Doubting my clinical write-up/lab analysis....

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So, we have only just started *touching* on Respiratory in class and I was assigned to a patient with history of COPD for my clinical rotation. Patient was admitted to the ED c/o SOB and chest pain. Heart problems ruled out. Pt. was tachycardic (121 bpm) and anxious, gasping between sentences.

Labs on admit were as follows:

pH 7.44

pCO2 29

pO2 60

HCO3 19.5

O2sat 92

ABGs are very new to me and I found some of these lab results to be conflicting. I ultimately settled on Respiratory Alkalosis. But, now I'm thinking it sounds more like Respiratory Acidosis. Any insight as to which it is and why? Thanks.

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I'm thinking anxiety related. He blew off all of his CO2.

Some COPDers live with a P02 of 60.

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Specializes in Psych.

Its Respiratory Alkalosis, you were right.

CO2 is an acid, so low CO2 is Alkalosis.

The body will lower the bicarb level to make the blood more acidic, which is why the pH is in the normal range.

when I was doing ABG's I googled abg interperter- calculator to check my answers. I plug numbers in to make sure I remembered, and it came up Compensated Resp. Alkalosis

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Specializes in NICU.

You were right, although if you want to be thorough, you'd call it compensated respiratory alkalosis. Is it the bicarb value that's throwing you off? The fact that it's low might make you think acidosis, except that it's low to balance out the low CO2. Hint: look at your pH. Even though it's in the normal range, it's on the high/alkalotic end of normal, so you should be looking for either a low CO2 or a high bicarb as the culprit.

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Thanks for the replies. After thinking about it further, I realized that it was compensated (resp. Alkalosis) and that that *was* what was throwing me off.

Figuring out ABGs is new to me. Our semesters are such a whirlwind of information thrown at us, that I haven't had as much time as I'd like to devote to studying ABGs. It does not come second nature to me quite yet, so I appreciate the reassurance. I feel much better. :D

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Its Respiratory Alkalosis, you were right.

CO2 is an acid, so low CO2 is Alkalosis.

The body will lower the bicarb level to make the blood more acidic, which is why the pH is in the normal range.

when I was doing ABG's I googled abg interperter- calculator to check my answers. I plug numbers in to make sure I remembered, and it came up Compensated Resp. Alkalosis

Thanks for this info. I think I'd feel better double checking myself against this until I'm more adept at interpreting ABGs.

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Specializes in Intermediate care.

i used to tutor adult health nursing. I came up with an amazing way to do ABG's that went down in history :) Too hard to explain over internet, sorry :( but the good news is the answer is Resp. Alkalosis.

Way to go.

Don't second guess yourself, go with your gut instinct!! Your usually right the first time.

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The ROME method (try an Allnurses search or a Google search) is a good trick to help you with gas interpretation when you feel unsure. Good luck as you continue your clinical experiences!

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Specializes in Nephrology, Cardiology, ER, ICU.

Moving to nursing student assistance.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
thanks for this info. i think i'd feel better double checking myself against this until i'm more adept at interpreting abgs.

go to this link there is a tic tac toe game that is very good!!!!!!

https://allnurses.com/nursing-blogs/active-learning-strategy-387179.html

the orange grove abg tic tac toe

doc.gifabg tic tac toe part 1.doc (52.5 kb, 3559 views)doc.gifabg tic tac toe part 2.doc (94.0 kb, 2035 views)

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