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Questions and Answers
What is the primary purpose of capnography in clinical settings?
Which of the following is NOT an indication for capnography use?
What does capnometry specifically evaluate?
What reaction should be monitored after the administration of contrast medium?
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Why is it important to keep emergency equipment nearby during procedures involving contrast medium?
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What does a PaO2 value less than 80 mmHg indicate?
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Which of the following is the most common site for arterial blood gas sampling?
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What is the normal range of pH for arterial blood?
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What does a SaO2 value lower than 95% indicate?
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Which value would indicate respiratory acidosis?
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What is the role of HCO3 in an ABG test?
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When obtaining an ABG sample via puncture, how long should pressure be applied to the site?
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What might indicate a patient's breathing was being supplemented with oxygen during an ABG analysis?
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What must be ensured when collecting an arterial blood gas (ABG) sample?
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Which statement about pulmonary angiography is correct?
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What should be assessed before performing a pulmonary angiography?
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How long should pressure be applied to the puncture site after an arterial blood draw?
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What is a nursing consideration during preprocedure patient care for pulmonary angiography?
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What could potentially lower PaO2 levels in an arterial blood gas sample?
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What sensation might a patient feel during the injection of contrast dye in pulmonary angiography?
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When using a heparinized syringe for an arterial blood gas sample, what is the first step?
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What should be monitored after a pulmonary angiography procedure?
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Which of the following is NOT a reason to encourage fluid intake after a pulmonary angiography?
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What should be done prior to conducting a ventilation-perfusion (V/Q) scan?
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During the ventilation portion of a V/Q scan, what does the patient inhale?
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What are common adverse reactions to the contrast medium that should be monitored after a procedure?
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Which nursing intervention is important after a V/Q scan?
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Why is it important to keep emergency equipment nearby during and after a contrast medium procedure?
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In a V/Q scan, what is the purpose of the perfusion portion?
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Study Notes
Arterial Blood Gas Monitoring
- Measures the amounts of arterial gases like oxygen and carbon dioxide
- Requires drawing blood from the radial artery, femoral artery, or an arterial catheter
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Key Components
- pH (7.35-7.45): Reflects blood acidity or alkalinity.
- PaCO2 (35-45 mmHg): Represents the partial pressure of arterial carbon dioxide and reflects the adequacy of lung ventilation.
- PaO2 (80-100 mmHg): Reflects the body's ability to pick up oxygen from the lungs.
- HCO3 (22-26 mEq/L): Bicarbonate level reflects kidney activity in retaining or excreting bicarbonate.
- SaO2 (95-100%): Represents the ratio of actual hemoglobin oxygen content to the potential maximum carrying capacity of hemoglobin.
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Interpretation
- PaO2: A value greater than 100 mmHg indicates more than adequate oxygen administration. A value below 80 mmHg signifies hypoxemia (low blood oxygen).
- SaO2: A value less than 95% suggests decreased oxygen saturation and may contribute to a low PaO2 value.
- pH: A value above 7.45 signifies alkalosis (excess alkalinity), reflecting a hydrogen ion deficit. A value below 7.35 represents acidosis (excess acidity), reflecting a hydrogen ion excess.
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Nursing Considerations
- ABG samples are usually drawn by a doctor, respiratory therapist, or a specially trained critical care nurse, often from an arterial line.
- If a percutaneous puncture is necessary, the site must be carefully chosen. The radial artery is most common, requiring an Allen's test before sampling.
- After obtaining the sample, apply pressure to the puncture site for 5 minutes and tape a gauze pad firmly. Monitor regularly for bleeding and signs of complications.
- Indicate if the patient is on room air or oxygen, specifying the number of liters for nasal canula or the fraction of inspired oxygen (FIO2) for masks or mechanical ventilation.
- Conditions like improper heparinization of the syringe, exposing the blood sample to air, or venous blood contamination can interfere with results.
- Keep the arterial blood sample cold, preferably on ice, and deliver it to the lab for analysis as soon as possible.
Obtaining an ABG Sample
- Prepare a heparinized blood gas syringe.
- After performing Allen's test, perform aseptic cutaneous arterial puncture (or draw from an arterial line if available).
- Eliminate air from the sample, place it immediately on ice, and transport it for analysis.
- Apply pressure to the puncture site for 3-5 minutes; extend pressure to 5 minutes or longer if the patient is on anticoagulants or has coagulopathy.
