Question

Page 1 of 4 Dropbox 1 Dropbox 1 Part A The table below presents results from two arterial blood gas (ABG) analyses. Analyze each of the results and respond to the following questions. Worth 60 points. Due Friday Part I: For each sample, indicate if the ABG results are: 1. Respiratory or Metabolic, normal, acid, or alkaline Part i: Discuss each of the following specific to the ABG results 1. Possible causes 2. Patient 3. Assessment parameters 4. Medical management 5. Nursing management 7407.45 7.29 72 26 741 6.89 7.35 7.31 7.44 7.487.31 48 pH 34 47 46 20 28 26 25 27 29 16 29 Part B The case study below presents a patient scenario. Analyze the information in the case study and respond to the following questions. Worth 30 points. Due Friday Infant Case Study Kirsten, a 3-month-old infant, has begun to have frequent loose stools that progress to a watery diarrhea. She is unresponsive, with dry mucous membranes, sunken fontanels, and oliguria. She has tachypnea and tachycardia 1. Based on the information provided, analyze the acid-base imbalance Kirsten is experiencing 2. Evaluate how this imbalance is affecting her ability to compensate. Relate the rationale for each of the manifestations that Kirsten is experiencing. 4. Discriminate the cause of oliguria. Assess how this complicates the situation 5. Formulate nursing and medical interventions that may posiively affect Ki acid-base Dropbox 1 Rubric Part A: Arterial Blood Gas (ABG) Analysis Dropbox Assignment 1: Part A

Answer 1

Part 1.

A. ABG 1 is normal

- ABG 2 is metabolic acidosis

- ABG 3 is respiratory acidosis

- ABG 4 is metabolic acidosis

- ABG 5 is normal

- ABG 6 is respiratory alkalosis

- ABG 7 is metabolic acidosis

-ABG 8 is normal

- ABG 9 is metabolic alkalosis

- ABG 10 is respiratory acidosis

B. ABG 1 is normal

- ABG 2 is uncompensated

- ABG 3 is uncompensated

- ABG 4 is , uncompensated

- ABG 5 is normal

- ABG 6 is respiratory alkalosis

- ABG 7 is metabolic acidosis

-ABG 8 is normal

- ABG 9 is metabolic alkalosis

- ABG 10 is uncompensated

Part 2.

1. Metabolic Acidosis

a condition characterized by a deficiency of bicarbonate ions in the body in relation to the amount of carbonic acid in the body, in which the pH falls to less than 7.35

Causes of Metabolic Acidosis

- Diabetic Ketoacidosis - Lactic acidosis - Starvation - Severe diarrhea - renal failure - GI fistulas - shock

Pathophysiology of Metabolic Acidosis

-Gain of fixed acid ,inability to excrete acid, or loss of base.

-Compensatory response of CO2 excretion by the lungs (Resp. Alkalosis) increase RR

Lab findings of Metabolic Acidosis

-Plasma pH increase -PaCO2 normal (uncompensated) -PaCO2 decrease (compensated) -HCO3 decrease -Urine pH <6 (compensated)

Neuro Sign & Symptoms of Metabolic Acidosis

-Drowsiness -Confusion -HA -Coma

CV S&S of Metabolic Acidosis

-Decrease BP -Dysrhythmias (related to hyperkalemia from compensation) -Warm, flushed skin (peripheral vasodilation)

GI S&S of Metabolic Acidosis

-N/V/D, abdominal pain

Resp. S&S of Metabolic Acidosis

-Deep, rapid respiration (compensation by the lungs)

2. Metabolic Alkalosis

a condition characterized by an excess of bicarbonate ions in the body in relation to the amount of carbonic acid in the body; the pH rises to greater than 7.45

Causes of Metabolic Alkalosis :-

-excessive vomiting -prolonged gastric suctioning -electrolyte disturbances (hypokalemia) -Cushing's disease -excessive NaHCO3 intake -OD on baking soda -diuretics -excessive mineralocorticoids.

