hey everyone nurse Mike here from simple nursing.com today we're tackling the oh so tricky AGS and acid base imbalances now listen up this stuff can seem like a foreign language but don't worry I've got tips and tricks that'll make this info actually stick for my simple nursing members grab these three study guides on AGS from your membership to follow along all right are you ready let's do this we're going to be covering the basic overview in this part one including pathophysiology and memory tricks and then we're going to break down some practice questions toward the end of this video including the really tricky fully compensated versus partially compensated AGS so be sure to stick around so what are acid base imbalances well it's just the balance of acid and base of the body kind of like a tug-of-war the body loves to keep these in balance measured in blood via the pH so normal pH is 7.35 to 7.45 too low under 7.35 we become acid basically the body goes into acidosis and too high over 7.45 we become more base the body goes into alkalossis now that sounds pretty simple right well here's where it gets confusing the key players that keep us in balance is HCO3 known as by carb this is our base that helps to put the body in this alkyossis so the memory trick think of the double B's base equals by carb and CO2 our carbon dioxide is our acid pushing the body into an acidotic state so too much CO2 we get a body that is in acidosis so the memory trick we use just think carbon dioxide is carbon dia acid since too much carbon dioxide pushes us into acidosis lastly hydrogen ions are a form of acid found in the stomach acids as well as urine so the memory trick just think hydrogen ions is high acid too much hydrogen ions equals an acidotic state now simply organize this in your mind what makes the body acidotic well hydrogen ions get high acid and carbon dioxide just think carbon d and for base which makes us alkalotic just think bicarb base now the main organs that control these are the lungs and the kidneys so the lungs control carbon dioxide that CO2 we breathe in oxygen and breathe out ah that CO2 normal gas exchange right so just like you heard the main way to get CO2 out of the body is by exhaling so the less you breathe out well the less CO2 comes out and so more CO2 is retained in the body which makes the body more acidic so remember more carbon dioxide means more carbon dio acid a very acidotic body so naturally decrease in respiratory rate we have more acid from more CO2 now we see this in patients who are intoxicated or overdose or even a head injury we have low respiratory rate so CO2 is higher in the body and with increased respiratory rate we have less acid that less CO2 like with hyperventilation from an anxiety attack we breathe out all that CO2 so the body becomes less acidic and more alkyotic that base now on the other side of things the kidneys control two key players here hydrogen ions and bicarb HCO3 the kidneys regulate this acid base imbalance by excreting more acid into the urine and retaining more base by cararb kind of like a teeter totter or a seessaw here so in the same way it helps to balance out acid base imbalances here let's just say the body has a base or alkyossis overload well it helps to balance out the body by excreting more by cararb and retaining more hydrogen ions to make the body more acidic it does its part to help balance out the acid base imbalance so naturally too much or too little of either acid or base can throw the body out of balance if one is out of balance well then the others will try and adjust by increasing or decreasing in order to steady out this pH level and put it in normal range now this concept is called compensation so just think the body is trying to find common ground with compensation just trying to find that balance but we'll cover that in a moment here now that we understand the basics behind acid and base let's talk about respiratory versus metabolic acidosis or alkyossis for metabolic as mentioned before acid can be found in the urine from those high hydrogen ions and also in the stomach acids right so what happens if the patient vomits out all that stomach acid well what are we left with acid or base well base we're left in alkalossis since we threw up all that acid out of the body and into the body now what about renal failure we have broken kidneys right so can the kidneys excrete those hydrogen ions via the urine well no so acid is retained putting the body into acidosis and lastly we know that the intestines hold more base right so say the client has diarrhea and they poop out all their base from the body and into the body what are we left with only acid so the body goes into acidosis okay now our memory tricks are really fun here so pay close attention with metabolic alkyossis we vomit out all that acid leaving us in a base or alkyotic state so just think alkyossis it kind of sounds like you're throwing up with ulosis and you hold your stomach region indicating that metabolic area with alkalossis now this is also true with NG tube suctioning that nasogastric tube again too much acid loss leaves us in a base or alkyotic state so the key points to write down is vomiting and too much NG tube suctioning is metabolic alkyossis and for metabolic acidosis we have diarrhea renal failure and DKA that diabetic ketoacidosis