# Arterial Blood Gases Made Easy

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Category: Education

## Presentation Description

Education piece for nursing students

By: redamahmoud2011 (31 month(s) ago)

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By: lahar (37 month(s) ago)

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By: yasserhkamel (41 month(s) ago)

## Presentation Transcript

### #1 Pass Review presents……… :

#1 Pass Review presents……… www.1passreview.com NCLEX Success with Less Stress 97% PASS RATE

### ABG’s MADE REALLY EASY! :

ABG’s MADE REALLY EASY! ABG’s don’t have to be complicated – one simply method to use for interpreting a set of ABG values. IT’S CALLED THE ARROW SYSTEM! ↑↓ www.1passreview.com NCLEX Success with Less Stress

### What 2 body systems control the acid/base system in the body? :

What 2 body systems control the acid/base system in the body? You are correct! Respiratory – Lungs – CO2 Metabolic – Kidneys – HCO3 www.1passreview.com NCLEX Success with Less Stress

### Let’s review the normal values for ABG’s before looking at arrows… :

Let’s review the normal values for ABG’s before looking at arrows… pH normal is 7.35-7.45 (low is acidotic and high is alkalotic) – (exact middle is 7.4) CO2 – normal is 35 – 45 HCO3 – normal is 22 – 26 www.1passreview.com NCLEX Success with Less Stress

### ARROWS :

ARROWS Here is a rule to remember – it will make sense in a minute: Respiratory Metabolic If pH is ↓, CO2 will be ↑ If pH is ↓, HCO3 will be ↓ If pH is ↑, CO2 will be ↓ If pH is ↑, HCO3 will be ↑ Therefore, for it to be a primary Therefore, for it to be a primary Metabolic Respiratory condition, arrows will condition, the arrows will be in the SAME be in the OPPOSITE direction direction Let’s do an example!! www.1passreview.com NCLEX Success with Less Stress

### Example Basic ABG :

Example Basic ABG pH = 7.26 CO2 = 56 HCO3 = 23 Step 1. Assign arrows pH = 7.26 ↓ (low – therefore acidotic – and outside the normal pH range) CO2 = 56 ↑ (high) HCO3 = 23 WNL Step 2. Determine what rule of arrows this follows. Remember – opposite direction means it is a respiratory condition, same direction means it is a metabolic condition. Always look at the pH arrow FIRST. Here, the pH is low and the CO2 is high (opposite direction). Therefore, this is in the opposite direction – which fits the respiratory rule. Since it is acidotic, this is a respiratory acidosis. Step 3. We will go into more about compensation in a minute. But that is the third step. Here, the HCO3 is in the normal range. Therefore, the other organ system has done nothing to compensate. Normally, more HCO3 would be secreted to prevent further acidosis. Since the HCO3 is normal here, we technically have UNCOMPENSATED RESPIRATORY ACIDOSIS. www.1passreview.com NCLEX Success with Less Stress

### Now You Do It :

Now You Do It pH = 7. 56 CO2 = 37 HCO3 = 42 Do all 3 steps. See next slide for answer www.1passreview.com NCLEX Success with Less Stress

Answer pH = 7. 56 CO2 = 37 HCO3 = 42 Step 1. Assign arrows pH = 7.56 ↑ CO2 = 37 WNL HCO3 = 42 ↑ Step 2. Determine what rule of arrows this follows. First look at the pH – then see what other system is abnormal. Here the CO2 is WNL but the HCO3 is high. Since the pH is also high, this follows the same direction rule – Metabolic. Since the pH is elevated, this is alkalosis. Step 3. Compensation? CO2 is normal. Therefore, there is no compensation. This is UNCOMPENSATED METABOLIC ALKALOSIS. www.1passreview.com NCLEX Success with Less Stress

