Nurs220 PowerPoint Presentation

A health promotion project directed towards PACU nurses regarding the collection and interpretation of ABGs. Also reviews interventions that can be taken to correct each acid-base imbalance.

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Nurs220 PowerPoint Presentation

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A health promotion project directed towards PACU nurses regarding the collection and interpretation of ABGs. Also reviews interventions that can be taken to correct each acid-base imbalance.
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  1. Health Promotion Power PointJanet BenedictColorado Mesa UniversityNURS 220Spring 2nd ½ 2015

    Slide 1 - Health Promotion Power PointJanet BenedictColorado Mesa UniversityNURS 220Spring 2nd ½ 2015

  2. What are ABGs?

    Slide 2 - What are ABGs?

    • Data from an arterial blood sample that tell us about
    • Oxygenation
    • Ventilation
    • Metabolic state
    • 2
  3. You’re Asking-Why is this important to me?

    Slide 3 - You’re Asking-Why is this important to me?

    • Advance professionally
    • Be proactive with your patients care
    • Give the best care possible
    • 3
  4. Three Main Objectives

    Slide 4 - Three Main Objectives

    • To learn the proper method of sample collection
    • To learn basics of ABG interpretation
    • To learn interventions
    • 4
  5. FirstObtain an Arterial Sample

    Slide 5 - FirstObtain an Arterial Sample

    • From an arterial line
    • Or
    • From a peripheral stick
    • 5
  6. CommonPre Analytic Errors

    Slide 6 - CommonPre Analytic Errors

    • Dilution caused by flush solution
    • Mixture of venous and arterial blood
    • Air bubbles in the sample
    • Inefficient mixing with heparin
    • Hemolysis of blood cells
    • Delay in processing (30 min)
    • 6
    • (Pramood, Gunchan, & Sandeep, 2010)
  7. Arterial Line Sample

    Slide 7 - Arterial Line Sample

    • Make certain that you remove an adequate amount of flush solution from the line prior to blood collection!!!!
    • 7
    • (Pramood, et al., 2010)
  8. Peripheral Blood Sample

    Slide 8 - Peripheral Blood Sample

    • Make sure that you are obtaining arterial blood
    • If it takes too long you will observe hemolysis
    • Prior to puncturing radial artery do a Modified Allen’s test!
    • 8
    • (Blevins, 2014)
  9. Modified Allen’s Test

    Slide 9 - Modified Allen’s Test

    • Have patient clinch fist
    • Occlude both radial and ulnar arteries
    • While occluding, have patient open fist (palm and fingers should look blanched)
    • Release pressure from ulnar artery (hand should flush within 5 to 15 seconds)
    • 9
    • (Gragham, 2014)
  10. Positive=Hand flushes

    Slide 10 - Positive=Hand flushes

    • Negative=Hand does not flush (Do not puncture radial artery)
    • 10
    • (Gragham, 2014)
  11. Pop Quiz

    Slide 11 - Pop Quiz

    • What is the purpose of the Modified Allen’s Test?
    • Name three possible pre-analytic errors.
    • 11
    • The answers coming soon so be ready.
  12. Main values that we look at are:

    Slide 12 - Main values that we look at are:

    • PH acid/base
    • PaCO2 partial pressure of carbon dioxide
    • HCO3 bicarbonate levels
    • 12
    • (Gragham, 2014)
  13. Normal Values forABGs

    Slide 13 - Normal Values forABGs

    • PH
    • PaCO2
    • HCO3
    • PaO2
    • BE
    • SaO2
    • 7.35-7.45
    • 35-45
    • 23-33
    • 75-100
    • -2 +2
    • 96-100%
    • 13
    • (Christensen, & Chen, 2013)
  14. Answers to previous questions

    Slide 14 - Answers to previous questions

    • The Modified Allen’s test is used to test ulnar perfusion prior to puncturing the radial artery.
    • Dilution caused by flush solution.
    • Air bubbles in the sample.
    • Hemolysis of blood cells.
    • Mixed sample.
    • Inefficient mixing of heparin.
    • Delay in analysis.
    • 14
    • (Gragham, 2014) (Pramood, et al., 2010)
  15. ABG  Interpretation

    Slide 15 - ABG Interpretation

    • It’s
    • Not Too
    • Complicated
    • Really
    • You can do it!
    • 15
  16. 1st StepLook at the PH to determine Acidosis or Alkalosis?

    Slide 16 - 1st StepLook at the PH to determine Acidosis or Alkalosis?

