1. As the pathogenic process of a respiratory disorder intensify,
    The patients arterial blood gas (ABG) values are usually altered to some degree.
  2. pH (Arterial & Venous)
    • Arterial 7.35 � 7.45
    • Venous 7.30 � 7.40
  3. Pc02 (Arterial & Venous)
    • Arterial 35 � 45 mmHg
    • Venous 42 � 48 mmHg
  4. HC03 (Bicarb) (Arterial & Venous)
    • Arterial 22 � 28 mEq/L
    • Venous 24 � 30 mEq/L
  5. P02 (How much O2 is in arterial blood) Arterial & Venous
    • Arterial 80 � 100 mmHg
    • Venous 35 � 45 mmHg
  6. Oxygenated blood is
    Arterial Blood
  7. CO2 is
    An acid in the body
  8. HCO3 is
    • Bicarb is a base and is not easily fixed. Usually means that there are other problems.
    • A patient with a biocarb of 40 would be chronic because it takes time for it to drop
  9. ABG�s have
    1st, middle and last names
  10. First name of an ABG is either
    Uncompensated or Compensated which depends on the pH of the blood
  11. Compensated blood has a pH of
    7.35 � 7.45 (7.40 is normal pH)
  12. The Middle name of an ABG is either
    Respiratory or Metabolic
  13. PaCO2 problem is a
    Respiratory Problem
  14. HCO3 Problem is a
    Metabolic Problem
  15. Last name of an ABG is either
    Acidosis or Alkalosis
  16. A PaCo2 between 35 � 45 is
  17. A PaCo2 of 34 and under is
  18. A PaCo2 46 and above is
  19. A HCO3 between 22 � 28 is
  20. A HCO3 21 and under is
  21. A HCO3 29 and above is
  22. PO2 of
    • 80 � 100 (Normal)
    • 60 � 80 (Mild)
    • 40 � 60 (Moderate)
    • Less than 40 aka <40 (Hypoxemia)
    • Greater than 100 aka 100< Hyperoxia
  23. Example
    • pH of 7.38 is Compensated
    • PaCO2 of 60 is Acidosis
    • PaOs of 61 is Mild
    • HCO3 of 36 is Alkaline
    • Compensated Respiratory Acidosis
  24. High CO2
    pH is Low
  25. Low CO2
    High pH
  26. Acute Alveolar Hyperventilation aka Acute Respiratory Alkalosis
    • Most common cause of hypoxemia
    • As the PaO2 drops, the peripheral chemoreceptors are stimulated, which in turn cause the vent rate to increase
    • This causes the PaO2 to decrease and the pH to increase
  27. Acute Alveolar Hyperventilation
    Acute Respiratory Alkalosis
  28. Acute Ventilatory Failure aka Acute Respiratory Acidosis
    • When a patient us unable to provide the work necessary to move gas into and out of the lungs to meet the normal CO2 production
    • This leads to increased PaCO2 and decreased PaO2
    • Acute vent failure can develop in response to any vent patern that does not provide adequate alveolar ventilation
  29. Acute Ventilatory Failure
    Acute Respiratory Acidosis
  30. Chronic Ventilatory Failure aka Compensated Respiratory Acidosis
    • Has a normal pH with a greater than normal PaCO2 level
    • Most commonly seen in patients with COPD, also seen in several restrictive diseases
    • When an individual hypoventilates for a long period of time, the kidneys work to correct the decreased pH by retaining HCO3
  31. Chronic Ventilatory Failure
    Compensated Respiratory Acidosis
  32. The lungs maintain
    PaCO2, HCO3 and pH levels on a moment to moment basis
  33. The Kidneys maintain
    HCO3 and pH levels (ONLY) during periods of hyperventilation or hypoventilation
  34. Patients can have
    • Chronic, Restrictive or Both
    • Can also have Acute Episodes
  35. Acute Alveolar Hyperventilation Superimposed on Chronic Ventilatory Failure aka Acute Hyperbentilation on Compensates Respiratory Acidosis
    • Like any person a pt with chronic vent failure can also acquire an acute disease (Pneumonia)
    • Some pt�s have a mechanical reserve to increase alveolar ventilation to attempt to maintain their baseline Pa02
  36. Acute Alveolar Hyperventilation Superimposed on Chronic Ventilatory Failure
    Acute Hyperventilation on Compensates Respiratory Acidosis
  37. CO2 retainers
    Are hard to vent
  38. Acute Ventilatory Failure Superimposed on Chronic Ventilatory Failure aka Acute Hypoventilation on Compensated Respiratory Acidosis
    • Some patients with chronic vent failure do not have the mechanical reserve to meet hypoxemic challenges of a respiratory disorder
    • When a patient tries to maintain a baseline PaO2 by increasing alveolar ventilation, they consume more oxygen than is gained
  39. Acute Ventilatory Failure Superimposed on Chronic Ventilatory Failure
    Acute Hypoventilation on Compensated Respiratory Acidosis
  40. Lactic Acidosis aka Metabolic Acidosis
    • Oxygenation is inadequate to meet tissue metabolism so altered biochemical reactions that do not use oxygen are activated (Anaerobic Metabolisms)
    • Lactic Acid is an end product of this
  41. Lactic Acidosis
    Metabolic Acidosis
  42. When acute hypoxemia exists
    Lactic acid is expected (Lactic/Metabolic Acidosis)
  43. Common Causes of Metabolic Acid-Base Abnormalities
    • Metabilic Acidosis
    • Lactic Acidosis (Most Common)
    • Ketoacidosis
    • Salicylate Intoxication (Aspirin O/D)
    • Renal Failure
    • Chronic Diarrhea
    • Metabolic Alkalosis
    • Hypokalemia
    • Hypochloremia
    • Gastric Suctioning
    • Vomiting
    • Excessive Corticosteroids
    • Excessive Sodium Bicarb
    • Diuretic Therapy
    • Hypovolemia (Dehydration)
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Patent Assessment