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ClinChem Test3

Chpt 9 Assessment of Respiratory Disorders

Glycolysis will falsely decrease the pH and PO2 and increase PCO2
Blood Gas Machines typically require QC to be performed every 8 hours
Blood Gas Machines typically Measure pH, PCO2, PO2, OSAT, CO, MET
Blood Gas Machines typically Calculate TCO2/ HCO3, Base Excess
Patients body temp can affect results and should be collected to make corrections for PCO2 and PO2
Fever or lowering body temp for surgery can greatly affect the results of the blood gas
Arteries typically used for arterial collection: Radial, Brachial, Femoral
Acid base status is determined by comparing the pH of the sample to the reference range. If pH of sample is below the reference range then the patient is acidotic
Common causes of metabolic acidosis include: diseases such as diabetic ketoacidosis (DKA), uremia, renal tubular acidosis, lactic acidosis, and the GI loss of bicarbonate, fluid, and potassium
Another example of metabolic acidosis arises from hypotension secondary to dehydration, which leads to poor tissue perfusion, lactic acid formation, and fluid and electrolyte imbalance
Metabolic alkalosis may stem from vomiting or gastric suctioning, low potassium or chloride levels, and liver cirrhosis with ascites, corticoid excess, and massive blood transfusion
Respiratory Acidosis can result from disease of the respiratory system that cause CO2 retention : Chronic Obstructive Pulmonary Disease (COPD) Blue Bloaters
Respiratory Alkalosis can result from respiratory or systemic diseases that cause hyperventilation and CO2 deficit
The following five factors must be considered to interpret acid-base balance: pH, HCO3,Pco2,anion gap and assessment for compensation
There is a direct relationship between HCO3 and pH based on which equation Henderson-Hasselbalch equation
Henderson-Hasselbalch equation CO2 + H2O = H2CO3 = H+ Hco3-
If both pH and HCO3 are decreased this is Metabolic Acidosis
If both pH and HCO3 are increased this is Metabolic alkalosis
There is an INVERSE relationship between pH and Pco2
If HCO3 is within the reference range and Pco2 is elevated and the patient is acidotic the condition is respiratory acidosis
If HCO3 is within the reference range and Pco2 is decreased but the patient is alkalotic then the condition is respiratory alkalosis
in metabolic or mixed acidosis the anion gap is significantly elevated
the pH, HCO3, and Pco2 are considered together to determine if compensation is occurring
Ventilation is inversely proportional to Pco2
The respiratory system responds rapidly to a change in CSF pH, more so than blood pH
Po2 is the partial pressure of oxygen which is dissolved in the plasma as well as the oxygen saturation So2
Hypoxia, decreased supply of oxygen to tissues is determined based upon Arterial Po2
The hemoglobin molecule can retain or release oxygen at different rates depending upon certain conditions such as pH,Pco2, temperature, or 2,3-DPG levels
In general as pH decreases or as Pco2, temperature, and/or 2,3 DPG increase, the oxygen dissociation curve shifts to the right, indicating that hemoglobin molecule has a lower affinity to oxygen
Two specific diseases fall within the COPD category they are emphysema, an chronic bronchitis
When CO2 is retained it initiates renal compensation, the kidneys retain HCO3 in an effort to return the pH to normal. This leads to increased levels of HCO3 and Pco2 in the body.
At the other end of the COPD spectrum are the “blue bloaters” they are overweight, edematous and cyanotic
If the kidneys are unable to retain additional HCO3 to combat the rising pH due to CO2 retention then pH remains acidotic. This is described as as acute-on-chronic CO2 retention and is associated with ARDS
Infants born before 37 weeks or weighing less than 2500g frequently experience respiratory distress from a lack of lung maturity
Oxyhemoglobin (O2Hb)can be measured using a co-oximeter, a dedicated spectrophotometer
Total Hemoglobin is a product of adding Oxyhemoglobin to Deoxyhemoglobin
Percent saturation = [O2Hb/(O2Hb+HHb)] X 100%
Transcutaneous monitoring of oxygen saturation can NOT measure dysfunctional forms of hemoglobin such as Carboxyhemoglobin, and Methemoglobin
These must be ruled out with an arterial puncture and direct measurement of Oxyhemoglobin
CO is the most commonly encountered toxic gas
Created by: Mgoodall