Recommended reading for a critical care placement

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Acute and Critical Care in Adult Nursing

img_2524Part of the transforming nursing practice series, which I am a big fan of! This book contains everything you would need to know before and during a placement in a critical care area. Includes information on ABGs and  is separated into sections such as pain, respiratory distress etc making it easy to read in sections.

Oxford Handbook of Critical Care Nursing

img_2523This book is small enough to carry around in your bag and explains most procedures you are likely to encounter on a critical care placement. Includes sections on common medications used and sections on disorders affecting different systems within the body.

Critical Care Nursing Made Incredibly Easy!

img_2525This is another series of books that I am a fan of, they explain things in a way that is easy for everyone to understand – perfect for students who may not have had an acute placement before. This book includes explanations of over 100 disorders you may come across in a critical care environment. The cartoon pictures included provide a little bit of light-hearted humour as well!

Intensive Care Nursing: A Framework for Practice 

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This book is described as the ‘bible of intensive care nursing’. It may be useful to read this book when you have read one of the others or if you decide to progress into a career in critical care, however it is a fantastic book and one which I read bits of during my time on ICU.

Websites

ABGs – you will not be expected to fully understand these but if you can go into the placement with a basic understanding it will help you understand some of the results

ECGs – you will not be expected to fully understand these but here are a few sources if you would like to do some reading on them

Tracheostomy care

You can read my critical care blog series here

Love,

T x

*Book Review* Notes on a nervous planet

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img_2948A few weeks ago I reached a breaking point. I was done with social media, done with looking at other people and questioning why I wasn’t like them. I tweeted about it and amongst the replies, @EnigmaGirl81 told me I needed to read this book. I had seen previous books of @matthaig1 but hadn’t read any so this was my first experience of his writing. I ordered the book the next day and waited for it to arrive. Amazon delivered it quickly and I sat down to read it.

 

The book is described as being a ‘personal and vital look at how to feel happy, human and whole in the twenty-first century’. It was written based on Matt Haigs’ experiences with anxiety and panic attacks, linking what he felt to the world around him. Matt includes many honest recollections of his own experiences’ and coping strategies, which I’m sure many people can relate their own anxieties to. 

There are a number of sections but it was the section on social media that really resonated with me. I have spent hours and hours scrolling through Twitter and Instagram, comparing myself to other student nurses, to other girls and wondering why I couldn’t look like them. I’m 30 years old and having self-esteem issues because I don’t look like the streams of girls looking perfect on Instagram, so how do 15,16,17-year-old girls feel?! I’m more than aware that the pictures are sometimes filtered and edited but that doesn’t stop me comparing myself to those girls and wishing I looked more like Kim Kardashian and less like me.

In the book, there is a chapter where Matt Haig asked his Twitter followers – ‘Is social media good or bad for your mental wellbeing?’ and one tweet, in particular, I really related to. 

@deansmith7 I can find myself comparing my behind-the-scenes footage (loneliness, anxiety etc) to people’s highlights reel (socialising, success etc). I know it’s not a true reflection of their lives but it can still get to me. 

People choose what they want to post online, so it’s natural to only choose the good moments. Posting the pictures where you look your best. discarding of the 50 other ones you took before you were in just the right angle for the perfect selfie. Talking about the good days and achievements, leaving out the rubbish days or ‘failures’. 

Life appears to have become a daily struggle to validate ourselves through the likes and comments from other people. 

I would recommend this book to anyone, a perfect manual on how to navigate the modern world and to keep your own head. Funny, honest and real – Matt Haig is a fantastic author with a unique writing style. 

There are so many quotes in the book that I could include, but here are a few of my favourites:

  • We are all connected to each other but we often feel shut out.
  • In a world of a million distractions you are still left with only one mind.
  • In an overloaded world we need to have a filter. We need to simplify things. We need to disconnect sometimes.
  • Accepting where you are in life makes it so much easier to be happy for other people without feeling terrible about yourself.

