Arterial blood gas (ABG) analysis evaluates gas exchange in the lungs by measuring the partial pressures of oxygen (PaO2) and carbon dioxide (Paco2) as well as the pH of an arterial sample. Pao2 measures the pressure exerted by the oxygen dissolved in the blood and evaluates the lungs’ ability to oxygenate the blood.
Paco2 measures the pressure exerted by carbon dioxide dissolved in the blood and reflects the adequacy of ventilation by the lungs. The pH measures the bloods hydrogen ion concentration and is carbonate (HCO3-) is a measure of the bicarbonate ion concentration in the blood, which is regulated by the kidneys. Oxygen saturation (Sa02) is the oxygen content of the blood expressed as a percentage of the oxygen capacity which is the amount of oxygen then blood is capable of carrying if all of the hemoglobin [Hb] were fully saturate). Oxygen content (o2CT) measures the actual amount of oxygen in the blood and isn’t commonly used in blood gas evaluation.
- To evaluate the efficiency of pulmonary gas exchange.
- To assess the integrity of the ventilatory control system.
- To determine the acidbase level of the blood.
- To monitor respiratory therapy.
- Explain the arterial blood gas analysis evaluates how well the lungs are delivering the oxygen to the blood and eliminating carbon dioxide.
- Tell the patient that the test requires a blood sample.
- Explain to the patient, who will perform the arterial puncture, when it will occur, and where the puncture site will be; radial, brachial, or femoral artery.
- Inform the patient that he may not need to restrict food and fluids.
- Instruct the patient to breathe normally during the test, and warn him that he may experience a brief cramping or throbbing pain at the puncture site.
- Use a heparinized blood gas syringe to draw the sample.
- Perform an arterial puncture or draw blood from an arterial line.
- Eliminate air from the sample, place it on ice immediately, and prepare to transport for analysis.
- Note the flow rate of oxygen therapy and method of delivery.
- Note the patient’s rectal temperature.
- After applying pressure to the puncture site for 3 to 5 minutes and when bleeding has stopped, tape a gauze pad firmly over it.
- If the puncture site is on the arm, don’t tape the entire circumference because this may restrict circulation.
- If the patient is receiving anticoagulants or has a coagulonopathy, apply pressure to the puncture site longer than 5 minutes if necessary.
- Monitor vital signs and observe for signs of circulatory impairment.
Normal ABG values fall within this ranges.
· Pao2 – 80 to 100 mm Hg (SI, 10.6 to 13.3 kPa)
· Paco2 – 35 to 45 mm Hg (SI, 4.7 to 5.3 kPa)
· pH – 7.35 to 7.45 (SI, 7.35 to 7.45)
· O2CT – 15% to 23% (SI, o.15 to 0.23)
· Sao2 – 94% to 100% (SI, 0.94 to 1)
· HCO3- -22 to 25 mEq/L (SI, 22 to 25 mmol/L)
- Low Pao2, O2CT, and Sao2 levels and a high Paco2 may result from conditions that impair respiratory function, such as respiratory muscle weakness or paralysis, respiratory center inhibition (fromhead injury, brain tumor, or drug abuse), and airway obstruction possibly from mucus plug or a tumor.
- Low readings may result from bronchiole obstruction caused by asthma or emphysema, from an abnormal ventilation perfusion ratio due to partially blocked alveoli or pulmonary capillaries, or from alveoli that are damaged or filled with fluid because of disease, hemorrhage, or near drowning.
- When inspired air contains insufficient oxygen, Pao2, O2CT, and Sao2 decrease, but Paco2 may be normal. Such findings are common in pneumothorax, impaired diffusion between alveoli and blood.
- Low O2CT – with normal Pao2, Sao2 and, possibly, Paco2 values – may result from severe anemia, decreased blood volume, and reduced hemoglobin oxygen carrying capacity.
- Wait at least 20 minutes before drawing arterial blood when starting, changing, or discontinuing oxygen therapy. After initiating or changing settings of mechanical ventilation or other extubation.