    • Acidosis
    • <7.35
    • PH
    • 7.35-7.45
    • Normal
    • Or
    • Compensated
    • Alkalosis
    • >7.45
    • (Christensen, & Chen, 2013)
    • 16
  17. 2nd StepLook at the PaCO2to determine respiratory effect

    Slide 17 - 2nd StepLook at the PaCO2to determine respiratory effect

    • PaCO2
    • 35-45
    • Normal
    • Or Compensated
    • (Note how the normal values of PH are similar to the normal values of PaCO2, you just add a 7)
    • < 35
    • Alkalosis
    • Blowing off too much CO2
    • ? Compensating for metabolic acidosis
    • >45
    • Acidosis
    • Retaining CO2
    • ? Compensating for metabolic alkalosis
    • 17
    • (Christensen, & Chen, 2013)
  18. 3rd StepLook at HCO3to determine metabolic effect

    Slide 18 - 3rd StepLook at HCO3to determine metabolic effect

    • HCO3
    • 23-33
    • Normal
    • Or
    • compensated
    • (Note that arterial HCO3 is the same as serum CO2)
    • < 23
    • Metabolic acidosis
    • >33
    • Metabolic alkalosis
    • (McAuley, 2014)
    • 18
  19. It’s all just a BALANCING act

    Slide 19 - It’s all just a BALANCING act

    • The body wants
    • Homeostasis!
    • (McAuley, 2014)
    • 19
  20. By the way

    Slide 20 - By the way

    • What are the normal ranges for the three main values of an ABG?
    • 20
    • The answer will come in after a few more slides.
  21. Ask yourself

    Slide 21 - Ask yourself

    • Is the PH
    • Normal or Abnormal?
    • 21
  22. Is the PaCO2 (respiratory effects) High or Low?

    Slide 22 - Is the PaCO2 (respiratory effects) High or Low?

    • High is
    • Respiratory Acidosis
    • Low is
    • Respiratory
    • Alkalosis
    • 22
    • (Blevins, 2014)
  23. Answer to earlier questionThe three main values we look at are:

    Slide 23 - Answer to earlier questionThe three main values we look at are:

    • PH 7.35-7.45
    • PCO2 35-45
    • HCO3 23-33
    • 23
  24. Is the HCO3 (kidneys control metabolic effects) High or Low?

    Slide 24 - Is the HCO3 (kidneys control metabolic effects) High or Low?

    • High is
    • Metabolic Alkalosis
    • Low is
    • Metabolic
    • Acidosis
    • 24
    • (Blevins, 2014)
  25. Compensation

    Slide 25 - Compensation

    • Normal PH
    • Abnormal PCO2 or HCO3
    • Means either the kidneys or lungs trying to correct acid-base imbalance
    • 25
    • (Blevins, 2014)
  26. Respiratory Systemis FastWill either retain or release CO2 to correct acid-base imbalance

    Slide 26 - Respiratory Systemis FastWill either retain or release CO2 to correct acid-base imbalance

    • Metabolic System (Kidneys)
    • Is Slow
    • Will alter bicarbonate production to correct acid-base imbalance
    • 26
    • (Blevins, 2014)
  27. Acid-Base imbalances and common causes

    Slide 27 - Acid-Base imbalances and common causes

    • 27
  28. Respiratory AcidosisPH low/PaCO2 high

    Slide 28 - Respiratory AcidosisPH low/PaCO2 high

    • Causes
    • (anything that decreases respirations)
    • Hypoventilation
    • Aspiration
    • Sedatives
    • ARDS
    • Sleep apnea
    • (Blevins, 2014)
    • 28
  29. Respiratory AlkalosisPH high/PaCO2 low

    Slide 29 - Respiratory AlkalosisPH high/PaCO2 low

    • Causes
    • (Blowing off too much CO2)
    • Hyperventilation
    • Anxiety
    • Hypoxemia
    • Fever
    • Infection
    • (Blevins, 2014)
    • 29
  30. Metabolic AcidosisPH low/HCO3 low

    Slide 30 - Metabolic AcidosisPH low/HCO3 low

    • Causes
    • (Loss of Bicarbonate)
    • Diarrhea
    • Drugs/Toxins
    • Sepsis
    • DKA
    • Renal failure
    • (Blevins, 2014)
    • 30
  31. Metabolic AlkalosisPH high/HCO3 high

    Slide 31 - Metabolic AlkalosisPH high/HCO3 high

    • Causes
    • (Excess of bicarbonate produced)
    • Cushing’s syndrome
    • Hypokalemia
    • Diuretic and corticosteroid usage
    • Vomiting
    • Dehydration
    • (Blevins, 2014)
    • 31
  32. Pop Quiz

    Slide 32 - Pop Quiz

    • What does HCO3 stand for and what is its significance in the interpretation of ABGs?
    • What organ regulates HCO3?
    • 32
    • Answer coming soon, so be ready.
  33. Now let’s put it all together!