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This is my favourite page 👌

 

 

 

 

You can purchase Notes on a Nervous Planet here.

Love,

T x

 

 

How to start blogging

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There have been some great blogs appearing recently on twitter, influenced by the 30 day July blogger challenge (@BloggersNurse) and the @WeNurses #70nursebloggers. I often see people asking how they can start a blog or for advice on what to blog about so I thought I would compile another one of my top tip posts around getting started as a student nurse blogger!

1. Choose your blogging platform

There are a number of free blogging platforms out there including WordPress and Blogger that are easy to use and can be personalised to how you want them. When you have been blogging a while, you could purchase a new theme or your own custom site address but for starting out the free ones are great.

2. Create a name

Try to choose something original and relevant to you. I chose student nurse and beyond because it describes where I am now and also allows me to carry on blogging using the same name once I qualify. There are some great blog names out there and you can really inject your own personality into them.

3. Personalise your blog

You can choose different themes and colour schemes to make your blog stand out. If you are a dab hand with graphics, you can design your own header or you can use one of the preloaded ones on the blogging site. I had my header designed by a friend and it gives my blog a personalised edge. Upload your own photos to give your blog a personal feel as well.

4. Create your first post

If you are a student nurse starting a blog, I would recommend blogging first about why you decided to start your nursing journey and why you chose the branch you did. This gives the reader an insight into you and helps to create a rapport with readers. Your posts don’t need to be too long and can be written in an informal style.

5. Read other blogs

Reading other blogs can help you to see different writing styles and what you may like to write about. If you see a topic on someone’s blog that you would like to write about, credit them within your post. It’s fine to take inspiration from other blogs, everyone does but people spend a lot of time of their posts so try not to just reword their posts to present as your own. Use your own skills and talent to create original content to you.

6. Don’t rely on a schedule

My advice would be to not put pressure on yourself when it comes to regular posting. Some bloggers post regularly and some don’t. Whatever works for you and your own schedule is good! Sometimes you can feel pressured to post once a week and it’s an added worry when you get busy and cannot manage to post that week.

7. Enjoy blogging!

I love blogging and find it really enjoyable to write, I like creating my top tip posts because I can give advice from my own experiences and if it even helps one person then that is fantastic! I personally stay away from commenting on political nursing issues but other bloggers comment on these really well (@Ewout1985, @CharlotteRCN, @JeepersMcCoy, @SchofieldRosie to name but a few). You can write about whatever you want to, but be mindful to maintain confidentiality at all times and to remain professional within your writing.

8. Don’t worry about the readers

It can take a while to build a regular readership on your blog, and even if you write a blog post to find only 5 people have read it it doesn’t matter! Write your blogs for you and if other people find them useful/interesting then that is a bonus. Blogging can soon become a ‘chore’ if you’re constantly writing to try to please other people.

9. Share your post

Promote your blog on social media – Twitter is a great place to share blogs! Some useful # to pop on your posts are: #nursebloggers #WeStNs #studentnurse

10. Continue blogging!

So you’ve got your first post out there and you really enjoyed writing it! Now carry on! Blog about your uni experience, your placement areas, your personal opinions, anything you want to write about.

If you want more information on how to start blogging, pop over to @WeNurses on twitter where there are some useful infographics to get you started!

Share your blog links with me as I love to read new blogs 😘

Love,

T x

My next placement is WHERE?!?

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My last placement was critical care and I’m sure you’ve all seen me banging on about how much I loved it 😂 So I was a little apprehensive about where my next placement would be and how it would compare to critical care. I know we shouldn’t compare placements and I would go into any future placement ready to learn and excited for the opportunity, but when you’ve had a placement as good as my critical care one was, it can be difficult not to worry about what future placement experiences you would receive.

We receive our placement allocations 4 weeks before we are due to start them, so I woke up on Monday morning to log in and check my allocation. I checked the placement and went back to sleep. When I woke up an hour later, I thought I had dreamt what it said. So I logged back on to find I hadn’t imagined it at all. I WOULD BE GOING TO NEONATAL FOR MY NEXT PLACEMENT!! 