#. Signs & Symptoms

mostly related to movement of Ca (decreased Ca ionization)

tingling of fingers and toes

dizziness

carpopedal spasm (Trousseau sign)

depressed respirations (b/c of compensation trying to hold CO2)

paralytic ileus (gut shuts down to hold HCO3)

# Diagnostic Findings

ABGs (increased pH and HCO3)

decreased respirations (shallow breathing) to hold CO2

hypokalemia

urine chloride

# Medical Management

eliminate the cause (too much bicarb, to much loss of acid)

use antiemetics, H2 blockers

correct electrolyte imbalances

give calcium gluconate

correct fluid volume depletion

# Calcium Gluconate

give to patient to correct calcium imbalance in patient with carpopedal spasms or tingling fingers/toes

3. Respiratory Alkalosis

Characterized by a pH > 7.45

PaCO2 < 35 mmHg

Always caused by hyperventilation, leading to carbon dioxide deficit

# Pathophysiology and Etiology: Acute Respiratory Alkalosis

pH rises rapidly as PaCO2 falls

--Kidneys unable to adapt rapidly bicarbonate level remains within normal limits

Anxiety-based hyperventilation is most common cause

Physiological causes of hyperventilation, include high fever, hypoxia, anesthesia and mechanical ventilation

Pathophysiology and Etiology: Chronic Respiratory Alkalosis

Kidneys compensate eliminate bicarbonate

Restore bicarbonate to carbonic acid ration

Bicarbonate level is lower than normal

pH may be close to normal range

# Results of Alkalosis

Increases binding of extracellular calcium to albumin

-Reduces ionized calcium levels

Neuromuscular excitability increases

Manifestations similar to hypocalcemia develop

Low CO2 levels cause vasoconstriction of cerebral vessels

# Risk Factors

Anxiety disorders with hyperventilation

Mechanical ventilation settings

--Breaths per minute too high

--Peak pressures too high

# Clinical Manifestations

Light-headedness

Feeling of panic and difficulty concentrating

Circumoral and distal extremity paresthesias

Tremors

Positive Chvostek's sign

Trousseau's sign

Tinnitus

Sensation of chest tightness

Palpitations

Seizures and loss of consciousness

ABGs

Show pH > 7.45

PaCO2 < 35mmHg

Chronic hyperventilation

Collaboration

Environmental

Calm, quiet, low stimulation

Reduce anxiety or panic

ABGs prior to meds or O2 therap

# Pharmacologic Therapies

Anti-anxiety agent

-Relieve anxiety

-Restore normal breathing pattern

# Respiratory Therapies

Paper bags can cause hypoxia

-Historically recommended

-Will help raise CO2 levels but may trigger panic attacks

-Other diseases can mimic hyperventilation

-Further hypoxia further cellular damage

4. Respiratory Acidosis

inadequate ventilation -> decreased excretion of CO2

hercapnia

carbonic acid excess -> pH below 7.35

Respiratory system can't rid the body of enough CO2 to maintain the pH balance; sometimes caused by decreased respirations or inadequate gas exchange

# Causes of Respiratory Acidosis :-

acute

chronic

# Acute Causes

-airway obstruction; food, foreign body, cardiac/resp arrest, pulmon. edema, acute bronchitis, atelectasis, ARDS, pneumonia (anything that constricts/occludes airway preventing exhalation)

-drugs; over dose of anesthetics, sedatives, narcotics

-head injuries; can interfere with signals from brain to lungs

-neuromuscular; impaired muscles round lungs prevent chest expansion

-mechanical ventilator; increase respirations

# Chronic Causes

COPD

obstructive sleep apnea

obesity

*the pH may be more to normal level

*CO2 will be increased

*if compensated, bicarb increased as well

# Signs & Symptoms

-breathing; slowed or difficult, retain CO2, late signs = cyanosis

-CNS; HA, drowsy, restless, tremor, cofusion, disorientation -> COMA (cerebral vasodilation, increased bloodflow to brain) & death

-increased HR, lack of energy, weakness

-hyperkalemia (as H+ moves into cells to compensate)

*always physically ASSESS the pt; listen to pt's family for clues to pt's normal

# Diagnostic Findings

ABG's

pH decreased; CO2 increased

kidneys attempt to compensate by holding HCO3 and excreting H+ (2-3 days)

# Other Diagnostic Clues

serum electrolytes; K, Mg, Ca

chest x-ray

drug screen; determine if drugs that could already have an effect on resp acidosis are currently in the system (such as; anesthetics, hypnotics, opioids, sedatives)

EKG; hyperkalemia could cause arrhythmias

# Medical Management

improve respiratory ventilation via:

-mechanical ventilation

-bronchodilators, antibiotics, anticoagulants

-pulmonary hygiene; coughing, turning, deep breathing INCENTATIVE SPIROMETER postural drainage

-adequate hydration

-supplemental oxygen (beware if chronic hypercapnia) *COPD pt's are accustomed to increased CO2 levels; a lack of O2 called hypoxic drive stimulates these pt's to breathe

-monitor I&O, VS (always include O2 sat), ABGs