Nursing implications
ABG values provide
important information about your patient’s condition. But never underestimate
the importance of your clinical assessment and judgment. As a nurse, you are
the most important advocate for your patients because you are constantly at the
bedside, monitoring, assessing, intervening, and reevaluating.
Your role begins with
identifying patients at risk for acid-base disturbances, including those who
have or are at risk for:
- significant electrolyte
imbalances
- net gain or loss of acids
- net gain or loss of bases
- ventilation abnormalities
- abnormal kidney function.
Assess patients carefully
to identify early clues of acid-base disturbances. Consider what your patient’s
vital signs are telling you. Count your patient’s respirations for a full
minute. What are the rate and the depth? Are they clues to an impending or
underlying respiratory or metabolic problem? What is your patient’s level of
consciousness? Confusion can be an early sign of an acid-base disturbance.
Correlate your patient’s fluid balance and creatinine levels with kidney
function. Always correlate your assessment findings with your patient’s
diagnosis. Do they match? Or is some clue pointing in a different direction? Be
sure to double-check the implications and adverse effects of all drugs you
administer.
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