- Tape a gauze pad firmly over the puncture site. Avoid taping the entire circumference of the arm to prevent restricted circulation.
Pulmonary Angiography
- Allows radiographic examination of the pulmonary circulation.
- A radioactive contrast dye is injected through a catheter inserted into the pulmonary artery, followed by X-ray images to visualize blood flow abnormalities potentially caused by emboli or pulmonary infarction.
- Considered more reliable and preferred than V/Q scanning, especially for patients on ventilation, but carries higher risk for cardiac arrhythmias.
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Nursing Considerations
- Explain the procedure to the patient and their family, answering any questions they may have.
- Ensure the patient understands who will perform the test, where it will be done, and how long it will take.
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Pre-Procedure Patient Preparation
- Confirm the patient is not allergic to shellfish or iodine. Notify the practitioner if allergies exist.
- Evaluate renal function with BUN and creatinine level measurements.
- Assess potential bleeding risk by checking PT, PTT, and platelet count.
- Instruct the patient to lie still during the procedure.
- Explain that they may experience a flushed sensation in their face as the dye is injected.
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Post-Procedure Patient Care
- Maintain bed rest as ordered, monitor vital signs, oxygen saturation levels, and heart rhythm.
- Apply a sandbag or femoral compression device over the injection site as directed.
- Check the pressure dressing for bleeding, monitor the peripheral pulse in the arm or leg involved in catheter insertion.
- Check the extremity's temperature, color, and sensation, comparing it to the opposite side.
- Unless contraindicated, encourage fluid intake to flush the dye from the body, or increase the IV flow rate as ordered.
- Check serum BUN and creatinine levels after the procedure.
- Monitor for adverse reactions to contrast medium, including restlessness, tachypnea, respiratory distress, tachycardia, facial flushing, urticaria, nausea, and vomiting.
- Keep emergency equipment nearby in case of a reaction.
Ventilation-Perfusion Scan (V/Q Scan)
- Is used to evaluate ventilation-perfusion mismatch, detect pulmonary emboli, and assess pulmonary function.
- Less risky but less reliable than pulmonary angiography.
- Two Parts
- Ventilation Portion: The patient inhales a contrast medium gas, and ventilation patterns and adequacy of ventilation are noted on the scan.
- Perfusion Scan: Contrast medium is injected intravenously, and pulmonary blood flow to the lungs is visualized.
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Nursing Considerations
- Explain the procedure to the patient and their family, answering any questions they may have.
- Ensure the patient understands who will perform the test, where it will be done, and how long it will take.
- Confirm that the patient is not allergic to the contrast material.
- Explain the two parts of the test.
- Ventilation Portion: A mask is placed over the patient's mouth and nose, and they breathe in the contrast medium gas mixed with air while the scanner takes images of their lungs.
- Perfusion Portion: The patient lies supine on a movable table while the contrast medium is injected intravenously, and the scanner takes images of the lungs.
- Maintain bed rest as ordered, monitor the patient's vital signs, oxygen saturation levels, and heart rhythm.
- Monitor for adverse reactions to contrast medium, including restlessness, tachypnea, respiratory distress, tachycardia, facial flushing, urticaria, nausea, and vomiting.
- Keep emergency equipment nearby in case of a reaction.
Capnography
- Noninvasive, continuous method for evaluating carbon dioxide exchange in the lungs.
- Measures the concentration or partial pressure of carbon dioxide (CO2) in respiratory gases.
- Primarily used as a monitoring tool during anesthesia and intensive care.
- Displays the concentration or partial pressure of CO2 in respiratory gases plotted against time.
- Provides rapid and accurate alerts for clinicians regarding perfusion and metabolic problems, offering more detailed information compared to traditional assessment tools.
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Indications:
- Useful for mechanically ventilated patients who require frequent blood gas sampling.
- Patients with unstable respiratory status where minute-to-minute assessment of gas exchange is necessary.
- Recommended for confirming endotracheal tube placement.
- Assessing patient response to different ventilation modes and tolerance to weaning.
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Description
This quiz covers the essential components of arterial blood gas monitoring, including pH, PaCO2, PaO2, HCO3, and SaO2 levels. Understanding these parameters is crucial for assessing respiratory and metabolic functions. Test your knowledge on blood gas interpretation and its significance in clinical settings.