    Slide 33 - Now let’s put it all together!

    • Based on the following ABG results
    • What is your diagnosis?
    • What treatment would be appropriate?
    • 33
  34. Answer to previous question

    Slide 34 - Answer to previous question

    • HCO3 stands for bicarbonate and it reflects metabolic status.
    • The kidneys regulate bicarbonate production to try to maintain homeostasis.
    • 34
    • (Blevins, 2014)
  35. DX-heroin overdose.Breathing-shallow, slow.

    Slide 35 - DX-heroin overdose.Breathing-shallow, slow.

    • ABG results
    • PH: 7.30
    • PaCO2: 55
    • HCO3: 27
    • (McAuley, 2014)
    • 35
  36. Answer isAcute Respiratory Acidosis

    Slide 36 - Answer isAcute Respiratory Acidosis

    • Potential Treatments would be:
    • Increase ventilation
    • Possibly BIPAP or ventilator
    • Treat the cause
    • 36
    • (McCauley, 2014)
  37. HX/DX: 77yo, anxiety, psychosomatic origin. Rapid breathing and slurred speech.

    Slide 37 - HX/DX: 77yo, anxiety, psychosomatic origin. Rapid breathing and slurred speech.

    • ABG results:
    • PH: 7.57
    • PaCO2: 23
    • HCO3: 21
    • 37
    • (McCauley, 2014)
  38. Answer isAcute Respiratory Alkalosis

    Slide 38 - Answer isAcute Respiratory Alkalosis

    • Potential treatment would be:
    • Slow down breathing
    • Paper bag breathing
    • If anxiety is the cause-sedatives might help
    • Treat the cause!
    • 38
    • (McCauley, 2014)
  39. Hx/Dx: 24 yo, DKA, BG 780, has insulin gtt infusing, has received one amp bicarb.

    Slide 39 - Hx/Dx: 24 yo, DKA, BG 780, has insulin gtt infusing, has received one amp bicarb.

    • ABG results:
    • PH: 7.33
    • PaCO2: 25
    • HCO3: 12
    • PaO2: 89
    • 39
    • (McCauley, 2014)
  40. Answer isMetabolic Acidosis

    Slide 40 - Answer isMetabolic Acidosis

    • Potential treatments are:
    • Treat the causes!!!
    • Give bicarbonate
    • Dialysis for renal failure
    • (Barnett, 2007)
    • 40
  41. Dx/Hx: 80 yo with heart disease, on a diuretic.

    Slide 41 - Dx/Hx: 80 yo with heart disease, on a diuretic.

    • ABG results:
    • PH: 7.58
    • PaCO2: 48
    • HCO3: 44
    • BE: +19
    • Serum CL: 95
    • 41
    • (Blevins, 2014)
  42. Answer isMetabolic Alkalosis

    Slide 42 - Answer isMetabolic Alkalosis

    • Potential treatment is:
    • Treat the cause!!
    • Increase respirations
    • Correct electrolyte abnormalities
    • 42
    • (Blevins, 2014)
  43. Case Study

    Slide 43 - Case Study

    • 40-year-old woman, SOB, cyanotic lips, productive cough x 2 weeks. Temp. 40.2, BP 110/75, HR 110, RR 34, rapid and shallow.
    • Breath sounds diminished bilateral bases, coarse rhonchi upper lobes. Chest X-ray indicates bilateral pneumonia.
    • 43
    • (Blevins, 2014)
  44. ABG results are:

    Slide 44 - ABG results are:

    • PH 7.44
    • PaCO2 28
    • HCO3 24
    • PaO2 54
    • 44
    • (Blevins, 2014)
  45. PH              is high normalPaCO2        is lowPaO2           is low

    Slide 45 - PH is high normalPaCO2 is lowPaO2 is low

    • What would you
    • Say is going on?
    • (Rnceus, 2005)
    • 45
  46. Compensated RespiratoryAlkalosis

    Slide 46 - Compensated RespiratoryAlkalosis

    • 46
    • (Blevins, 2014)
  47. Probable CausesARDS?PneumoniaHyperventilation

    Slide 47 - Probable CausesARDS?PneumoniaHyperventilation

    • (RnCeus, 2005)
    • 47
  48. Possible Treatments

    Slide 48 - Possible Treatments

    • Improve PaO2 and RR should normalize
    • May need intubation or BIPAP
    • Antibiotics and possible steroids
    • Chest physiotherapy
    • (RnCeus, 2005)
    • 48
  49. Our ABG Log Book

    Slide 49 - Our ABG Log Book

    • Our Log book is just a simple way to help us keep track of how we’re doing
    • Keep track of statistics
    • It will help identify needed educational supplementation
    • You can self-evaluate and get help if needed
    • A way to recognize successes!
    • 49
  50. Date

    Slide 50 - Date

    • Patient ID
    • Diagnosis
    • Rationale for ABG
    • Routine/Emergent
    • Interventions
    • Initiated by
    • RN or MD
    • Comments
    • (self-evaluation)
    • ABG Log Book
    • 50
  51. Conclusion

    Slide 51 - Conclusion

    • Using the proper techniques to collect ABGs is very important!
    • Knowing how to interpret ABGs is vital knowledge needed by every PACU nurse.
    • It’s very important to know the interventions needed to correct an acid-base balance.
    • 51
  52. Does anyone have any Questions?

