Introduction to Interpreting ABGs

Acid-Base Balance
The body has three systems that work to keep the pH in the narrow range of normal. Blood buffers: Buffers circulate throughout the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions. Lungs: By speeding up or slowing down respirations, the lungs can increase or decrease the amount of carbon dioxide in the blood. Kidneys: They excrete varying amounts of acid or base. The three systems work closely together to maintain a normal hydrogen ion concentration.

Acid-Base Balance
Acid-base balance means homeostasis of the hydrogen ion concentration in the body fluids. The hydrogen ion concentration is determined by the ratio of carbonic acid to bicarbonate in the extracellular fluid. The ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate. The symbol used to indicate hydrogen ion balance is pH. Arterial blood gases determine whether a solution is acid, neutral, or alkaline; the more hydrogen ions in a solution, the more acid is the solution, and the fewer hydrogen ions, the more alkaline is the solution.

Objectives
1. Define ABG
2. Recognize the normal parameters of ABG components (pH, CO2, HCO3) 3. Interpret the acid-base state of the body from the ABG lab report

ABG is the acronym for Arterial Blood Gas

.
A blood gas is exactly that

Blood drawn from an artery (usually the radial, brachial, or femoral artery) Measures the dissolved gases in your bloodstream Provides one of the best measurements of the acid-base balance in the body

Allens Test

*Pressure over Radial &

Ulnar artery simultaneously

*Open & close hand repeatedly

hand blanches

* Hold hand up and release pressure

from ulnar artery to assess color of hand

* If pinkness fails to return in 6 seconds

the ulnar artery is insufficient Whats wrong with this picture???

Review
What does ABG stand for? Arterial Blood Gas The ABG measures the dissolved G____ Gases in the B____ Blood drawn from an A______ Artery

What is pH?

The pH is the measurement of hydrogen ions in a solution like our blood. pH is measured on a scale of 0 to 14 Pure water has a pH of 7.0 which is termed neutral Our body solutions are slightly on the alkaline side but in a very narrow range of 7.35 to 7.45

Normal Blood pH 7.35 7.45

In the body:
pH < 7.35 = acidosis Below 7.2 = death pH > 7.45 = alkalosis Above 7.6 = death

Our body functions in a very narrow range of pH balance!

Review
If the pH is less than 7.35, the body is in a state of _________ Acidosis What is the normal range for pH in the blood? 7.35 to 7.45

If the pH is greater than 7.45, the body is in a state of __________ Alkalosis

Acid Base Balance

The lungs and the kidneys work to buffer the blood to keep it from getting too alkaline or too acidotic Carbon Dioxide (C02) Acid regulated by the lungs = RESPIRATORY System

Bicarbonate (HC03-) Alkaline regulated by the kidneys = METABOLIC System

Normal Ranges of the ABG

pH 7.35 7.45
This tells us if the body is in a normal range or if it it is in a state of acidosis or alkalosis

CO2

35 45 mmHg

This tells us if the respiratory system is functioning normally

HCO3-

22 26 mEq/L

This tells us if the metabolic system is functioning normally

Now we are ready to interpret ABGs!

When we get the lab results, its just like somebody handed us a little baby ABG and asked us to look at the lab results and name our baby ABG.

Naming your baby ABG

We need to determine our baby ABGs first name (Respiratory or Metabolic) and last name (Acidosis or Alkalosis) And to do this..

To name our baby ABG, we need to determine first

Whos Your Daddy?

Your last name is determined by the pH. (P = Poppa)

If the pH is <7.35 Your Daddys last name is Acidosis
If the pH is >7.45 Your Daddys last name is Alkalosis

Your First name is determined by the CO2 and HCO3

If the CO2 is outside the normal range of 35-45, your first name is Respiratory If the HCO3 is outside the normal range of 22-26, your first name is Metabolic

Studio Audience Participation !

As members of the studio audience, I am asking you to help determine for these baby ABGs

Whos Your Daddy?

Whos your Daddy?

Babys Last Name ?
pH = 7.33 Whos your Daddy? Acidosis

Whats your babys first name?