so for diarrhea you poop out all of your base right which leaves the body in acidosis because only acid's left so just think if it comes out of your acidosis well then you'll be in metabolic acidosis or just think if base comes out of your butt well then you're only left with acidosis and in renal failure you retain too much urine right so is urine an acid well yes high hydrogen ions means high acid so the memory trick we use if your kidneys fail then acid prevails and lastly DKA diabetic ketoacidosis even the name includes the word acidosis so that one's an easy one here but a little side note for the pathophysiology here these clients try to compensate with those cous respirations that rapid breathing and hyperventilation this is done to breathe out that acid via that CO2 to try to get into alkalossis so once again the memory tricks metabolic alkyossis just think about vomiting and alosis and metabolic acidosis is diarrhea because you poop out from your acidosis and renal failure since the kidneys fail acid prevails now on the other side of things you know that you breathe oxygen in and CO2 that carbon dioxide out which we call carbon dia acid since it makes the blood more acidic right so in respiratory acidosis we have low and slow respiratory rate so just think the respiratory rate is slow in acidosis naturally a client with hypoventilation is not breathing out that CO2 so more carbon dio acid is retained in the body from low and slow breathing so the memory trick just think of someone sleeping here or snoring like they kind of sound like respiratory acidosis sounding like someone's snoring right so breathe slow in acidosis so common causes are from sleep apneoa that airway obstruction at night which can lead to acidosis and head trauma from being like knocked out like in a boxing match you went to sleep you went mimmeis and now you have low and slow respiratory rate and you're inidosis or post-operative like after surgeries when you're waking up from anesthesia and that body has been put to sleep from all that anesthesia the respiratory rate will be low and slow putting us into asidosis okay now for drugs CNS depressants this one's huge on exams so write these down this makes the breathing low and slow it makes the vital signs in general low and slow so opiate overdose morphine hydromemorphone etc as well as alcohol intoxication that one's a huge one and bzzoazipines ending in Pam and lamb like dasipam all CNS depressants make the breathing slow putting the body in acidosis now we can also have impaired gas exchange from let's say pneumonia where we get thick mucus buildup inside the lungs so you have to ask yourself do you have good gas exchange well no so CO2 is retained in the body making the blood more acidic and COPD or asthma attacks do we have good gas exchange well no so CO2 is retained so just think COPD retains more CO2 now on the other side for respiratory alkyossis we have a fast respiratory rate hyperventilation is the key term you have to know so hyperventilating from let's say an anxiety attack from taking a nursing exam so the memory trick we use think of a person panting like a dog basically breathing too fast it'll put them in respiratory alkalossis so the big one to know for exams is a panic attack or hyperventilation so you have to ask yourself why though well again in hyperventilation we blow off all that carbon dioxide that carbon dia acid so all that acid leaves the body right which leaves the body in which state acid or base well you just blew off all your acid so you're only left in base an alkyotic state so just remember alkalossis now Kaplan mentions what is the cause for respiratory alkyossis and the answer is hyperventilation so again just think for your exams every condition that's breathing too slow is acidosis or respiratory acidosis and every condition that's breathing too fast puts the body into h alkyossis now for the topmost missed exam question here the nurse expects which client to be in respiratory acidosis so before looking at the options just think here acidosis is that slowis so slow breathing so option number one morphine overdose yes it makes things low and slow putting us into acidosis like snoring acidosis now option two is incorrect a panic attack we have fast rapid breathing more h alkyossis not acidosis now option three is correct sleep apneoa yes we have slow acidosis remember like snoring acidosis and option four this one's tricky here COPD is correct because do we have slow or fast breathing H so just think about it here we actually have decreased gas exchange from chronic obstruction so CO2 is actually retained putting us into acidosis so that's correct and option five and six are also correct So an asthma attack you have to ask yourself can they breathe well no is that good gas exchange well then no so we have low and slow airflow putting us into acidosis and six was a little bit of an easy one here alcohol intoxication yes alcohol is a depressant making the respiratory rate low and slow putting us into hypoventilation with acidosis remember always sleepiness is like snoring for aidosis looking for more tips and strategies for questions like the ones we just covered well our simple nursing membership includes exit prep lectures and thousands of questions across all nursing school and INLEX topics so once again a quick recap