NORMAL BLOOD GAS VALUES
INTERPRETING ABNORMAL BLOOD GAS RESULTS
Arterial
Venous
pH
7.35-7.45
7.31-7.41
PaCO2/PCO2
35-45 mmHg
41-51 mmHg
HCO3
22-28 meq/L
23-29 meq/L
pO2
80-100 mmHg
30-40 mmHg
O2 Sat
>95%
60-80%
pH
HCO3
CO2
Possible Causes
Metabolic Acidosis
Diabetes/DKA, Addison’s, Liver/Renal Failure, Diarrhea,
Toxins/Drugs, Ethylene Glycol
Metabolic Alkalosis
Vomiting, Diuretics, Antacids Use, Cushing’s, Administering
Alkaline Solutions, Continuous Suctioning of Gastric Contents
Respiratory Acidosis
Obstruction, Pneumonia, Over Sedation, Paralysis, Increased
Metabolism, CNS Depression
Respiratory Alkalosis
Anemia, CHF, Over Mechanical Ventilation, Increased
Respiratory Rate/Depth, Fever
SHOCK
BP
HR
CO
Hypovolemia
Pulse Pressure
SVR
Narrow
Cardiogenic
Nml/
Neurogenic
Anaphylactic
Nml/
Early Sepsis
Nml/
Late Sepsis
CAP Refill
CVP
UOP
Assessment
Poor
Weak thready pulse, cool, pale
Nml/
Narrow
Poor
Nml to Wide
Nml
Warm dry skin, vasodilation, loss of sympathetic tone
Narrow
Nml
Skin reactions, throat swelling, Dyspnea, pruritus, urticarial, restlessness,
decreased LOC, bounding pulses
Nml to Wide
Nml
Narrow
Poor
Varies
Weak thready pulse, cool, pale, tachypnea, crackles
Nml
Bounding pluses, tachypnea, flushed skin, fever, alkalosis
Weak pulse, cool, difficulty breathing, acidosis, decreased LOC
BLOOD PRODUCT TRANSFUSIONS - ADULTS
Product
Suggested flow rate
Considerations
PRBC’s
1st 15 min: 60-120 ml/hr
Active hemorrhage: infuse as rapidly as possible
After 15 min: 240 ml/hr
For pt’s at risk for fluid overload, 1ml/kg/hr
Infusions must not exceed 4hrs
Use filter in line – 170-260 microns
Platelets
1st 5 min: 120-300 ml/hr
Active hemorrhage: infuse as rapidly as possible
After 1st 5 min: 300 ml/hr
Generally given over 1 hr. Do not exceed 4 hrs.
Use filter in line – 170-260 microns
Plasma
1st 5 min: 120-300 ml/hr
Active hemorrhage: infuse as rapidly as possible
After 1st 5 min: 300 ml/hr
Use filter in line – 170-260 microns
Cryoprecipitate
As rapidly as tolerated
All products
Use filter in line – 170-260 microns
Monitor closely for VS/assessment changes
in the first 5-15 minutes of infusion.
Normal Vital sign changes
Temp +/- 0.5 C
RR +/- 5 bpm
HR +/- 10 bpm
BP +/- 20 mmHg
BASIC ASSESSMENT
Pupils, Orientation, Speech,
Vein distention, auscultate heart,
Cardiac:
assess pulses and perfusion.
Ears, Nose, Throat, auscultate
Respiratory:
lung sounds, inspect chest rise/rate.
Inspect, auscultate, palpate 4 quadrants.
Palpate/percuss liver. Palpate stomach/
GI/GU:
bladder. Assess bowel/bladder elimination.
Nutritional status.
Color/appearance, intact w/o wounds, rashes,
Skin/
Musculoskeletal: lesions, erythema. ROM. Turn and reposition.
Neuro:
If reaction is suspected:
Stop the transfusion
Keep line open with saline
Call the physician and blood bank
Document pt’s symptoms
Send patient's labs and return blood
product to the lab
MEDICATION MATH MADE SIMPLE
Desired Dose
Available Dose
Quantity or Concentration = Dose
GLASGOW COMA SCALE
PRESSURE ULCER CLASSIFICATION
Staging
1
Description
Non-blanchable erythema/purple hue of skin changes in temperature and sensation
2
Partial-thickness skin loss (i.e. blister or shallow crater)
3
4
Full-thickness skin loss involving necrosis of subcutaneous tissue
Full-thickness skin loss with extensive necrosis to tendon, muscle, bone, or joint
Unstageable
DTI
Stages
Behavior
Response
Eye opening
response
Spontaneously
To speech
To pain
No response
Best verbal
response
Ulcer with eschar. Wound base cannot be assessed
Purple non-blanchable area of intact skin that demarcates between 24-48 hours due to deep
tissue destruction
1
2
3
4
Best motor
response
Skin
Fat
Muscle
Total score:
Bones
Time
HR
RR
BP
Temp
Sat
O2
I
Score
4
3
2
1
Oriented to time, place, and person
5
Confused
4
Inappropriate words
3
Incomprehensible sounds
2
No response
1
Obeys commands
6
Moves to localized pain
5
Flexion withdrawal from pain
4
Abnormal flexion (decorticate)
3
Abnormal extension (decerebrate)
2
No response
1
________
Best response
15
Comatose patient
8 or less
Totally unresponsive
3
O
Tubes