Walkthrough: Physiological Adaptation Q12 – NCLEX-RN®

00:01 Oh, welcome to this question. This is an ABG question.

00:05 I love these.

00:07 Now, if you haven't really learned ABG yet, don't worry.

00:10 We'll walk you through this question.

00:11 And then you can always catch our video on ABGs.

00:14 We have a whole series on how you can learn to interpret ABGs.

00:19 So let's get going on this question.

00:21 The nurse is assessing a client with COPD, who has a pH of 7.32, a CO2 of 46 and a bicarb of 28.

00:32 For which condition does the nurse associate these assessment findings? Wow, that sounds very proper. Doesn't it? What's our strategy? Take a look at the first sentence.

00:44 And remember with every number you have to decide, is it high, low, or normal? Okay, so I'm assessing a client with COPD.

00:55 We know they got respiratory problems, right? Now they have a pH of 7.32. Is that high, low, or normal? It's low. Normal pH is 7.35 to 7.45.

01:12 Okay, I want you to work through the rest of the options.

01:17 CO2, is that high or low? Bicarb, or HCO3 of 28? Is that high, low, or normal? Okay, now we're going to find out which condition does a nurse associate these assessment findings? So what would you expect if we interpret these ABGs, we're likely going to have four options.

01:42 And you're going to have to identify which one is the best description of where this patient is? All right, ready? Let's bring in those answer choices.

01:53 Okay, work through these.

01:56 Push the pause button, and then start us back up again.

01:59 And we'll walk through the answer choices.

02:01 Alright. See you in a minute.

02:10 Welcome back.

02:12 All right, when I see answer choices like this, my brain gets a little squishy, like, "Oh, they look all the same." Not a problem.

02:21 Anytime you have four answer choices that look this close, in similar to each other, let's make sure we use some key strategies.

02:30 Let's look at what's the same. And what is different.

02:34 Well, the first two answers are respiratory, respiratory.

02:37 The last two are metabolic metabolic.

02:40 Okay, so we've got respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis.

02:50 Great. All right, so we have all four options, right? When you're looking at some type of imbalance, you can only be one of those four things.

02:59 Kind of perfect for a multiple select question.

03:02 So we know that we've got these four options.

03:05 Now, pH, is the one that determines if I'm acidotic or alkalotic.

03:10 If I have a pH of 7.32, that is not normal.

03:15 It's a little bit below normal.

03:18 So pH of 7.32, is considered acidotic.

03:23 Okay. So what can I get rid of? All right, now I can get rid of number two.

03:30 So I'm going to cross through that. Because that's alkalosis.

03:33 And I know that pH is acidosis.

03:36 I can get rid of number four, because that's metabolic alkalosis.

03:41 So I'm going to cross through that.

03:44 That quickly, we're down to those two answers, that I always do my best to get the correct one.

03:50 No more saying, "I always get it down to two.

03:53 And then I always pick the wrong one." That's not true. You can do hard things.

03:59 We're here to help you.

04:01 So we're left with respiratory acidosis partially compensated or metabolic acidosis partially compensated.

04:09 Well, here's what you have to look at.

04:11 The CO2 of 46.

04:15 Now, is that normal? Well, normal CO2 is 35 to 45.

04:19 This is just a skosh above it. Right? Just a little bit.

04:24 Now bicarb normal range is 20 to 26 ish.

04:29 Right in there, right? So we know that this is high.

04:34 Whoa, wait a minute. What's going on here? Well, we have a patient that's acidotic.

04:40 Their CO2 is high, but their bicarb is also high.

04:45 What we have going on here is so cool.

04:48 What our body does, alright.

04:50 So I am an acidosis.

04:52 Now is CO2 considered an acid in the blood or is bicarb? CO2 is considered an acid in the blood.

05:01 Which body system control CO2? The lungs.

05:05 Bicarb is considered a base or alkalotic.

05:10 Think about the kidneys kind of controlling that system.

05:13 So, if I'm in respiratory acidosis, that would mean I'm an acidosis. And the cause is an elevated CO2.

05:25 That ring a bell? Okay, that's sounding pretty good.

05:28 Why would this not be metabolic acidosis? Well, if bicarb is a base, in order for this to be metabolic acidosis, I would expect there to be less base.

05:42 If the cause of this pH of 7.32 is metabolic, that means I would have less base available.

05:51 This one's got extra, right. It's got extra bicarb.

05:55 That means my body is trying to get back to homeostasis, hence, the terms partially compensated.

06:03 So this is technically respiratory acidosis.

06:08 That's what got us to this acidotic state.

06:11 Now I look at the opposite system. And I see bicarb.

06:16 Is the body responding in a way that's helpful? Well, if I'm acidotic, if I can raise my alkalotic or bicarb levels, then I'll bring that pH higher and higher to be back in the normal range.

06:31 So this has to be respiratory acidosis partially compensated.

06:38 Woohoo! Why is it partially compensated? Well because the pH is still 7.32. It's outside of the normal range.

06:48 Now in real life would be pretty happy with this.

06:51 Probably. Depending on what else is going on.

06:53 But remember, we're talking about testing world and NCLEX world.

06:58 And those are the perfect worlds.

07:01 Okay, if you've never been exposed to ABGs before, that may have been like, "What did we just talk about?" If it's been a while, hopefully it came back to you.

07:11 And if you know, I'm like a rockstar, Stella Brightman, take a victory lap.

07:16 If you got that question, right.

07:18 And you understood, why you got that question right. Cool.

07:23 Now, if you want to learn more, and you want to refresh, we did a whole series with a couch.

07:28 We got a pillow on each side for acidosis and alkalosis.

07:33 We got all kinds of cool stuff talking about the couch of homeostasis.

07:37 Check it out. I promise you will be a rock star on ABGs after watching that video series.