for the memory tricks here write these ones down metabolic alkyossis is like you're vomiting up alosis metabolic acidosis means you're pooping out your acidosis for diarrhea and renal failure when kidneys fail acid prevails and for respiratory acidosis just think about that slow breathing that acidosis and for respiratory alkyossis is that fast breathing that hyperventilation kind of like panting like a dog hulk h alkalossis okay now that we have the basics down here's a critical thinking exercise what will the body do to get back into normal range remember this is called compensation so again think compensation is finding that common ground of balance for that pH to be in normal range kind of like that tug-of-war or that balancing act the lungs and the kidneys will compensate for each other to help keep that pH in normal range so too much acid the body will breathe faster to get into alkyossis increasing that respiratory rate to blow off that CO2 that carbon dio acid in order to be more alkalinic we see this a lot as mentioned before with DKA diabetic ketoacidosis when patients breathe those kousal respirations and on the opposite side with too much base that alkyossis the body needs to breathe more slowly to retain more of that CO2 to make the body more acidic right so we'll have patients breathe into paper bag breathing slowly and rebreathing that CO2 for more carbon dio acid here's another common enclelex question pulled from our extensive library of over 8,000 combined questions in our nursing school and enclelex memberships ag numbers for a client in metabolic acid dosis asking how does the nurse expect the client to show compensation and a little side note don't worry about interpreting all these crazy numbers we'll break this down next so just think metabolic acidosis right they need to go into alkyossis so h alkyossis they need to breathe faster hyperventilation so the correct answer is to increase the respiratory rate to blow off all that acid that carbon dia acid decreasing the respiratory rate would lead to more acidosis so option two is correct lastly before we take our AG practice questions here are some key points for the AG itself so Kaplan mentions "What is the most important objective data when determining if a client is hypoxic?" And the correct answer was abnormal blood gases yes this is the most accurate way to determine oxygenation of the body and a common exam question asks the best diagnostic test to evaluate a patient's oxygenation key term there and ventilation after a traumatic brain injury correct answer arterial blood gases i would write that one down because these came up a lot now AGs are typically done by a respiratory therapist now before the procedure the RT will prepare to draw blood from the radial artery and do an Allen's test this is done to determine the patency of the ulner artery now the test is done in three steps step one the client makes a fist and the RT oludes the radial artery and ulner artery step two the palm is open to reveal a pale palm from the lack of blood flow and lastly step three releasing the pressure on the ular artery here first the palm should regain its color in about 15 seconds or less this indicates the key term patency of the uler artery now after the procedure key terms here you have to hold firm pressure on the puncture site since we just punctured an artery and not a vein here so there's more pressure in arteries and a higher bleed risk so Kaplan mentions essential actions after AGs are drawn we have to apply pressure to the puncture site and Hessie also mentions the priority intervention following an AG procedure hold firm pressure at the site okay now part two of this video showing you how to solve those darn ABGs now a lot of students and instructors use the Rome or tic-tac-toe method but that can get really confusing especially when we get into partial versus full compensation make sure to pull out this study guide for this section so you can follow the key points so I personally created the marching band suit method for myself during nursing school and have never got a question wrong in over 8 years now so I recommend using this chart and writing it out 5 to 10 times every single day the week of your exam so pause your screen and write this down then we'll break it down and I'll explain why it's so perfect okay now this chart is so great because it's so organized starting with the names here first on the left side ph is on top so just think pH is primary because it comes first co2 is second so you see the two there so that's how you know it comes second and H3 well just look at the three there that's how you know it's the third one down next you just draw normal anatomy lungs over kidneys so lungs are on top near the CO2 and the kidneys are on bottom okay now for the key numbers and you have to memorize this so writing it out makes it simpler we have pH at 7.35 to 7.45 then just drop the sevens because they went to heaven so CO2 is just 35 to 45 and lastly by carb is 22 to 26 finally we label it all abba on the left side and bab on the other side so the A's are for acid and the B's are for base so once again pause this screen and again I recommend writing this out five to 10 times the week of your exam this is vital to know since this chart will save your booty on exams and even the EN clicks okay now