Neonatal is somewhere I hadn’t even thought of having a placement, it had crossed my mind for my 4-week elective at the end of year 3 but it is notoriously hard to get as it is a popular choice. To receive it as a spoke placement is fantastic and I am very grateful for the opportunity to spend 4 weeks on neonatal.

I would be lying if I said I wasn’t nervous because I really am! Having read the student handbook, it appears that a few of the skills learnt within critical care will be transferable to neonatal but there will be a lot of new learning to be done. Plus, the fact that these are little babies and not adults scares me! What if I ‘break’ one of the little babies?! (Now I know this is irrational and I will not be ‘breaking’ any babies 😂 but it is still a worry!) Everything is different, they are so tiny (even full-term babies are tiny) and need caring for in a way that is very different from the adults I have cared for in the past. I will be completely out of my comfort zone here but I was entering critical care, after spending a year in a community hospital.  The idea of looking after critically ill babies in neonatal terrifies me, but the idea of looking after critically ill adults also terrified me and I thrived on that placement.

I don’t have any experience with children as I don’t have my own so it will be a huge learning curve but one that I am very excited for. If you’ve experienced a placement on neonatal, any tips will be gratefully received 😊

Love,

T x

 

 

Revision! Revision! Revision!

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Here are my top tips for revision!

  • Start early. As soon as the exam date is announced, plan how you will organise your revision.
  • Plan your time. I had a revision schedule so I planned 3 hours of revision a day (with a 15 minute break) where possible and stuck to this. My exam was anatomy & physiology so I chose a different system every week to revise.
  • Break it into sections. If your revision is for a&p, break it down into systems. If its for another module, break it down into manageable sections and try not to revise too much at once.
  • Create a checklist to keep track of your revision.

  • I have learnt to do what I call ‘skim reading’, so I can pick out the important words/points in a section of text and make my own notes on it. This improves understanding as you’re writing your own notes as you go along and also helps you to develop your paraphrasing skills.
  • Learn as you go along. Revise the things you have learnt that day in university as the information will be fresh and I find it easier to retain things if I look over them again after university has finished for the day.
  • Discover what type of learner you are. There are a number of types: visual, aural, reading/writing and kinesthetic. I learn through reading/writing, others learn through the use of colour or videos.
  • Use colour. Coloured posters, highlighters, flashcards. If it’s in colour, you may find it easy to remember instead of just being on white paper.

  • Make flashcards. I wrote a question on one side, answer on the other and asked people to test me. I also made ones with key pieces of information on to read through in my spare time. Below are some of the flashcards I created.

  • Diagrams are useful. I printed some a&p diagrams without labels on and worked on labelling them over and over again until I knew all the labels.
  • Youtube. If you’re a visual learner, there are bound to be videos on youtube for your subject. If you are revising for a&p, crash course with Hank is fantastic.
  • Utilise available apps. Khan Academy is fantastic for a&p, it’s free and includes quizzes.
  • Put posters around the house. During your exam you may be able to visualise the room and the information in there. It may also help you to revise as every room you go in with have some information to look at whatever you are doing at the time.

  • I have seen people recommending recording yourself talking about your revision and listening to it as you fall asleep on a night can help. I haven’t tried this myself but you could always try it to see if it works for you!
  • Find a quiet space. Try to revise on your own, I like to listen to music quietly in the background but others prefer silence. You will learn pretty quickly what works best for you.
  • Use mnemonics. You can create these and by remembering these, it helps you to remember the more complex thing it stands for. An example is: for the layers of the epidermis, they all begin with stratum. So to remember the order of the layers (superficial to deepest):

Clever (Corneum)

Ladies (Lucidum)

Get (Granulosum)

Skin (Spinosum)

Beautiful (Basale)

(This is from my fantastic a&p lecturer @JaneTurnerStH who told us some fantastic mnemonics).