- Before sending the sample to the laboratory, note on the laboratory request whether the patient was breathing room air or receiving oxygen therapy when the sample is collected.
- Exposing the sample to air increase or decrease in Pao2 and Paco2.
- Venous blood in sample possible decrease in Pao2 and increase Paco2.
- Use of Diamox, Macrodantin, and Tetracycline may decrease Paco2.
- Fever may cause false-high Pao2 and Paco2.
- Bleeding from the puncture site.
Generic Name: Albuterol
Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol, Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira ER
Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)
- To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
- Quick relief for bronchospasm
- For the prevention of exercise-induced bronchospasm
- Long-term control agent for patients with chronic or persistent bronchospasm
Mechanism of Action
It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.
- First, it binds to the beta2-adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 3’5’-adenosine monophosphate (cAMP).
- When cAMP increases, kinases are activated.
- Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.
- Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.
- Hypersensitivity to adrenergic amines
- Hypersensitivity to fluorocarbons
- Cardiac disease including coronary insufficiency, a history of stroke,coronary artery disease and cardiac arrhythmias
- Geriatric patients – older individuals are at higher risk for adverse reactions and may require lower dosage
- Pregnancy especially near term
- Children less than 2 years of age because safety of its use has not been established
- Excess inhaler use which may lead to tolerance and paradoxical bronchospasm
Side Effects and Adverse Reactions
- Chest pain
- Nausea and vomiting
Route and Dosage
PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of extended dose tablets twice a day.
PO (Geriatric Patients): initial dose should not exceed 2 mg 3-4 times a day and may be increased carefully up to 32 mg/day
PO (Children 6-12 years old): 2 mg 3-4 times a day or 4 mg as extended-release tablets twice a day; may be carefully increased as needed but not to exceed 24 mg/day
PO (Children 2-6 years old): 0.1 mg/kg 3 times a day
Inhalation (Adults and children more than 4 years of age): 2 inhalations every 4-6 hours
Inhalation (Children 2-12 years old): 0.1-0.15 mg/kg/dose 3-4 times a day
- Assess lung sounds, PR and BP before drug administration and during peak of medication.
- Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.
- Administer PO medications with meals to minimize gastric irritation.
- Extended-release tablet should be swallowed-whole. It should not be crushed or chewed.
- If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.
- Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.
- Inform the patient that Albuterol may cause an unusual or bad taste.
Your skin is the first line of defense for the body’s immune system. The average adult’s skin spans 21 square feet, weighs nine pounds, and contains more than 11 miles of blood vessels. So it would make sense to spend a few extra minutes in the morning or evening taking care of your body’s largest organ.
Dr. Marina Peredo, owner of Spatique Medical Spa in Smithtown, N.Y. and clinical professor at Mount Sinai School of Medicine, recommends that everyone should change their daily skin regimen when the weather changes — especially during the winter months. Not only is it cold outside, but the heat inside if your home can tend to dry out your skin. Here are a few recommended and helpful tips that you can implement in your everyday winter beauty routine.
1. Eat More Tomatoes
Since tomatoes are one of the biggest sources of lycopene — a powerful antioxidant — eating them can help protect your skin against sun damage. Even during the winter months, sun damage can still happen. Tomatoes help block UV penetration and prevent damage to vulnerable skin.
2. Use an Ointment Moisturizer
By using something that is oil based rather than water based you will create a protective barrier on your skin. “You can also look for lotions or creams containing humectants, including glycerine, alpha-hydroxy acids that attract moisture to your skin,” Paredo tells Medical Daily. By adding moisture to your skin, you’re preventing it from cracking and drying out which can lead to premature aging.
3. Don’t Forget Your Hands and Feet
Since your hands and feet have fewer oil glands the change of weather will cause them to become even drier. Try to use mild cleansers when washing your hands and avoid using hand sanitizers since the alcohol in many of them can dry skin out. If you’re stepping outside, don’t forget to protect your hands with gloves.
