1. A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.21,
Pco2 of 60, and HCO3- of 24. The nurse analyzes these results as indicating which condition?
A. Normal
B. Respiratory acidosis uncompensation
C. Metabolic acidosis, partial compensation
D. Respiratory acidosis, complete compensation
Answer: B
Answer: D
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2. A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45,
PaCO2 50, HCO3- 30 nurse analyzes these results as indicating which condition?
A. Respiratory Acidosis, Partially Compensated
B. Respiratory Alkalosis, Fully Compensated
C. Metabolic Alkalosis, Partially Compensated
D. Metabolic Alkalosis, Fully Compensated
3. A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.6,
PaCO2 53, HCO3- 38 nurse analyzes these results as indicating which condition?
A. Metabolic Alkalosis, Fully Compensated
B. Respiratory Alkalosis, Fully Compensated
C. Metabolic Alkalosis, Partially Compensated
D. Respiratory Acidosis, Partially Compensated
Answer: C
4. A young man with chronic asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal
HCO3 blood gas value. The nurse interprets this as which of the following?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
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Answer: C
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5. A 54 old patient has COPD and was brought into the ED. After measurement of arterial blood
gas, they showed pH 7.31, PaCO2 68, HCO3 28, and PaO2 60 mm Hg. The nurse would
interpret which of the following?
A. Respiratory Acidosis, Partially Compensated
B. Respiratory Acidosis, uncompensated
C. Metabolic Alkalosis, Fully Compensated
D. Metabolic Acidosis, partially compensated
Answer: B
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Arterial blood gases (ABGs) are an important to monitor the acid-base balance of patients. They
may help make a diagnosis, indicate the severity of a condition and help to assess treatment.
ABGs provide the following information: oxygenation, adequacy of ventilation, and acid-base
levels. As blood passes through your lungs, oxygen moves into the blood while carbon dioxide
moves out of the blood into the lungs. Blood for an ABG test is taken from an artery.
An ABG measures:
 Partial pressure of oxygen (PaO2). This is pressure of oxygen dissolved in the blood
and how well oxygen is able to move from the airspace of the lungs into the blood.
 Partial pressure of carbon dioxide (PaCO2). This measures the pressure of carbon
dioxide dissolved in the blood and how well carbon dioxide is able to move out of the
body.
 pH. The pH measures hydrogen ions (H+) in blood. The pH range is 7.35 and 7.45. A
pH of less than 7.0 is acid and a pH greater than 7.0 is basic (alkaline). Blood is
slightly basic.
 Bicarbonate (HCO3). Bicarbonate is a chemical (buffer) that keeps the pH of blood
from becoming too acidic or too basic.
 Oxygen saturation (O2Sat) values. O2 content measures the amount of oxygen in the
blood. Oxygen saturation measures how much of the hemoglobin in the red blood cell
is carrying oxygen (O2).
Normal values for ABGs:
pH 7.35-7.45
PaCO2 35-45
HCO3 22-26
Respiratory Acidosis- cause of CO2 build up in lungs.
To compensate for this the kidney starts to conserve bicarbonate to increase the blood’s pH back
to normal.
Cause: “ DEPRESS”
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Drug: opioids, sedative and poison can cause respiratory depression. (Hypoventilation). Disease
of neuromuscular system (guillain-barre, myasthenia gravis.
Edema (pulmonary) extra fluid in the lung causes impaired gas exchange
Pneumona-excessive mucous production affect gas exchange.
Respiratory center of brain damaged (brain injury, stroke)
Emboli- blocks the pulmonary artery or branch of the lungs causes carbon dioxide to increase.
Spasms of bronchial tubes (asthma) bronchioles constrict and you have decreased gas exchange
Sac elasticity of alveolar sac are damaged and this restricts air flow in and out of the lungs and
this increases carbon dioxide (Emphysema & COPD)
Sign and symptoms:
 Altered level of consciousness
 Confusion
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Personality Changes
LOC Progressively decreases
Hypotension
Bradypnea
Dysrhythmias
Pulse Elevated
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Nursing interventions: oxygen therapy, encourage deep breath and coughing, maintain patent
airway, bronchodilation, mucolytic, place in semi-flowers, monitor heart rate and rhythm,
administer IV solution such as LR.
Respiratory alkalosis (Hyperventilation )
To compensate for this the kidneys, start to excrete bicarbonate to decrease the blood’s pH back
to normal.
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Cause: TACHYPENA
Temperature increase due to increased metabolic needs of the body which causes the respiratory
center to try to compensate by making the respiratory rate increase.
Aspirin toxicity: too much aspirin in the body leads to hyperventilation
Controlled ventilation mechanical ventilation
Hyperventilation expelling too much carbon dioxide
hYsteria (anxiety) leads to rapid breathing and expelling of carbon dioxide.
Pain…rapid breathing blowing off too much carbon dioxide.
Pneumonia
Neurological injuries from a head injury or
Embolism or Edema in the lungs
Asthma due to hyperventilation
Sign and symptoms:
 Syncope
 Vertigo
 Seizures
 Coma
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Nursing Interventions: oxygen therapy, breathing techniques, anxiety reduction, closely watch
patients on mechanical ventilation to ensure breaths are not hyperventilating the patient, provide
safety and seizure precautious. Assess level or awareness.
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Metabolic Acidosis is a metabolic problem due to the buildup of acid in the body fluids which
affects the bicarbonate. This is from increased acid production, decreased acid excretion and loss
of too much bicarb.
To compensate, the repiatory system will cause the body to start to hyperventilate by increase
breathing. (Kussmauls) The body is trying to expel CO2, to help increase the pH.
Cause:
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
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DKA
Shock
Diarrhea
Impaire kidney function
Lactic acidosis
Excessive intake of acid (aspirin)
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Sign and Symptoms
 Weakness
 Altered level of Consciousness
 Tachypnea
 Kussmal respirations
 Abdominal discomfort
 N/V
 Dysrhythmias
 Hypotension
 Coma
Nursing Interventions
 Assess electrolyte levels
 Watch neruo status
 Dialysis may be needed if patient is renal failure
 Give insulin if DKA
 Administer antidiarrheal
 Provide rehydration
 If bicarbonate low, administer sodium bicarbonate
Metabolic Alkalosis: a metabolic problem caused by the excessive loss of acids or increased
amount of bicarb produced in the body that leads to an alkalotic state in the body.
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Cause: “ALKALI”
Aldosterone production excessive (hyperaldosteronism) activates renin-angiotensin-aldosterone
system.
Loop diuretics (Lasix) or thiazide therapy: causes the kidneys to waste hydrogen ions and
chloride through the urine which in turn increases the bicarb.
alKali ingestion of food (baking soda, milk, antacids) increases bicarb level in the blood
Anticoagulant “citrate” used as a storage agent in blood and during continuous forms of renal
replacement therapy
Loss of fluids – cause by vomiting and GI suctioning.
Increased sodium bicarb administration (trying to correct metabolic acidosis)
Sign and symptoms:
 Altered Level of Consciousness
 Nausea
 Vomiting
 Diarrhea
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 Bradypnea
 Seizures
 Coma
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Nursing Intervention:
 Based on cause, if vomiting give antiemetic, stop diuretic
 Monitor electrolyte status
 Doctor may order diamox (Carbonic anhydrase inhibitors): a diuretic which reduces the
reabsorption of bicarb
 Watch ABGs and signs of respiratory distress
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