  • Try to get plenty of rest. A well rested mind will help you to revise and retain information.
  • Remember to keep your energy levels up whilst revising, this helps with concentration levels and gives you an opportunity for a 15 minute break. Snack on fruit and try to limit caffeine as this can cause slumps in concentration levels.

  • If you can access past papers, these are great to get a feel for the style of questions and what will be required in the test.
  • Consider revising in groups if this is how you like to work, you will be able to test each other and assist with each other’s knowledge.
  • Celebrate reaching revision targets as this helps to keep you motivated.
  • Don’t compare yourself to others, we all learn at different rates.
  • If you know you get nervous on the morning of the exam, try not to be around other people who will be fretting and talking about the exam. It will just make you worry more.

Let me know if you have any other great tips!

Love,

T x

Images sourced from pixabay unless stated otherwise.

Common myths you may hear as a student nurse

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1. It doesn’t matter what degree classification you get. 

In the grand scheme of things, it’s true it doesn’t matter what classification you get. As long as you pass and are signed off as competent, you will qualify and receive a pin. BUT if you want to go on and do further study like a masters, the chances are you will need a 2:1 at least. This is where degree classification does matter. There is no shame in aiming high and wanting to achieve something which you know you are capable of.

2. Every day will be amazing and you will love every minute.

This might happen. But there’s also the chance that you will have ‘off’ days or a negative experience which will make you doubt/question everything. I know, I’ve been there. I didn’t talk about it and it made me doubt my decision for a long time. I felt useless because I was struggling and everyone around me seemed to be loving every minute. If you feel this way, talk about it. Others will feel the same you just don’t realise it.

3. You must work on a general ward for at least a year before specialising.

NO.

Want to work in the community? Go for it. Critical care? You can. A&E? DO IT! If you know you want to work in an area that isn’t a general ward and they accept NQN (which more and more areas do now) then go where you know your heart lies. Why ‘settle’ for a job you know isn’t your first choice when your dream job is waiting for you to grab with both hands?! Yes you will learn transferable skills on a general ward, but the skills learnt in other areas are usually very different to the skills learnt on general wards. Each area has its own strengths and skills to be learnt, all of which can be transferred to other areas if you decide to change direction later in your career.

4. You can’t work around your degree.

You can, I do. I HAVE TO. Always put uni/placement/deadlines above picking up a shift. And always be careful of doing too much and ‘burning out’. Your uni may have rules about how many hours you can do a week, so if you have a 30 hour uni week you may only be able to work 18 hours around that. You don’t need to work in healthcare, it’s beneficial to keep care skills up to date but you spend enough time on placement that this shouldn’t be an issue. You can have any part-time job as long as it’s flexible enough to fit around uni/placement.

5. You can’t be yourself on social media.

You can. Be mindful of abiding by the code and maintaining professionalism/confidentiality, but if you want to tweet about your favourite tv show or sport then go for it! It’s great to get to know the personalities behind the student nurse ‘tag’ and you can make some wonderful friends through social media and shared interests.

6. You must spend every waking moment reading, researching, working etc.

Yes it’s important to read around assignments and research up coming placements. But you need to remember to take time for yourself as well. See your friends, go to the cinema, go for a run. Something completely unrelated to nursing, give yourself a break regularly. Take care of yourself.

7. Male nurses are gay.

This is one I hear time and time again and it’s simply not true. Yes some male students/nurses will be gay, just like some female students/nurses will be. But there are also many who are not. Don’t assume someones sexuality based on the job they do, its outdated and stereotypical. Plus, someones sexuality is nobody’s business unless they choose to share it with you, assumptions can be damaging and hurtful.

8. Nurses are only nurses because they are not clever enough to be a doctor. 

If I wanted to be a doctor, I would have been a doctor. Many of us are clever enough to be doctors but didn’t want to be. Yes they are both careers within healthcare, but the roles are very different. Gone are the days where nurses are just there to help the doctors, they are recognised in their own right now. The care that nurses provide is just as vital to a patient. It’s insulting to hear someone say you chose your career path because you’re not intelligent enough for another one.

