NCLEX Final Exam Study Guide
ACID BASE GASES
A. ABG Interpretation
a. RuleoftheB’s
i. If the pH and the BICARB (HCO3)
ii. Are BOTH in the same
... [Show More] direction,
iii. Then it is METABOLIC
b. ↓pH=acidosis
c. ↑ pH= alkaline
B. Values
a. NormalpH=7.35–7.45
b. NormalBicarb=22-26
c. PaO2= 80-100 mmHg
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CHOLINERGIC
• Bronchorrhea (large amounts
of mucus in
• Bronchoconstriction
• Salivation
• Lacrimating
• Urination
• Diaphoresis/Diarrhea
• GI Upset
• Emesis
airway)
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D. Causes of Acid-Base Imbalance a. Firstask,“IsitLung?”
i. If YES- then it is Respiratory b. Thenaskyourself:
i. Are they Overventilating or Underventilating? 1. IfOverventilating pickAlkalosis
2. IfUnderventilating pickAcidosis
c. If not lung, then it’s Metabolic
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d. PaCO2=35-45mmHg
e. SaO2=95-100%
C. Signs & Symptoms of Acid-Base Imbalance
a. AsthepHgoes,sogoesthepatientexceptforPotassium(bcitwill try to compensate)
pH UP ↑ K↓ [ALKALOSIS] pH DOWN ↓ K↑ [ACIDOSIS]
•••• Tachycardia •• Tachypnea • Diarrhea
Hyperreflexia Agitated
• Bradycardia
• Bradypnea
Tremors
• Hypotension
• ↓ lucidity
• Seizure •
anorexia coma lethargy
•
• • • •
•
•
Borborygmi (↑ bowel sounds) • Hypertension • Palpitations
Tetany
Anxiety/Panic Poly
cardia arrest
suppressed, decreased, falling
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i. If the patient has prolonged gastric vomiting or suction, pick Metabolic Alkalosis
ii. For everything else that isn’t lung, pick Metabolic Acidosis
1. Also,ifyoudon’tknowwhattopickchooseMetabolic Acidosis
VENTILATOR ALARMS
1. HighPressureAlarmsaretriggeredby↑resistancetoairflowandcanbe caused by obstructions of three types:
a. KinkedTube
i. NRS ACTION: Unkink it
b. Waterintubing(causedbycondensation)
i. NRS ACTION: Empty it/Remove H2O
c. Mucus in airway
i. NRS ACTION: Turn, C&DB; only use suction if C&DB fails,
as a last resort
2. LowPressureAlarmsaretriggeredby↓resistancetoairflowandcanbe caused by disconnections of the:
a. Tubing i.
ii.
NRS ACTION: Pay attention to where tubing is...(contamination)
If on floor, change out
If on chest, clean with alcohol then put back on
3. RespiratoryAlkalosis(Overventilation)meansventilatorsettingsmaybe
too HIGH.
4. RespiratoryAcidosis(Underventilation)meansventilatorsettingsmaybe
too LOW.
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