after this chart is set up then we can use the three steps to interpret any ABG for acid base imbalances so step number one the pH this is our key here always look at pH first remember pH is primary we must look here first less than 7.35 is a for acid and over 7.45 is B for base or alkalotic so for example pH of 7.2 is acidosis and pH of 7.65 what do we have here yes it's base alkyossis now step two we match the pH with the partner below let's say the pH is an acid and the CO2 our respiratory is acid as well and the HCO3 are metabolic is in normal range well the two acids with pH and CO2 make it respiratory acidosis since the two acids match and our little lung icon here tells us it's a respiratory problem now if we have pH that is base or alkyossis and a CO2 that's a normal range and the HCO3 is high very alkyotic well then we have metabolic alkyossis since the two bases match and it's a metabolic problem here now step three is the hard part here so pay attention compensated versus uncompensated always look at the pH first so remember pH is primary the body hates to be out of balance right so it will try and balance the pH acid and base sort of like a tug-of-war or like a negotiation process to help bring that pH back into normal range this balance again is called compensation so once again think compensation is finding common ground just finding that balance for pH to be in that normal range so fully compensated means that the pH is in normal range yoo this is our goal boom we Gucci baby and we see the kidneys here and the lungs are doing their job to work together and work out their problems they're basically offsetting each other in order to sort of balance out the boat here and find that common ground of compensation for the pH it's like the pH is our little baby here keeping the pH baby happy and in normal range as the parents underneath are working through their problems with couples counseling now uncompensated this is our broken home our pH baby is not in normal range we do not have a happy baby oh no our pH has no compensation since it's not normal there's no common ground and the body isn't doing anything to help the balancing act either it's like a lazy partner who ain't doing nothing around the house and ain't doing anything to help out the relationship so the memory trick is think uncompensated is very unfriendly and let me explain why for example let's say the pH and the lungs are in acid overload they need some serious help so we expect the kidneys to help a brother out and go to base to balance us out right but nah in unfriendly uncompensation the kidneys don't care about the acid problem they just living their best life saying "Not my lung not my problem." This is like some Jerry Springer type stuff so this is uncompensated since it's the most unfriendly and lastly partially compensated our pH is not in normal range but it's okay at least the body is working through it and trying to balance itself out it's like the lungs and the kidneys are going to couple's counseling here to work things out and make steps for improvement sure the body is still in acidosis but at least base is trying here and that's why it's partially done so partial compensation it's a work in progress all right now for our ABG practice questions so using our three steps let's break this down abg practice question number one here we have a pH of 7.25 a PA CO2 of 55 and a HCO3 of 25 so using our marching band suit let's break this down step number one starting with pH because it's primary 7.25 is way below 7.35 so is it acidosis or in base that alkyossis well using our chart we know the A is for acid so acidosis step two we have to find the match on the bottom does CO2 or HO3 have that acid match well CO2 is 55 which is over that 45 so that's the acid we got an acid match in the lung area because our little lung picture hints that it's respiratory acidosis now HCO3 is 25 so that's a normal range now step three is it compensated or uncompensated so you have to ask yourself look at the pH is it normal well no so it's not in balance it did not find common ground of compensation so it would be uncompensated since it's very unfriendly here so the correct answer is respiratory acidosis that is uncompensated now for our next question ABG practice question number two we have a pH of 7.57 a pa2 of 25 and HO3 of 22 so filling out your marching band suit here then we use our three steps so step number one starting with pH because it's primary so 7.57 is that acid or is it base well it's way over 7.45 so that little B tells us it's base or an alkyossis now step two we have to find that alkyossis match so CO2 is 25 that's pretty low so that is base as well in alkalossis and the respiratory icon we have a match for respiratory alkyossis it looks like HCO3 is 22 so it's technically right on the border but it's normal so it's not a match now step three is it compensated or uncompensated so you have to ask is the pH in normal range well no so it's not in balance it didn't find that common ground of compensation so it would be uncompensated so the answer is respiratory alkalossis that is uncompensated okay the next question ABG practice question number three the pH is 7.21 21 pa2 is 39 and HCO3 is 19 so we fill out our marching band suit and step one looking at the pH because it's primary 7.21 is way below 7.35 so