4. Use a Humidifier
A humidifier is a machine that reinfuses moisture into the air that typically evaporates in the winter. The lack of moisture could dry out your skin over time. Use the machine at 30 to 50 percent humidity and use it in rooms that you are most often in.
5. Take Shorter and Cooler Showers
Taking a cold shower can improve the blood circulation between organs and skin considerably. Increased circulation keeps your skin looking younger and will help to keep you warmer.
6. Drink Just As Much Water
One important tip that many doctors and health care professionals recommend is to stay hydrated. Many people feel that since they are not sweating or losing as much water as they would in the summer months that drinking water and staying hydrated is not as important. However, keep drinking your eight glasses of water per day, wear sunscreen, bundle up, and enjoy the winter.
Working the holidays is tough, especially if you’ve never had to do it before. But you will get through it, and you might even find out it’s not as bad as you thought.
5 Tips For the Newbie Nurse: Getting Through the Holidays
1. Focus on the positive
OK, so maybe you don’t get to eat turkey and stuffing this Thanksgiving, topped with some football and followed by a nap. But you’ve made some huge strides this year — you’re a NURSE. Holidays are important, but focusing on your accomplishments and your sense of pride makes just one day seem a little less essential. Keep in mind that your presence is very likely a shining light for patients going through a tough time.
2. But allow yourself to be sad
It’s a bummer. There’s no arguing that. For many of you new grads, it may the first time you’ve spent a holiday without your loved ones. If your family is local, you might be able to squeeze in an after shift dinner (or an after shift breakfast for you night nurses!). But if your family isn’t nearby, you may be missing out altogether. Either way, it’s OK to cry. Acknowledge your feelings — they’re valid and deserve your attention.
3. Do something small for yourself
Choose some way to treat yourself ahead of time and then follow through. It doesn’t have to be expensive or take a lot of time. What about a real bubble bath with candles and champagne? Make it special and celebrate you.
4. Create a fab holiday re-do
Missing out on you favorite holiday? Create your own re-do and out-do the original! Invite your favorite people and have all your traditional rituals, but add something new. Rules are made to be broken.
5. Share the day with a new kind of family — your colleagues
Your nursing (and physician and admin!) colleagues are the only ones who truly understand what you go through every day. And guess what? Everyone else you’re working with is also working the holiday. So no one ‘gets it’ better than they do. Relish in your new work family and celebrate the amazing group of people you work with.
Now that you are a registered nurse, you are ready to face the real world of giving quality nursing care. Aside from acquiring the much coveted duty uniform, shoes and apparel, you might be thinking how you can be protected while at work. Whether you are working with pay or not, it is of essential to be armed with potent protection against the hospital or community setting you will be able to encounter.
Hand washing frequently has been of essential importance. Aside from that, immunization is also important to stress especially for newly hired nurses. Yes, nurses are not exempted to undergo their usual clinical procedure – injections.
Here are some essential immunizations that must be attained.
- Hepatitis B vaccine – Since college days, it was clear that you won’t be able to pursue on clinical duty if you have not undergone such Hepatitis B vaccine. Let’s face it, anytime of the day nurses will be exposed to blood and other body fluids so it is important to protect yourself from any infection that those fluids can bring when in contact with the skin or open wound.
Boosters can also be importance if you have checked your titer. It is still a good practice to observe universal precaution even though you are already immunized. Having an injection might be a little painful but it will pay off, almost all foreign countries may require Hepatitis B vaccination for future applicants or even here in the Philippines. Having Hepatitis B infection can mean a career-ending situation.
- Tetanus Toxoid – Nurses and needle-prick or needle-stick injuries are favorite topics of research. Seminars sprouted left and right with this topic and how to prevent or lower the rate of needle-prick injuries. It is another way to be exposed to infectious agents especially when pricked with used needles. Some patients may have blood borne diseases that can easily be transmitted through needle-prick. Aside from that, needle-prick injuries might also pave way to infected wounds which can lead to tetanus.