### More Practice :

More Practice pH = 7.16 3. pH = 7.23 CO2 = 78 CO2 = 42 HCO3 = 25 HCO3 = 12 2. pH = 7.56 4. pH = 7.86 CO2 = 18 CO2 = 37 HCO3 = 24 HCO3 = 62 www.1passreview.com NCLEX Success with Less Stress

Answers UNCOMPENSATED RESPIRATORY ACIDOSIS UNCOMPENSATED RESPIRATORY ALKALOSIS UNCOMPENSATED METABOLIC ACIDOSIS UNCOMPENSATED METABOLIC ALKALOSIS www.1passreview.com NCLEX Success with Less Stress

### Step 3. Compensation :

Step 3. Compensation Step 3 involves determining the level of compensation. There are 3 possibilities: no compensation (Uncompensated – see previous examples), partial compensation, or full compensation. We will now look at the differences.

### Uncompensated :

Uncompensated There is no compensation when the secondary organ system is still within normal range. Take this example: pH = 7.16 ↓ CO2 = 78 ↑ HCO3 = 25 (this is the secondary organ system – it would compensate for the respiratory acidosis by releasing more bicarbonate to lessen the acidosis). The kidneys have not yet compensated – therefore, this is UNCOMPENSATED RESPIRATORY ACIDOSIS. www.1passreview.com NCLEX Success with Less Stress

### PARTIAL COMPENSATION :

PARTIAL COMPENSATION pH = 7.16 ↓ CO2 = 78 ↑ HCO3 = 44 ↑ This was a previous example. Before, the HCO3 was normal and it was uncompensated. Now, the kidneys are now trying to compensate by releasing more HCO3 to bring the pH up. If you look at the pH and then the arrows: comparing the pH and CO2 (opposite) and the pH and HCO3 (opposite). You know that the rule states that the opposite rule fits the respiratory system. Therefore, the kidneys are the compensation piece. next slide…….. www.1passreview.com NCLEX Success with Less Stress

### PARTIAL COMPENSATION :

PARTIAL COMPENSATION You then look at the pH. A pH of 7.16 is not in the normal range (7.35 to 7.45) therefore this is partial compensation. So: pH of 7.16 CO2 = 78 HCO3 = 44 This is PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS. www.1passreview.com NCLEX Success with Less Stress

### FULL COMPENSATION :

FULL COMPENSATION pH = 7.36 CO2 = 78 HCO3 = 44 The only difference here is that the pH is now within normal range. The other numbers are the same as the previous example. The pH is within normal range but all of the other organ systems have abnormal values. Therefore, we do need to sign an acid/base imbalance to this problem. www.1passreview.com NCLEX Success with Less Stress

### FULL COMPENSATION :

FULL COMPENSATION Remember – the normal value for pH is 7.35 to 7.45. 7.4 is the middle point (here we can say anything between 7.36 to 7.39 is acidotic and anything between 7.46 to 7.44 is alkalotic). pH = 7.36 (this is on the acidotic side of 7.4) CO2 = 78 HCO3 = 44 www.1passreview.com NCLEX Success with Less Stress

### FULL COMPENSATION :

FULL COMPENSATION pH = 7.36 (this is on the acidotic side of 7.4) CO2 = 78 HCO3 = 44 Since the pH is in the normal range, this is FULLY COMPENSATED RESPIRATORY ACIDOSIS. The only difference between full and partial compensation is whether or not the pH is in the normal range. www.1passreview.com NCLEX Success with Less Stress

### Now you practice!! :

Now you practice!! pH = 7.18 CO2 = 56 HCO3 = 24 _________________ pH = 7.58 CO2 = 37 HCO3 = 46 _________________ pH = 7.22 CO2 = 6 HCO3 = 12 _________________ pH = 7.62 CO2 = 86 HCO3 = 82 _________________

### More Practice :

More Practice pH = 7.44 CO2 = 66 HCO3 = 72 __________________ pH = 7.36 CO2 = 66 HCO3 = 92 __________________ pH = 7.22 CO2 = 76 HCO3 = 24 ___________________