we know it's the A of acid then in step two we're going to find our acid match here so CO2 is 39 that's in normal range so there's no match and HCO3 is 19 on that aside so we have our acid match so the kidney icon tells us it's metabolic acidosis now step three is it compensated or uncompensated so look at the pH is it normal so it's not in normal range so it's not in balance it didn't find that common ground so it's not compensated so it's uncompensated the answer here is metabolic acidosis that is uncompensated now last but not least the trickiest questions fully or partially compensated so remember the body will try and balance the pH the acid and base sort of like tugof-war this balance once again is called compensation so again think compensation is finding that common ground of balance again a little recap here if the pH is normal between 7.35 and 7.45 this is full compensation and if the pH is not normal we have partial compensation basically that work in progress so for example say the pH is acidic then by carb that base will try to increase to balance it out if pH is still acidic but by carb is high then it's partially compensated so let's do an example question to see this in action abg question one full or is it partial compensation so looking at our numbers here pH is 7.32 we have a CO2 at 55 and HO3 at 42 so we fill out our marching band suit like normal step number one the pH is acid 7.32 step two we're going to find the match like normal and we find that CO2 is a little bit high and in the acid range so we know the respiratory icon it's respiratory acidosis so the body is in an acidotic state now step three the tricky part compensation hco3 our by cararb is 42 so we have a high base the body is trying to pull us out of that acidosis and back into balance this means compensation it's trying to work out its problems so it's trying to find that common ground of compensation but here's the key point is it partial or full compensation well look at the pH here is it normal well no so it's not fully compensated so it's just partially compensated since the pH has not fully recovered and the body is still trying to balance itself out so the correct answer here is respiratory acidosis that is partially compensated now AG question number two ph that is 7.55 CO2 of 49 and a HCO3 of 35 we're filling out the marching band suit so step number one what is our pH that is primary 7.55 so that's B that is base alkalossis step number two we're going to find our base match here so CO2 is in the acid area of 49 but it doesn't match to our pH base now by carb is 35 that's definitely a base match so two bases make a match and the kidneys tell us it's metabolic and the base alkyossis metabolic alkyossis now for step three the compensation of the inspiration of the perspiration okay okay compensation since CO2 that acid is out of range we know that the body is trying to pull us back into balance so this means compensation but again is it partial or full compensation so look at the pH remember that's primary so is it normal so no it's not normal so it's not fully compensated since it's not fully normal so we must conclude that it's partially compensated since the pH hasn't fully recovered yet so the correct answer is metabolic alkyossis that is partially compensated next question please abg question number three our pH is 7.37 oo that's normal co2 is 52 and HCO3 is 32 okay step number one pH that is normal but here's the trick it kind of looks like it's leaning toward the acid side now step number two we need to find a match but now you're thinking wait a minute how do you find a match from a normal pH h uhoh well CO2 is in the acid area right and we know that by carb is in the base area so oh snap what do we do now okay okay okay calm down calm down get it together we're going to pass this enlex we're going to pass our exams we're going to be a badass nurse oh gosh i should have been an Instagram influencer okay okay ignore that inner dialogue remember this acid base imbalance is kind of like a tug-of-war right so simply ask yourself who's winning this tug-of-war so look at that pH scoreboard here is the pH closer to the base or closer to the acid side well in this case pH is leaning closer to that acid side right so we must say that acid is winning so our match is CO2 that acid since it's in the acid area so the answer must be respiratory acidosis now step three is the compensation fully or is it partial well is the pH normal well yes it's in normal range we have a happy baby so the answer is respiratory acidosis that is fully compensated woohoo all right our last and final AVG question number four the pH is 7.45 45 and the CO2 is 43 and the HCO3 is 33 okay step number one the pH is in normal range but it's closer to the base side so base is winning our tug-of-war here now step two finding our base match co2 is in the acid range so that can't be our match hco3 our byarb is 33 that's definitely in the base side so metabolic specifically metabolic alkyossis since the bases are a match now step three compensation is it fully compensated or partially well look at the pH here our pH is fully normal so it's fully compensated so our answer is metabolic alkyossis that is fully compensated woohoo thanks for watching did you know you can unlock 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