[SOLVED] Arterial Blood Gas Interpretation
Interpret arterial blood gas analysis (acid-base, ventilation, oxygenation) of mechanically ventilated patients Background Monitoring arterial blood gases (ABGs) is vital to the proper care and management of patients receiving mechanical ventilation. The patients that primarily require mechanical ventilation suffer from acute respiratory failure. Respiratory failure is a condition in which respiratory activity is completely absent or is inadequate to maintain oxygen uptake and carbon dioxide clearance. There are two types of respiratory failure: Type I acute respiratory failure also known as hypoxemic respiratory failure and Type II acute respiratory failure also known as hypercapnic respiratory failure. Type I respiratory failure is failure of the lungs and heart to provide adequate oxygenation. This type of respiratory failure is often associated with restrictive lung disease and occurs when oxygen consumption, due to increase work of breathing, exceeds the amount of oxygen available in the blood (CaO2). Patients who experience Type I respiratory failure hyperventilate in an attempt to increase oxygen intake. The rapid and sustained increase in the patients respiratory rate can abruptly lead to apnea if not treated promptly and effectively. The primary goals of mechanical ventilation in the patients with Type I acute respiratory failure are restoring oxygenation, preventing oxygen toxicity, and preventing lung damage. Restoring oxygenation in patients with Type I respiratory failure is done as follows: Increase concentration (FiO2) Use caution with COPD patients during weaning An FiO2 greater than .60 will risk oxygen toxicity Increase lung diffusion area (inspiratory time or PEEP PEEP may negatively impact cardiac output Increased I time will be uncomfortable to patient and may result in auto PEEP Type II respiratory failure is failure of the lungs to eliminate adequate carbon dioxide. Type II respiratory failure is often associated with obstructive lung disease, hypoventilation, and hypoxemia. Patients in Type II respiratory failure due to obstructive lung disease suffer from high resistance in the airways, which causes most of the pressure required to breathe to be exhausted in the airways and not to expanding the alveoli. The consequence of less pressure in the alveoli is smaller volumes of gas available for gas exchange. The primary goal of mechanical ventilation in the patient with Type II acute respiratory failure is to prevent intubation whenever possible and implement the use of noninvasive positive pressure ventilation (NPPV) promptly and correctly; cautious use of oxygen, treating with bronchodilators, pulmonary hygiene and steroids and ventilation to baseline PaCO2 and pH levels. Refer to the information below when interpreting arterial blood gas reports. pH < (less than) 7.35 = acidosis pH > (greater than) 7.45 = alkalosis PaCO2 < (less than) 35 = alkalosis PaCO2 > (greater than) = acidosis HCO3 < (less than) = acidosis HCO3 > (greater than) = alkalosis pH Represents patient’s homeostasis, otherwise known as balancing or equilibrium zone Low pH = acidosis High pH = alkalosis Out of normal range = acute episode Within normal range = chronic condition PaCO2 ~ arterial carbon dioxide tension in the blood Represents the lungs or respiratory function Low PaCO2 = alkalosis or hyperventilation High PaCO2 = acidosis or hypoventilation HCO3 ~ bicarbonate or base Buffer system of the body Represents the kidneys or metabolic function Low HCO3 = acidosis High HCO3 = alkalosis PaO2 ~ arterial oxygen tension in the blood Represents degree of patient’s oxygenation Low PaO2 = hypoxemia High PaO2 = hyperoxemia Prompt For this assignment, you will provide detailed responses to the following questions regarding each case study. Provide an interpretation for each ABG Identify the problem Provide your recommendation for correcting the problem. 1. A patient is on SIMV 6, VT 700, FIO2 – .85, PEEP +5. The ABG results are as follows: PH 7.44 PaCO2 36 torr HCO3 23 mEq PaO2 229 torr 2. A patient is being ventilated follow an exploratory abdominal surgery. His lean body weight is 110 lb. He is on AC mode, 550ml, and a mandatory rate of 14 without any spontaneous respiratory efforts, FIO2 .40. ABG results are as follows: pH 7.51 PaCO2 31 torr HCO3 24 mEq PaO2 100 torr 3. A 68 Kg patient has the following ABG results on SIMV mode, rate of 12, VT 550, FIO2 of .30, PEEP 0. No spontaneous breaths are noted. PH 7.23 PaCO2 68 torr HCO3 24 mEq PaO2 83 torr 4. A 12-year- old female weighing 40kg (88 lb) is receiving continuous mechanical ventilation following an accidental drug overdose. The respiratory care practitioner notes the following: Mode SIMV Set rate 12br/min Total rate 12br/min Vt 750 ml FiO2 0.30 Arterial blood gases are as follows: Ph 7.58 PCO2 23mmHg PO2 141mmHg HCO3 22mEq/L 5. A 70 kg (154 lbs) post-cardiopulmonary arrest patient is on a volume-cycled ventilator in the assist/control mode. The respiratory care practitioner notes the following data: Set rate 8 br/min Total rate 8 br/min FiO2 0.65 VT 850 ml The arterial blood gas results are as follows: pH 7.30 PCO2 56 mmHg PO2 78 mmHg HCO3- 21 mEq/L Submit your answers in at least 500 words on a Word document with at least 1 citation. You must cite your references in IWG format where appropriate to defend and support your position.
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