Evaluation
1)ABG Pre test
2)ABG Post Test
3)Informal Feedback of interventions/patient safety related to scenario
4)Demonstration on clinical area
ABG Pre Test Quiz
1.
Briefly describe what ABG’s mean from a physiologic perspective (Small group discussion)
2.
List three factors that can affect ABG’s.(Small group discussion; also explore possible
physiological interactions)
3.
Group practice calculate the following ABG’s and determine if they are normal, respiratory
acidosis, respiratory alkalosis metabolic acidosis or metabolic alkalosis. Partially compensated,
uncompensated, fully compensated.
Pre-Test and Post-Test Matching
1. ______pH = 7.576, CO2 = 28, HCO3 = 25
2. ______pH = 6.96, CO2 = 71, HCO3 = 26
3. ______pH = 7.51, CO2 = 9, HCO3 = 7
4.______pH = 7.16, CO2 = 82, HCO3 = 29
5.______pH = 6.68, CO2 = 86, HCO3 = 10
6.______pH = 7.76, CO2 = 28, HCO3 = 40
7.______pH = 7.32, CO2 = 68, HCO3 = 36
8.______pH = 7.365, CO2 = 40, HCO3 = 23
9.______pH = 7.49, CO2 = 19, HCO3 = 16
10.______pH = 7.20, CO2 = 62, HCO3 = 19
Answer Choices:
A)
Normal
B)
Respiratory Acidosis
C)
Compensated Metabolic Acidosis
D)
Partially Compensated Respiratory Acidosis
E)
Combined Acidosis
F)
Respiratory Alkalosis
G)
Combined Alkalosis
H)
Partially Compensated Respiratory Alkalosis
Post Test Correct Answers
1. F
2. B
3. H
4. D
5. E
6. G
7. D
8. A
9. H
10.E
Post-test Patient Scenario
A 60 year-old man with amyotrophic lateral sclerosis (ALS) is admitted to s medical unit. His family are
concerned, they report to the nurse he is more somnolent than normal. On further history, it is noted
the patient has been having problems with morning headaches and often seems exhausted when he
wakes up. His thinking is slow and he reports to them he is not refreshed.
Acid-base status review:
• The patient has a low pH (acidemia)
• The PCO 2 is high (respiratory acidosis) and the bicarbonate is high (metabolic alkalosis). The low pH in
combination with the high PCO 2
Assessment
Respiratory acidosis is the primary process. The metabolic alkalosis is the compensatory process.
Summary: A chronic respiratory acidosis with a compensatory metabolic alkalosis. Alveolar-arterial
oxygen difference: The alveolar-arterial oxygen difference is 9 mmHg, a normal value, which tells us that
the hypoxemia is entirely due to hypoventilation.
Explanation for the clinical picture
The patient has a respiratory acidosis with a compensatory metabolic alkalosis. The respiratory
acidosis tells us that the patient is hypoventilating while the compensatory metabolic alkalosis tells us
that this is a chronic process. The patient is likely hypoventilating due to progression of his amyotrophic
lateral sclerosis, a neurodegenerative disorder associated with progressive muscle weakness that
eventually involves the muscles of respiration.
3) Safety and Quality Principals: Small group discussion questions.
Introduction to discussion: Continuous quality improvement encourages a culture of inquiry, welcomes
question, investigates outcomes and critically analyzes incidents. Based on the scenario, discuss the
questions below with your group.
Have a group leader write your answers on the flip chart provided.
* It is important to educate the patient and family about respiratory health and warning signs of
respiratory distress; how would you do this?
* You call the respiratory therapy to reinforce education, he replies he is too busy to see the patient
prior to discharge. How would you encourage reinforcement of quality and safe care if this occurs?
* Your health assessment the next day confirms the patient is now respiratorily compromised. You
report this to your chief nurse, she replies the on call MD never answers his phone, just monitor the
patient. What other action could you take to provide the patient with quality and safe care? (see
considerations below)
Interventions/Considerations of safe care may include putting patient on CPAP if already ordered,
intermittent bagging to increase ventilation, and calling attending or alternate physician if on-call
resident doesn’t answer. Due to his diagnosis, his condition will not improve by encouraging patient to
‘take deep breaths’.