9. Your cohort will be amazing and you will all be friends for life.

Your cohort will be full of people just like you, student nurses trying their hardest to succeed. You will make friends and those friendships may continue after uni. But you will not like everyone. This is the same in any situation in life, yes you will be friendly towards people but you don’t have to become best friends with every person you meet just because they are a student nurse too.

10. You will always be supernumerary.

Now this may not 100% be a myth and in a majority of placement areas you will be supernumerary. Just be aware that if you feel your supernumerary status is not being implemented then you should speak to someone about it. There is a difference between helping HCAs and assisting with the ward routine, and constantly being used as a HCA/extra pair of hands with no learning opportunities or mentor guided time.

11. You cannot be good academically and on placement, it’s one or the other.

I’ve heard this on many occasions and even had it directed towards me more than once. There is no reason you cannot excel in both areas, many people do. It’s another outdated view that you can only be good academically or in practical situations, not both.

Let me know if there are any other myths you have heard!

Love,

T x

How to survive group work as a student nurse

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“This module will include group work”. Something that I’m sure many of us dread hearing at university. This may be because you prefer working on your own or because you’ve had a bad group work experience before. Group work brings different personalities together and these can sometimes clash, I’ve compiled a few tips to help get you through the group work and out of the other end smiling!

1. Make sure everyone understands the assignment 

When the project is first assigned, the most important thing is to make sure everyone understands what is needed and when by. Making sure all group members are on the same page early on is essential to good group work. Get to know a little bit about all the group members and where they feel their strengths will lie within the project.

2. Spilt up tasks and create a team 

Once you’ve determined what people’s strengths are, you can use them to make your project a success. Some people may be creative, some may enjoy writing, some may prefer to present the presentation (if this is part of your task). If you can split the work up evenly between yourselves and utilise everyone’s strengths, it makes the whole process run a lot smoother.

3. Encourage participation 

Sometimes during group work, it’s easy for people to feel as if their ideas are not valued or are not being listened to. Always try to encourage members to talk about their ideas and if you don’t agree with them, try to say this in a non judgemental, constructive way….so explain why you don’t think that’s the right idea for the project or what you could change slightly to make it the right idea. Trying to compromise on ideas is always better than saying no outright. Challenge opinions respectfully and always be open to other members’ points of view.

4. Communication

Communication is key to group tasks! You will never have a good group work experience unless you communicate. Stay in regular contact with group members and keep everyone up to date with anything that is happening. I’ve always found creating a WhatsApp or Facebook chat group is an easy way to keep group work chat in one place. Try to meet up regularly as well, having a message group is good but messages can often be taken in a different manner to which they are meant. Meeting up as a group is good for brainstorming and developing the project.

5. Don’t try to take charge immediately 

I get it, some people are naturally ‘leaders’. Try not to be the person who walks into group work and immediately tries to take charge, this can cause problems within the group from the start that may be hard to rectify later on. Everyone within the group should be equal and often one person ‘taking charge’ is great for organisation but when there is more than one person who wants to be the ‘leader’, this can often lead to clashes. Everyone should work together to ensure the project is completed. A ‘leader’ may naturally emerge throughout the weeks, and that is a much better way than someone assuming they will be from the start.

6. Pull your weight

It can be easy during group work for someone to take on a lot of the tasks and for others to not do much. This isn’t fair on the other members and can often lead to resentment. If you are assigned a task within the group, keep up with the work for it and have it completed by the relevant deadline date.

7. Picking your group

If you find yourself in a situation where you can pick your own group, you think ‘great! I can be with all my friends and it will be great’. Whilst it’s nice to be in a group full of friends, it may not be right for you. If you’re the kind of person who likes to be organised and your friend is a last minute type of person, being in a group together may not work for you. Try to be in a group with people who work like you and you may just find that you enjoy the process!

