Page 280 - Saunders Comprehensive Review For NCLEX-RN

A. Collection of an ABG specimen
1. Obtain vital signs.
2. Determine whether the client has an arterial line in
place (allows for arterial blood sampling without
further puncture to the client).
3. Perform the Allen’s test to determine the presence of
collateral circulation (see Priority Nursing Actions).
4. Assess factors that may affect the accuracy of the
results, such as changes in the O settings, suctioning
2
within the past 20 minutes, and the client’s activities.
5. Provide emotional support to the client.
6. Assist with the specimen draw; prepare a heparinized
syringe (if not already prepackaged). After obtaining
a specimen, prevent any air entering the syringe,
because air can cause a blood gas analysis alteration.

7. Apply pressure immediately to the puncture

site following the blood draw; maintain pressure for 5
minutes or for 10 minutes if the client is taking an
anticoagulant to decrease the risk of hematoma.
Reassess the radial pulse after removing the pressure.
8. Appropriately label the specimen and transport it on
ice to the laboratory.
9. On the laboratory form, record the client’s
temperature and the type of supplemental O that the
2
client is receiving.
B. Respiratory acid-base imbalances (Table 9-4)
1. Remember that the respiratory function indicator is
the Paco .
2
2. In a respiratory imbalance, you will find an opposite
relationship between the pH and the Paco ; in other
2
words, the pH will be elevated with a decreased Paco 2
(alkalosis) or the pH will be decreased with an
elevated Paco (acidosis).
2
3. Look at the pH and the Paco to determine whether the
2
condition is a respiratory problem.
4. Respiratory acidosis: The pH is decreased; the Paco is
2
elevated.
5. Respiratory alkalosis: The pH is elevated; the Paco is
2
decreased.
C. Metabolic acid-base imbalances (see Table 9-4)
1. Remember, the metabolic function indicator is the
bicarbonate ion ( ).
2. In a metabolic imbalance, there is a corresponding
relationship between the pH and the HCO –; in other
3
words, the pH will be elevated and HCO – will be
3

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