Question

Mr. Blue is a 45 year old who came into the ED for shortness of breath. He has a medical history of asthma. Upon assessment, you find cyanosis of the lips, a productive cough, temp is 102.1, BP 135/89, HR 110, RR 34, and has rapid and shallow breathing. Breath sounds are diminished bilaterally and you hear coarse rhonchi in the upper lobes. X-ray indicates bilateral pneumonia.

ABG is drawn:

pH 7.42

PCO2 24

HCO3 24

What does this ABG indicate? Compensated or Uncompensated? Is this respiratory of metabolic? Is this alkalotic or acidotic?

What are 3 nursing interventions you can provide to help Mr. Blue clear his airways?

What are 2 medications you expect the physician to order for Mr. Blue?

Answer 1

ABG stands for Arterial Blood Gas test. It is used to determine whether or not the patient is suffering from pH abnormalilties and if the underlying cause is respiratory or metabolic. The ABG test results for Mr. Blue along with the normal levels are given below:

Parameters	Normal levels	Patient levels
pH	7.35 - 7.45	7.42
pCO2	35 - 45 mm Hg	24 mm Hg
pHCO3	22 - 26 mEq	24 mEq

Analysis: The patient shows normal pH and HCO₃ levels but lowered CO₂ levels. This indicates compensation for abnormal pH levels have occured by lowering CO₂ levels. A lowered CO₂ level means less amount of acid in blood as CO₂ is a weak acid. Hence, this indicates alkolosis. Levels of CO₂ along with HCO₃ indicates if the condition has underlying metabolic or respiratory cause. In a metabolic disorder, the HCO₃ levels would also become abnormal. As it is a base, it levels would rise in case of an alkolosis. But no such thing occurs. Hence the condition must be respiratory.

Thus, the patient suffers from compensated respiratory alkolosis.

Nursing interventions:

3 nursing interventions that can be provided to the patient to help clear his airways are:

• As the patient is asthmatic, he must be placed in an optimal position to breath, with head of bed elevated at a 45 degree angle.
• He may be provided with prescribed medications, including his inhaler to assist in breathing. Breathing assistance can also be provided by breathing into a paper bag to prevent hyperventilation and regulate breathing rates and also by providing him with oxygen.
• Patient also must be helped to clear his airways by controlled coughing and removing mucus secretions from pharynx.

Medications:

Two medications expected to be prescribed for the patient are:

• Penicillin antibiotic in case of bilateral pneumonia for bacterial infection.
• Anti viral drugs such as ostelamivir, perimivir to reduce the viral infection, if that is the underlying cause of pneumonia.

Respiratory alkolosis is usually not life threatening. Hence the symptom itself is not treated but doctors would work to eliminate the underlying condition. So, Mr. Blue will likely be prescribed antibacterial or antiviral drugs to treat his pneumonia.

In most cases, cough suppressants are not given. However incase of extreme pain and headache, pain relief and cough suppressants such as aspirin and ibuprofen may be given. As the patient is asthmatic, his inhaler medication dosages may also be adjusted.