8. Recognise why group work is used 

Group work may feel like a pointless task at times, but there are many benefits to it. You can improve communication skills that you already have and work with a variety of different people. In first year, group work is a great tool for getting to know other people in your cohort. Group work can help with team building and collaboration skills which we will all need when we start our NQN jobs. Other skills you can develop are problem solving, time management, delegation and confidence in your own knowledge.

Love,

T x

 

 

Common equipment used in critical care

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Monitor – Every patient requires a monitor which allows for continuous monitoring of observations. These include blood pressure, heart rate, respiratory rate and oxygen saturations, CO² and temperature can also be added on to the monitor.

Ventilator – A ventilator can assist patients’ with their own breathing, or completely take over the control of a patients’ breathing. This allows their body to rest and recuperate. The patient will either have an endotracheal tube or a tracheostomy. A tracheostomy tube allows the patient to receive full support whilst awake. If the patient has an endotracheal tube, they will be sedated.

Arterial line – An arterial line is inserted into an artery and this enables constant monitoring of blood pressure, through being connected to the monitor. They also allow access for frequent blood samples and ABGs. The arterial line can be inserted into the radial, brachial, femoral or pedal artery. The most common ones I saw in critical care were radial ones. The arterial line is sutured to the skin to keep it in place.

Central line – A central line is an intravenous line, inserted into one of the larger veins in the body. They are mainly used for administering medications, IV fluids are also given through central lines. Central lines are usually inserted into the jugular vein, but they can also be inserted into the femoral or subclavian veins.

endotracheal-tube-500x500Endotracheal tube – This is a plastic tube that is used during mechanical ventilation. The tube is inserted into the patient’s trachea, often the tube will be cut to a size recommended by the Dr carrying out the intubation. A bougie may be used to guide the insertion of the tube. Once inserted, the tube will be attached to the ventilator via ventilator piping. There is a cuff on these tubes that will be inflated to prevent movement of the tube, cuff pressure is checked regularly to ensure there are no leaks.

Indwelling urinary catheter – All patients within critical care will have a urinary catheter in place. This is to ensure accurate monitoring of urine output for the patients fluid balance records. Urine output will usually be recorded every hour.

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Vas Cath – A vas cath is a specialised central line that is used only for dialysis. Placed in the jugular, femoral or subclavian veins. I only saw one of these in my time on critical care and it was placed in the femoral vein.

 

Product_PicWindow_Carefeed-AdultNasogastric tube – This is a flexible tube that is inserted through the nose and down into the stomach. The NG tube can be used to provide nutrition via a ng feed and to administer certain medications. The NG tube is aspirated regularly to check if the patient is absorbing the ng feed and to test the ph level of any aspirations collected. The position of the NG tube should be checked and recorded regularly by measuring the length of the tube visible. Before using the NG tube, the guide wire should always be removed.

tracoe-twist-ref-301-tracheostomy-tubeTracheostomy tube – A small tube placed into a hole made in the neck, allowing access to the trachea. A tracheostomy is used when a patient is being weaned from ventilator support. These are temporary and will be removed when the patient no longer needs them. The inner tubes are cleaned every 4 hours.

Intravenous infusion pumps – Used for any medication that is administered through a central line. The amount of medication infused every hour is recorded on the fluid balance chart. These are the ones used in my trust, others may vary.

 

Let me know if you’ve seen any other equipment on your critical care placements!

Love,

T x

 

 

Acidosis and Alkalosis

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You can read my post about ABGs here.

Respiratory Acidosis

Respiratory acidosis is caused by poor alveolar ventilation. This leads to the retention of CO². Causes can include asthma, respiratory depression and COPD.

An ABG would show:

ph level

CO²

Respiratory Alkalosis

Respiratory alkalosis is caused by excessive alveolar ventilation, also known as hyperventilation. This causes more CO² to be exhaled than usual. PaCO² is reduced, causing the ph level to increase. Causes can include anxiety (panic attack), pulmonary embolism and pneumophorax.