CO2 = 47, HCO3 = 22 Respiratory

Respiratory Acidosis

Respiratory Acidosis
Lung diseases such as COPD and severe asthma. Anesthesia and Narcotic Overdose Severe deformities of the spine and rib cage such as severe scoliosis Diseases that prevent fully expanding lungs and deep respirations (Guillain-Barr syndrome ) Airway obstruction Clinical manifestations include:
Confusion Drowsiness Weakness Dyspnea Hyperkalemia (increased K+ >5 mEq/L)

Acid-Base Imbalance
Respiratory Acidosis This is caused by any condition that impairs normal ventilation. A retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood. As the pH falls, the Pco2 level increases. Shallow respirations result because of the retained carbon dioxide. Treatment is aimed at improving ventilation; correcting the primary condition responsible for the imbalance.

Whos your Daddy?

Babys Last Name ? pH = 7.32 Acidosis
Whats your babys first name? CO2 = 43, HCO3 = 20 Metabolic

Metabolic Acidosis

Metabolic acidosis
Kidney failure, shock, and diabetic ketoacidosis (which will cause Kussmauls respirations in trying to blow off the acid abnormally deep, regular & increased in rate) Ileostomy (Intestinal secretions are high in bicarbonate & are lost through an ileostomy) Swallowing toxic substances such as antifreeze or excessive amounts of aspirin

Clinical manifestations include:

Muscle weakness Malaise Headache Hyperkalemia (increased K+ >5 mEq/L)

Acid-Base Imbalance
Metabolic Acidosis This can result from a gain of hydrogen ions or a loss of bicarbonate: retaining too many acids or losing too many bases. Without sufficient bases, the pH of the blood falls below normal; the bicarbonate level will also drop. The effect is hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level. Treatment is the administration of sodium bicarbonate.

Whos your Daddy?

Babys Last Name ? pH = 7.48 Alkalosis
Whats your babys first name? CO2 = 32, HCO3 = 26 Respiratory

Respiratory Alkalosis

Respiratory Alkalosis
Common causes include hyperventilation, anxiety, and fever (blow off too much CO2) Any lung disease that leads to shortness of breath & hypoxia (like pneumonia) Clinical manifestations include:
Mental Status Changes Pallor around mouth Tingling fingers Spasms of hand muscles Hypokalemia (decreased K+ <3.5 mEq/L)

Acid-Base Imbalance
Respiratory Alkalosis This is caused by hyperventilation. Respirations that increase in rate, depth, or both can result in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood. The pH rises because of the decrease in carbonic acid being blown off with each exhalation. Treatment is sedation and reassurance; breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide.

Whos your Daddy?

Babys Last Name ? pH = 7.47 Alkalosis Whats your babys first name? CO2 = 40, HCO3 = 28 Metabolic

Metabolic Alkalosis

Metabolic Alkalosis
Severe sustained vomiting or nasogastric tube suctioning (removes too much acid) Overdose of baking soda or antacids
Clinical manifestations include:
Disorientation Lethargy Convulsions Hypokalemia (decreased K+ <3.5 mEq/L)

Acid-Base Imbalance
Metabolic Alkalosis
This results when a significant amount of acid is lost from the body or an increase in the bicarbonate level occurs. The most common cause is vomiting gastric content, normally high in acid. It can also occur in patients who ingest excessive amounts of alkaline agents, such as bicarbonate-containing antacids. The central nervous system is depressed. Treatment is aimed at the cause.

If you have a patient with:

pH 7.30
CO2 50

HCO3 23

Diagnosis????????

Respiratory Acidosis

What assessments would you expect to find from this patient?

Confusion Dyspnea Drowsiness Hyperkalemia Weakness

If you have a patient with:

pH 7.49
CO2 37

HCO3 28

Diagnosis?????????????

Metabolic Alkalosis

What assessments would you expect to find from this patient?

Disorientation Convulsions Lethargy Hypokalemia

If you have a patient with:

pH 7.48 CO2 32

HCO3 26

Diagnosis??????????

Respiratory Alkalosis

What would you expect to assess a patient with Respiratory Alkalosis?

Mental status changes Pallor around mouth Tingling in the fingers Spasms in the hands Hypokalemia

If you have a patient with: pH 7.32 CO2 40

HCO3 20
Diagnosis???????????????

Metabolic Acidosis

What would you expect to see in a patient with Metabolic Acidosis?

Muscle weakness Malaise Headache Hyperkalemia

COMPENSATION
A process where healthy regulatory systems will attempt to correct acid-base imbalances.