Almost all of the hospitals may have protocols regarding needle-prick injuries. Some health care institutions may also shoulder the expenses when it comes to intervening cases of needle-prick injuries.
- Flu Vaccine – Nurses can be exposed to various health care settings and viral agents can be taken up into the respiratory tract. Aside from the stress and shifting hours of work, accumulated stress may exhibit physical symptoms such as flu. Having flu while working is totally uncomfortable and you might even need to take a day off in order to recuperate.
Good thing there are flu vaccines available upon doctor’s prescription and assessment. Complete assessment must be done also because allergic reaction may also occur. Anyway, getting a flu vaccine can ensure you a year round free from acquiring flu together with proper diet and hygiene.
- Pneumonia Vaccine – Specialized areas of clinical nursing may house patients with chronic ailments. Aside from intensive care units, the emergency room may also be another place wherein nurses are prone to various types of pneumonia. Pneumonia may initially pose as flu-like symptoms but may eventually need antibiotic intervention or even hospitalization upon proper diagnostic work-up.
From community-acquired pneumonia to hospital-acquired pneumonia, nurses are at high risk for exposure. Once again, taking time off from work may not only be a waste of money but also an increased working for nurses who will cover you from your duty hours. So it is also important to get an evaluation whether you are entitled to have a pneumonia vaccine.
These are just some of the important vaccines that can be done in order to strengthen acquired immunity against infectious and common diseases that can infect nurses in their workplace. It is still an important thing to note that before having an immunization, you must consult a physician first so that proper medical evaluation can be done in order to prevent allergic reactions and other untoward situations.
Good day fellow medical practitioners (and health conscious people as well). I’ve decided to keep this blog alive again. Message me if you want to request a specific topic. Thank you!
Nerve cells arranged in networks communicate information with one another through neurotransmission which is the conduction of electrical messages from neuron to neuron. The electrochemical messages cross the synapses between neural cells by way of special chemical messengers called neurotransmitters.Neurotransmitters are chemicals found and produced in the brain to allow the transmission of impulses from one nerve cell to the next across synapses. They aid in the conduction of information throughout the body. These chemicals fit into specific receptor cells embedded in the membrane of the dendrite that either fuel up or excite action in the cells (excitatory) or stop or inhibit an action (inhibitory). Presence or absence of these neurotransmitters can directly or indirectly have an effect on neurons in a specific portion of the brain. Thus, the levels of these chemicals in the brain have an effect to a person’s behavior.
Mechanism of Nerve Impulse
Nerve cell conduction or communication is an extremely rapid process which involves the following:
- The impulse moves through the nerve in a long and slender cellular part called the axon.
- As the impulse travels through the axon it travels the presynaptic membrane. It is in this area that neurotransmitters are released in the free space called the synaptic cleft.
- The receptors located in the postsynaptic membrane of another nearby neuron pick up the free flowing neurotransmitters.
- The molecule is adapted in the next nerve cell and the impulse continues to the next nerve cell until the message is relayed throughout the body.
What happens after neurotransmitters sent the information?
After they served their purpose of being released into the synapse and relaying the messages to the receptor cells, they are transported back from the synapse to the axon to be stored for later use which is a process called reuptake. If the neurotransmitters will not undergo reuptake, they will be metabolized and inactivated by enzymes, primarily monoamine oxidase.
This is the first neurotransmitter discovered which is found in the brain, spinal cord and particularly at the neuromuscular junction of the skeletal muscle of the peripheral nervous system. The mechanism of action of acetylcholine could either be excitatory or inhibitory. Acetylcholine is synthesized from dietary choline found in red meat and vegetables. Research and studies have linked the incidence of Alzheimer’s disease with decreased acetylcholine secretion in the neurons.
Physiologic Effects and Functions:
- Muscular stimulation – acetylcholine signals muscles to become active including the muscles of the gastrointestinal system.
- Controls the sleep and wakefulness cycle of a person. It has a part in scheduling the rapid eye movement (REM) sleep or dream.