    Slide 52 - Does anyone have any Questions?

    • Evaluation time
    • 52
  53. Barnett, J. (Writer), (2007, May). Acid-Base Balance and Imbalance. [Power Point].  Retrieved from    www.mc.vanderbilt.edu/.../WEB_O...Blevins, S. (2014). Making ABGs simple. MEDSURG Nursing, 23, pp. 185-186. Retrieved from http://ehis.ebscohost.com/ehost/detail/detail?sid=4037c242-7bed-4b3c-92b3-75bc7cb5b62c%40sessionmgr198&vid=2&hid=103&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ccm&AN=2012637650Burns, G. P. (2014). Arterial blood gases made easy. Clinical Medicine, 14, pp. 66-68. ISSN: 14702118. Retrieved from http://ezproxy.coloradomesa.edu:2074/ehost/pdfviewer/pdfviewer?sid=478dc742-205d-4ede-aa7b-1e92fd164b05%40sessionmgr110&vid=1&hid=117Christensen, M., & Chen, F. (2012). Advanced arterial blood gas analysis in septic shock: A Singaporean nursing case review. Journal of Intensive and Critical Care Nursing, 29, pp. 70-77. doi: 10.1016/j.iccn.2012.08.002Graham, T. (2006). Acid base online tutorial. National Library of Medicine, National Institutes  of Health. Retrieved from http://fitsweb.uchc.edu/student/selectives/TimurGraham/Modified_Allen%27s_Test.html McAuley, D. (2014). Common laboratory (LAB) values-ABGs. Global RPh: The Clinician’s Ultimate Reference. Retrieved from http://www.globalrph.com/abg_analysis.htmPramod, S., Gunchan, P., & Sandeep, P. (2010). Interpretation of arterial blood gas. Indian Journal of Critical Care Medicine, 14, 57-64. doi: 10.4103/0972-5229.68215RnCeus Interactive (2005). Simple method of acid base balance interpretation: A FOUR STEP METHOD FOR INTERPRETATION OF ABGS. Retrieved from http://www.rnceus.com/abgs/abgmethod.html

    Slide 53 - Barnett, J. (Writer), (2007, May). Acid-Base Balance and Imbalance. [Power Point]. Retrieved from www.mc.vanderbilt.edu/.../WEB_O...Blevins, S. (2014). Making ABGs simple. MEDSURG Nursing, 23, pp. 185-186. Retrieved from http://ehis.ebscohost.com/ehost/detail/detail?sid=4037c242-7bed-4b3c-92b3-75bc7cb5b62c%40sessionmgr198&vid=2&hid=103&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ccm&AN=2012637650Burns, G. P. (2014). Arterial blood gases made easy. Clinical Medicine, 14, pp. 66-68. ISSN: 14702118. Retrieved from http://ezproxy.coloradomesa.edu:2074/ehost/pdfviewer/pdfviewer?sid=478dc742-205d-4ede-aa7b-1e92fd164b05%40sessionmgr110&vid=1&hid=117Christensen, M., & Chen, F. (2012). Advanced arterial blood gas analysis in septic shock: A Singaporean nursing case review. Journal of Intensive and Critical Care Nursing, 29, pp. 70-77. doi: 10.1016/j.iccn.2012.08.002Graham, T. (2006). Acid base online tutorial. National Library of Medicine, National Institutes  of Health. Retrieved from http://fitsweb.uchc.edu/student/selectives/TimurGraham/Modified_Allen%27s_Test.html McAuley, D. (2014). Common laboratory (LAB) values-ABGs. Global RPh: The Clinician’s Ultimate Reference. Retrieved from http://www.globalrph.com/abg_analysis.htmPramod, S., Gunchan, P., & Sandeep, P. (2010). Interpretation of arterial blood gas. Indian Journal of Critical Care Medicine, 14, 57-64. doi: 10.4103/0972-5229.68215RnCeus Interactive (2005). Simple method of acid base balance interpretation: A FOUR STEP METHOD FOR INTERPRETATION OF ABGS. Retrieved from http://www.rnceus.com/abgs/abgmethod.html

    • 53
    • References