Acid Base Who is Your Daddy

Introduction toInterpreting ABGs

Acid-Base BalanceThe 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 BalanceAcid-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 thatBlood 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???

ReviewWhat does ABG stand for?Arterial Blood Gas

The ABG measures the dissolved G____ Gasesin the B____Blooddrawn 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 pH7.35 7.45

In the body:pH < 7.35 = acidosis pH > 7.45 = alkalosis

Below 7.2 = death Above 7.6 = death

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

ReviewIf the pH is less than 7.35, the body is in a state of _________ AcidosisWhat 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 BalanceThe 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 ABGpH 7.35 7.45This 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 mmHgThis tells us if the respiratory system is functioning normally

HCO3- 22 26 mEq/LThis 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 7.45Your Daddys last name is Alkalosis

Your First name is determined by the CO2 and HCO3If 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 AcidosisLung diseases such as COPD and severe asthma.Anesthesia and Narcotic OverdoseSevere deformities of the spine and rib cage such as severe scoliosisDiseases that prevent fully expanding lungs and deep respirations (Guillain-Barr syndrome )Airway obstruction

Clinical manifestations include:ConfusionDrowsinessWeaknessDyspneaHyperkalemia (increased K+ >5 mEq/L)

Respiratory AcidosisThis 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.Acid-Base Imbalance

Whos your Daddy?

Babys Last Name ?pH = 7.32 Acidosis

Whats your babys first name?CO2 = 43, HCO3 = 20 Metabolic

Metabolic Acidosis

Metabolic acidosisKidney 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 weaknessMalaiseHeadacheHyperkalemia (increased K+ >5 mEq/L)

Metabolic AcidosisThis 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.Acid-Base Imbalance

Whos your Daddy?

Babys Last Name ?pH = 7.48 Alkalosis

Whats your babys first name?CO2 = 32, HCO3 = 26 Respiratory

Respiratory Alkalosis

Respiratory AlkalosisCommon 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 ChangesPallor around mouthTingling fingersSpasms of hand musclesHypokalemia (decreased K+

Respiratory AlkalosisThis 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.Acid-Base Imbalance

Whos your Daddy?

Babys Last Name ?pH = 7.47 Alkalosis

Whats your babys first name?CO2 = 40, HCO3 = 28 Metabolic

Metabolic Alkalosis

Metabolic AlkalosisSevere sustained vomiting or nasogastric tube suctioning (removes too much acid)

Overdose of baking soda or antacids

Clinical manifestations include:DisorientationLethargyConvulsionsHypokalemia (decreased K+

Acid-Base ImbalanceMetabolic AlkalosisThis 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 7.30CO2 50 HCO3 23

Diagnosis????????

Respiratory Acidosis

What assessments would you expect to find from this patient?

ConfusionDyspneaDrowsinessHyperkalemiaWeakness


pH 7.49CO2 37 HCO3 28

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

Metabolic Alkalosis

What assessments would you expect to find from this patient?

DisorientationConvulsionsLethargyHypokalemia


pH 7.48CO2 32 HCO3 26

Diagnosis??????????

Respiratory Alkalosis

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

Mental status changesPallor around mouthTingling in the fingersSpasms in the handsHypokalemia

If you have a patient with:pH 7.32CO2 40HCO3 20Diagnosis???????????????

Metabolic Acidosis

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

Muscle weaknessMalaiseHeadacheHyperkalemia

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

Interpreting ABG Compensation1. Label the pHpH less than 7.35 = ACIDOSISpH greater than 7.45 = ALKALOSIS2. Label the PaCo2If the PaCO2 is less than 35 = ALKALOSIS More CO2 is being exhaled than normalIf the PaCO2 is greater than 45 = ACIDOSIS Less CO2 is being exhales than normal3. Label the BicarbonateIf the HCO3 is less than 22 = ACIDOSISIf the HCO3 is greater than 26 = ALKALOSIS

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

EXAMPLEpH = 7.35 (acidosis)PaCO2 = 55 (acidosis)HCO3 = 29 (alkalosis)

The client has RESPIRATORY ACIDOSIS

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

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

RESPIRATORY ALKALOSISpH > 7.45PaCO2 < 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 ACIDOSISpH < 7.35PaCO2 = Normal OR 45mmHg with respiratory compensation (CO2 is retained to compensate for excess base)HCO3 >26mEq/l (excess HCO3)


pH 7.30PaCO2 50 HCO3 27Diagnosis????????Compensation?????

pH 7.30 = acidosisPaCO2 50 = acidosis HCO3 27 = alkalosis

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


pH 7.49CO2 44 HCO3 28Diagnosis??????????Compensation??????

pH 7.49 = alkalosisCO2 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 7.48PaCO2 32 HCO3 20

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

pH 7.48 = AlkalosisPaCO2 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 7.32PaCO2 30HCO3 20

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

pH 7.32 = AcidosisPaCO2 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 DiagnosesActual or risk for deficient fluid volume Imbalanced nutrition, less than body requirementsFluid volume excessImpaired or risk for impaired skin integrityImpaired tissue integrityImpaired oral mucous membraneIneffective tissue perfusionDecreased cardiac outputImpaired gas exchangeIneffective breathing pattern

NURSING IMPLEMENTATIONSMonitor Fluid Intake & OutputEducate patient about Fluid ManagementMaintain Dietary & Fluid BalanceSafetyAppropriate Medications as orderedReferals 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 PLAYINGWHOS YOUR DADDY!!!

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

ENJOY!!!!!!!

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Acid Base Who is Your Daddy