An ABG would show:

ph level

CO²

Metabolic Acidosis 

Metabolic acidosis can occur due to increased acid production or decreased acid excretion. Can be caused by things such as diabetic ketoacidosis and Addison’s disease.

Metabolic Alkalosis

Metabolic alkalosis occurs due to a decreased hydrogen ion concentration. This leads to a rise in bicarbonate. Can also occur directly due to an increased bicarbonate concentration. Causes can include vomiting/diarrhoea (gi loss of H+ ions) and heart failure or cirrhosis (renal loss of H+ ions).

Below is what an ABG would show for metabolic acidosis and alkalosis:

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Love,

T x

 

 

 

A guide to ABGs

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ABG is an abbreviation for arterial blood gas. ABGs are performed by taking blood from an artery instead of from a vein. ABGs are performed to give an accurate measurement of ph, oxygen and carbon dioxide levels within the blood. They are used to check the function of the lungs and how well they are able to move oxygen and remove carbon dioxide.

To begin to understand ABGs and be able to interpret them, you need to know the normal ranges:

  • pH – 7.35 – 7.45
  • paO² – 10 – 14 kPa
  • paCO² (carbon dioxide) – 4.5 – 6.0 kPa
  • HCO3 (metabolic) – 22 – 26 mmol/L
  • Base excess – -2 to +2 mmol/L
  • O² sats – 94-100%

 

paO² – partial pressure of oxygen

This should be >10kPa (kilopascal) on room air in a healthy patient.

If patient is <10kPa on room air – patient is hypoxaemic (lack of oxygen within the blood)

If patient is <8kPa on room air – patient is severely hypoxaemic and in respiratory failure, CO² would be looked at to determine type 1 or type 2.

Ph level – acidity/alkalinity of the blood 

Acidotic – <7.35

Alkalotic – >7.45 

The smallest change in the ph level can have detrimental effects on the human body. The causes of a change in ph level can be respiratory or metabolic. Changes in ph are caused by a CO2 imbalance (respiratory) or a HCO3 imbalance (metabolic). Co2 and HCO3- act as buffers to keep the ph level within its normal range.

paCO² – partial pressure of carbon dioxide

paCO² is the respiratory element of an ABG.

The chemistry behind respiratory acidosis/alkalosis follows:

CO² binds with H2O and forms carbonic acid (H2CO3). This is acidic, causing the ph level to decrease below 7.35. If the patient is retaining CO², the blood will become more acidic. If the patients’ respiratory rate is raised, CO² will be ‘blown off’ meaning there is less CO² in the system than usual therefore the blood becomes more alkalotic.

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HCO3- (Bicarbinate)

HCO3- is produced by the kidneys and ‘collects’ acids (H+ ions). It is a byproduct of the body’s metabolism.

When HCO3- is raised, ph level is increased due to a decrease in H+ ions (alkalosis).

When HCO3- is low, ph level is decreased due to an increase in H+ ions (acidosis).

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Base Excess

Base excess is another marker of metabolic acidosis/alkalosis. It is the amount of acid that must be added to each litre of fully oxygenated blood to return the ph level to 7.40 and to gain a paCO² level of 5.3kPa.

If the base excess is high ( > +2mmol/L) = this indicates higher than normal HCO3- within the blood.

If the base excess is low (< -2mmol/L) = this indicates lower than normal HCO3- within the blood.

Compensation

Respiratory acidosis/alkalosis can be metaolically compensated. This is done by increasing or decreasing the levels of HCO3-.

Metabolic acidosis/alkalosis can be compensated by the respiratory system. This is done by retaining or ‘blowing off’ carbon dioxide.

You can read more about acidosis and alkalosis here.

Love,

T x

 

Information researched through critical care nurse, on Geeky Medics, Oxford Medical Education and from medical textbooks.