Carotid Artery
All of the following can help avoid the problem of arterial blood sample contamination with air except? Mixing before expelling air
Compared with arterial blood a blood gas sample contaminated by an air bubble will have which of the following? Increased PaO2, Decreased PaCo2, Increased pH
While performing a blood gas analysis on a PT who is breathing room air, you note the following values? PaO2 110, PaCo2 47 Ph 7.43 Pt blood gas results should be Discarded because the are not physiologically possible
Respiratory Disorders Pathological process which disrupts acid base balance due to effects on the lungs
Respiratory Acidosis PaCo2 over 45 mmHg = Hypoventilation
Respiratory Alkalosis PacO2 is unders 35 mmHg Hyperventilation
Metabolic Disorders Pathological process which disrupts acid base balance due to their effect on anything other than the lungs
Metabolic Acidosis HCO3- is lower than 22
Metabolic Alkalosis HCO3- is higher than 26
Arterial Blood Gas values pH < 7.35= Academia 7.45<=Alkalosis PaCo2 35-45 HCO3- 22-26 PaO2 80-100 SpO2 95-100
Start with pH less than 7.35 acedemia higher that 7.45 alkalosis Check PaCo2 Same way it's Metabolic Opposite it's Respiratory
PaO2 formula PaO2=FiO2 (Pb-P h20)-PaCo2/RQ FiO2=.21 Pb= 760 Ph20= 47 RQ= .8
What is the Alveolar arterial gradient equation PAo2-PaO2= A-a gradient
List the three barriers of diffusion Alveolar membrane Interstitial Space Capillary Membrane
What is the arterial oxygen content equation CaO2= (PaO2 x.003) + (1.34 x Hb x SaO2)
What is the Venous oxygen content equation CVO2= (PvO2 x .003) + (1.34 x Hb x SvO2 )
What is the arterial venous oxygen content equation C(a-v) O2
What is the PaO2 of an oxygen saturation of 70% 40 mmHg
What is the SaO2 of a PaO2 of 50 mmHg 80%
What is the PaO2 of an SaO2 of 90% 60 mmHg
What is the SaO2 of a PaO2 of 100 mmHg 97%
Which way does the HBO2 dissociation curve go on Acidosis Right
Which way does the HbO2 dissociation curve go an hypothermia Left
Which way does the HbO2 dissociation curve go on High 2,3-diphosphpglycerate Right
HbO2 curve on a fever Right
HbO2 curve on hypercapnia Right
HbO2 curve on Carboxyhemoglobin Left
Inadequate delievery of O2 to the tissues is known as Hypoxia
Low levels of O2 in the blood Hypoxemia
When blood passes throuhg no areas of ventilation what is that physiologic Shunt
What is the most common causes of low blood o2 in patinets with lung disease Ventilation perfusion imbalances
PT with pulmonary fibrosis have an what defect that results in low blood O2 levels diffusion
Low blood pressure results in what and poor tissuue O2 delivery Shock
Myocardial infarction is an example of what ischemia
Increased what may result in increased levels of Co2 in the blood dead space ventilation
Drug overdose may result in inadequate ___________ due to CNS depression minute/alveolar ventilation
Pt with severe COPD are unable to maintain adequate ventilation duue to what ventilation -perfusion
A room air blood gas reveals the following : pH 7.50 PaCo2 30 PaO2 110 WHat should the RT do Report the results to the physician
Bufferes are composed of what Acids and Bases
What does ventilation remove from the body and help eliminate acids Co2 and the H+ bind to make H20
Henderson-Hasselbach equuation pH= 6.1 + log [ HCO3-/PcO2 x.03]
Respiratory acidosis primary defect and compensation Increased PaCO2 Increased HCO3- Hypoventilation
Respiratory Alkalosis Decreased PaCo2 Decreased HCO3-
Metabolic Acidosis decreased HCO3- Decreased PaCo2
Metabolic Alkalosis increased HCO3- Increased PaCo2 `
what is the rule of thumb on determining the expected increase in bicarbonate for any acute increase in Carbon dioxide? HCO3- rises by 5 mEq/L every 10 mmHg of increases in PaCO2 above 40 mm Hg
What is noraml anion Gap 9-14
three common causes of anion gap metabolic acidosis Lactic Acidosis Ketoacidosis Renal Failure
Signs of respiratory compensation for metabolic acidosis dyspnea kussmal's breathing (gasping)
What are neuurological sysmptoms of severe acidosis Lethargy to Coma
Waht is the anion gap equation AG= Na+ - (Cl+ HCO3-)
Normal values fo Na+ 135-145 mmol/L
Normal values for K+ 3.5-5.0 mmol/L
normal values for HCO3- 22-26 mEq/L
Normal values of Ca++ 8.5-10.0 mg/dL
Normal values of Cl- 97-108 mmol/L
Respiratory Acidosis causes Hypoventilation CNS depression due to drug overdose
Respiratory Alkalosis causes Hyperventilation Anxiety
Metabolic Acidosis Ketoacidosis , diabetes