Interpreting ABG Compensation

1. Label the pH
pH less than 7.35 = ACIDOSIS pH greater than 7.45 = ALKALOSIS

2. Label the PaCo2

If the PaCO2 is less than 35 = ALKALOSIS More CO2 is being exhaled than normal If the PaCO2 is greater than 45 = ACIDOSIS Less CO2 is being exhales than normal

3. Label the Bicarbonate

If the HCO3 is less than 22 = ACIDOSIS If the HCO3 is greater than 26 = ALKALOSIS

COMPENSATION (continued)
Determine the cause of the acid-base imbalance Look at the pH Acidosis or Alkalosis? Determine the origin of the imbalance Is it Respiratory or Metabolic? Which one (PaCO2 or HCO3) matches the pH? The one that matches is the origin of the imbalance.

EXAMPLE
pH = 7.35 (acidosis) PaCO2 = 55 (acidosis) HCO3 = 29 (alkalosis)

The client has RESPIRATORY ACIDOSIS

*Look at the value that does not match the pH
if it is within normal range, there is NO compensation If it is above or below normal range, there IS compensation

COMPENSATION (continued)
RESPIRATORY ACIDOSIS
pH < 7.35 PaCO2 > 45mmHg (excess CO2 & Carbonic Acid) HCO3 = Normal OR >26mEq/l with renal compensation (the kidneys are retaining HCO3 to minimize the acidosis)

RESPIRATORY ALKALOSIS
pH > 7.45 PaCO2 < 35mmHg (inadequate CO2 & Carbonic Acid) HCO3 = Normal OR < 22mEq/l with renal compensation (the kidneys are are excreting HCO3 to minimize alkalosis)

COMPENSATION (continued)
METABOLIC ACIDOSIS
pH < 7.35 PaCO2 = Normal OR <35mmHg with respiratory compensation (CO2 if being blown off to minimize acidosis) HCO3 <22mEq/l (inadequate HCO3)

METABOLIC ALKALOSIS
pH > 7.45 PaCO2 = Normal OR >45mmHg with respiratory compensation (CO2 is retained to compensate for excess base) HCO3 >26mEq/l (excess HCO3)

If you have a patient with:

pH 7.30
PaCO2 50

HCO3 27

Diagnosis???????? Compensation?????

pH 7.30 = acidosis PaCO2 50 = acidosis HCO3 27 = alkalosis

The first 2 match so.. This is Respiratory Acidosis with renal compensation

If you have a patient with:

pH 7.49
CO2 44

HCO3 28

Diagnosis?????????? Compensation??????

pH 7.49 = alkalosis CO2 44 = Normal HCO3 27 = alkalosis (Metabolic) The pH and HCO3 match and the CO2 is normal so.. This is Metabolic Alkalosis with no compensation

If you have a patient with:

pH 7.48
PaCO2 32 HCO3 20

Diagnosis?????????? Compensation??????

pH 7.48 = Alkalosis PaCO2 32 = Alkalosis HCO3 20 = Acidosis (Metabolic)

The pH and PaCO2 match and the HC03 is Acidosis so.. This is Respiratory Alkalosis with renal compensation

If you have a patient with: pH 7.32

PaCO2 30
HCO3 20

Diagnosis?????????? Compensation??????

pH 7.32 = Acidosis PaCO2 30 = Alkalosis HCO3 20 = Acidosis (Metabolic)

The pH and HCO3 match and the PaCO2 is Alkalosis so..

This is Metabolic Acidosis with respiratory compensation

Nursing Process
Nursing Diagnoses
Actual or risk for deficient fluid volume Imbalanced nutrition, less than body requirements Fluid volume excess Impaired or risk for impaired skin integrity Impaired tissue integrity Impaired oral mucous membrane Ineffective tissue perfusion Decreased cardiac output Impaired gas exchange Ineffective breathing pattern

NURSING IMPLEMENTATIONS
Monitor Fluid Intake & Output Educate patient about Fluid Management Maintain Dietary & Fluid Balance Safety Appropriate Medications as ordered Referals and Community Resources

Review of the Objectives You Met:

1. Defined ABG 2. Recognized the normal parameters of ABG components
(pH = 7.35-7.45, CO2=35-45, HCO3 = 22-26)

3. Interpreted the acid-base state of the body from the ABG lab report

Congratulations !

Weve successfully named our Baby ABGs!

Questions?

THANKS FOR PLAYING

WHOS YOUR DADDY!!!

Whos your Daddy

was developed by
Kim DeBord MS RN ACNP CCRN for Nursing students!!!!

ENJOY!!!!!!!