Arterial Blood Gases Uncomplicated Study Guide – Part 4

One of the most difficult, confusing topics in your nursing fundamentals would be determining whether your client is alkalotic or acidotic.

To help you create a more functional method of expertly distinguishing your respiratory and metabolic acidosis and alkalosis, SimpleNursing.com has created the marching band suit especially for you.

What is the marching band suit?

The marching band suit is an ABG figure with three rows and six buttons (three buttons on each end of the row).

On the left side, label each button as A-B-A and on the right side, label each button as B-A-B. The As stand for acidosis and the Bs stand for base or alkalosis. As for the three rows, label each row as pH, lungs, and kidneys.

Now, let’s put in the normal values so that it would look something like:

pH 7.35 A —————— B 7.45

Lungs 35 B —————— A 45

Kidneys 22 A —————— B 26

So, once you have this kind of figure drawn and labeled out, you are now ready to interpret your scenarios.

Important: The pH above is going to act as your key to interpreting your ABGs.

Now, let’s proceed with the different scenarios.

How does your marching band figure works?

If you are given an ABG question that indicates a pH of 7.25, that would automatically mean that it’s acid. Now, you just need to match that acid with the A (acid) in your lungs (respiratory acidosis) and with the A (acid) in your kidneys (metabolic acidosis). You can match either of the two in different scenarios.

Technically, you will be matching your pH which is your key, to the figures of the lungs and the kidneys to pinpoint the ABGs effectively.

To further explain, here are some scenarios.

Scenario #1

A client who failed to take her benzodiazepine and just experienced a traumatic event, like a car accident, came in hyperventilating and is becoming very anxious. How are you going to interpret this?

Tips for answering:

1. When a person is hyperventilating, they tend to make the sound of a dog that’s breathing fast like, “Alk, alk, alk, alk.”
2. pH level – more than 7.45.
3. Lungs – breathing off the carbon dioxide (Mike calls it carbon diacid to help with memorization); retain base inside your lungs, making the base below 35.
4. Kidneys (aim for homeostasis) – compensate since the body is alkalotic, would make the body a bit acidic.

Answer: Respiratory alkalosis

Scenario #2

A client with respiratory depression who’s manifesting improper breathing pattern like slow or labored breathing which technically means that there is more carbon dioxide in the lungs.

Tips for answering:

1. When a person has respiratory depression, you have to remind yourself of someone who’s sleeping soundly in their sleep, snoring while breathing slowly and making a hissing sound like, “Hiss, hiss.” Like that of a snake. You can remember this as, “hiss-cidosis or acidosis.” The respiratory rate is expected to be less than 12 to 20.
2. pH level – less than 7.35
3. Lungs – acid is more than 45
4. Kidneys – would compensate and make the body alkalotic.

Answer: Respiratory acidosis

Scenario #3

A vomiting client.

Tips for answering:

1. When vomiting, a client will go, “Ulk! Ulk-alosis.” This means that the body is giving out all the acid from the stomach; thus, increasing its alkaline level.
2. pH level – more than 7.45 (for confirmatory purposes)
3. Kidneys – more than 26

Answer: Metabolic alkalosis

Scenario #4

A client who has been experiencing two days of severe diarrhea.

Tips for answering:

1. When a client has diarrhea, alkaline from the GI tract, intestines and colon goes out. Alkaline, for your information, enables proper food digestion and the breaking down of enzymes. Diarrhea gets rid of your base; thus, increasing the acid level.
2. pH level – less than 7.35
3. Kidneys – less than 22

Answer: Metabolic acidosis

A quick refresher

Lungs

If the client is hyperventilating (alk, alk, alk-alosis), that client has respiratory alkalosis. On the other hand, if the client is hypoventilating (hiss, hiss, hiss-cidosis), that client has respiratory acidosis.

Kidneys

If the client is vomiting (ulk, ulk, ulk-alosis), that client has metabolic alkalosis. On the other hand, if the client has diarrhea, that client has metabolic acidosis.

So, that’s your ABG interpretation for you, guys. Hopefully, that helped clarify all your questions.

For more useful and free nursing content, drop by at simplenursing.com. You can also catch up on the ABG topics we’ve previously discussed.