Review ABG Results – COPD Nursing Care in ER

00:00 Before we do, I wanna talk about that why did the health care provider write a titration-based order to change the nasal cannula to a Venturi mask? Well, we touched on it earlier but see if you can remember.

00:13 Now you see the nasal cannula on one patient mannequin and then you see the mask on the other patient.

00:21 So it's definitely a different oxygen delivery method but what does the Venturi mask do? What can it do for a patient that the nasal cannula can't? Well, Venturi masks are used for patients with COPD fairly often because they can especially benefit from precise oxygen measurement.

00:40 Okay, so it's not as perfect with the nasal cannula.

00:43 Sometimes if a patient's a mouth breather, we've got problems with that and we're not really sure they're getting that exact amount of oxygen.

00:50 Now you have it right on the flow meter but because of if the patient's breathing in their mouth, they may be getting more room air et cetera, et cetera.

00:57 If they need very precise oxygen measurement which Mrs. Taylor likely may because we're not getting the response we want so far for the nasal cannula, then you put on a Venturi mask. And so this will help us for people with hypercarbia.

01:13 Remember? Hypercapnia, same thing. They have an elevated CO2 level in the blood.

01:19 So if you're taking care of a COPD patient, you might expect that this would be a method delivering oxygen that would be considered because it's more precise, this is for people who have low to moderate oxygen needs, and they are at risk for hypercapnia which she is.

01:36 Think of the symptoms.

01:38 Oh, she had that headache, having some problems, so depends on how far progressed the COPD is, we need to look at the results of those ABGs to really know for sure if it is.

01:48 Well, here they are. The initial ABG results are back.

01:53 So how would you interpret these results? Do they make sense with your clinical assessment and the patient's history? Pause the video and label each one of these. pH, CO2, bicarb, and PaO2 and I want you to write out in your opinion where is this patient.

02:15 Okay, welcome back.

02:17 Well, if you haven't learned how to interpret ABGs yet, that would be a great video series for you to check out because this is a critically important skill particularly in the ER and critical care units.

02:28 So a pH of 7.32. What's the normal level? 7.35 to 7.45 so this is lower than normal.

02:37 That's acidosis. CO2, the normal level is 35-45.

02:43 Well, this is elevated. That's also acidosis.

02:47 Bicarb of 26. Okay, that's normally 22-26 so that's okay.

02:54 That's within the normal range but that PaO2 is very low.

02:59 Now, what you know about interpreting ABGs, this patient is clearly in respiratory acidosis as evidenced by a high CO2 level, the pH that acidotic, and it's not compensated because the bicarb level's still within normal range.

03:16 It's not responding in a way that's helpful yet. PaO2 is still very low.

03:22 So respiratory acidosis, we have a PaO2 that is not normal.

03:28 Does this make sense with your clinical assessment? See, lab is worthless unless you take the numbers and compare them to the patient and assessment data that you've actually done.

03:39 Well, does it make sense that she's in respiratory acidosis? It does because she's having such a difficult time breathing.

03:46 Just because she's breathing fast doesn't mean she's breathing efficiently.

03:50 Would I expect that CO2 level to be up? Yeah, that lines up.

03:54 Now I'm thinking that's probably why she had the headache.

03:58 This is also a sign that wow, she's got elevated CO2, this COPD is definitely not doing great right now.

04:05 Also look at that PaO2. We've got to keep working on getting that up.

04:10 So how would you interpret these results? Please write in your notes respiratory acidosis.

04:18 Please make sure that you've got by the CO2, that's too high and the PaO2, that's also too low.

04:25 Does it make sense? Absolutely. So pause the video and I want you to answer that question and tick through all the reasons that we discussed why this particular set of ABGs make sense with your clinical assessment of Mrs. Taylor and Mrs. Taylor's medical history.