Metabolic alkalososis Loss of H+ vommiting Loss of HCO3- diarrhea
two common types of electrochemical analyzers Galvanic Polargaphic
List four reason's why Radial artery is the preferred site Near Surface Easy to Palpate Collateral Circulation in Ulnar artery Not near any large veins Pain free site
What is the modified Allen test Clench hand to tight fist Apply pressure to radial and ulnar artery Open hand palm will be white remove pressure on ulnar Artery If its positive hand will become pink in 10 seconds
Four other sites you can usue if the radial artery is unavailable Brachial Femoral Dorsalis Temporal infants
How long should you wait after changing the FiO2 before performing an ABG on a PT with healthy lungs? COPD? 5 min for healthy lung 20 to 30 min for COPD lung
What helps prevent hyperventilation from pain or anxiety? Apply local anesthetic or lidocane
two anticoagulants (clot preventors) Warfin Heparin
Two thrombolytics ( clot busters) Streptoknase Tissue plasminoge activator
Four things you can do to avoid most preanlytical sampling error Air in sample Venous Admixture Excess Anticoagulant Metabolic Effect
Precauutions you take before handling lab specimins GLoves, Recap sample, Ice , Disopse sharp edges properly
Three primary parameters measuured by a blood gas analyzer pH PaCo2 PaO2
What device do you use to meauusre acutal hemoglobin satuuration Hemoximeter
Range of accuracy for most commercially available pulse oximeter 3% to 5%
What PT is capillary sampling appropriate? Infants and small children
Common errors committed during capillary sampling ? Squeezing the puncture site Not warming the skin
Variables that are reliable in capillary sampling compared to arterial sampling PO2 not valuuable for capillary pH and PaCo2 give rouugh estimates compared to arterial
Advantages for transcutaneous gas monitoring Noninvasive Continuous
Disadvantages of transcuutaneous gas monitoring Not sueful for short term procedures/ emergencies Poor Correlation of Values in Some cases
Proper pplacement of capnometer for patient mechanically ventilates? Btwn Pt and Wye connector of Vent circuit
Normal end tidal CO2 values for healthy individuals? What is the difference from arterial 35-43 (5% to 6% ) 1 to 5 less than arterial values
End tidal of "0" indicates a serious problem 2 life threatening causes of a "0" valeu for end-tidal Co2 Esophageal intubation Cardiac Arrest
WHat does it mean when the end tidal Co2 measurement you notice that the baseline does not return to "0" on inspiration what does this mean? Re breathing
end tidal Co2 measurement you notice that there is no plateau why? Left ventricular failure/ shock Airway obstruction/ COPD
three most common casues of oxygen analyzer malfunctions? Low batteries Sensor depletion Electronic Failure
WHat are the three general areas that a blood gas helps to assess? Ventilation Oxygenation Acid-Base Balance
Max time between ABG sampling and analysis? 15 minutes
two primary benefits of indwelling peripheral arterial lines? Continuous pressure monitoring Ready access for blood sampling
two primary hazards of indwelling peripheral arterial lines? increase of infection increase risk of thrombosis
Point of care testing Measures blood gas and other values at bedside
Why is point of care testing beneficial reduces turnaround time improve care lowers cost may decrease the need for personal and complex lab equipment
What is a capnometry measures Co2 in Res Gases and are continuous
What is a Capnography Real time graphic display of CO2 levels during breathing
Clinical signs of hypoxemia abnormal breath sounds Labored breathing tachycardia tachypnea
WHy might a pulse oximeter read 100% with clinical signs of hypoxemia Pt could have carbon monoxide poisoning
Range of Po2 that is possible of an SpO2 of 100% 100-600
Transcutaneouus monitoring provides what? a noninvasive way to assess oxygenation in terms of keeping a minimally acceptable PaO2 and avoidng hyperoxia
simpliest way to assess oxygenation pulse oximeter
If Pt Co2 levels rise what you do Manlly ventilate or increase ventilation to decrease the CO2 Capnometry helps
increases levels of CO2 causes increases levels of intracranial pressures why? Co2 is = vasoactive increase vasodilation blood vessels dilate take up more space in brain skull doesn't expand ICP goes p
COmplications of Arterial puncture hematoma infection nerve damage
Created by: Meares8321