Chapter 16

Tests and Procedures

Arterial Blood Gases

Electrolyte Imbalances

Fluid Volume Imbalances

Diagnostic Tests

For an in-depth study of tests and procedures, consult the following publications:

Lewis SM, et al: Medical-surgical nursing, ed 8, St. Louis, 2011, Mosby.

Nugent P, Green J, Hellmer Saul MA, Pelikan P: Mosby’s comprehensive review of nursing for the NCLEX-RN examination, ed 20, St. Louis, 2012, Mosby.

Myers JL: Quick medication administration reference, ed 3, St. Louis, 1998, Mosby.

Pagana KD, Pagana TJ: Mosby’s diagnostic and laboratory test reference, ed 10, St. Louis, 2010, Mosby.

Patton K, Thibodeau G: Structure and function of the human body, ed 14, St. Louis, 2012, Mosby.

Potter PA, Perry AG, Stockert PA, Hall A: Fundamentals of nursing, ed 8, St. Louis, 2013, Mosby.

Weilitz P, Potter PA: Pocket guide for health assessment, ed 6, St. Louis, 2007, Mosby.

Laboratory Values*

^*Averages may vary per facility.

Acid–Base Imbalances

CNS, central nervous system.

Arterial Blood Gases

Acid–base balance (pH) Measures hydrogen concentration (7.35–7.45)

Oxygenation (PaO₂) Measures partial pressure of dissolved oxygen in the blood (80–100 mm Hg)

Saturation (SO₂) Measures percentage of oxygen to hemoglobin (95–98%)

Ventilation (PaCO₂) Measures partial pressure of carbon dioxide (38–45 mm Hg)

Nursing Interventions

Preparation Cleanse the area over the artery per organizational policy. Collect an arterial blood gas (ABG) per organizational policy.

Post-ABG The sample needs to go to the laboratory immediately. Some facilities may require an advance call to the laboratory before an ABG test specimen can be sent.

Electrolyte Imbalances

Clinical Manifestations

Hyponatremia (less than 135 mEq/L)

Signs and symptoms Fatigue; abdominal cramps; diarrhea; weakness; hypotension; cool, clammy skin.

Causes Overhydration, kidney disease, diarrhea, syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Hypernatremia (greater than 145 mEq/L)

Signs and symptoms Thirst; dry, sticky mucous membranes; dry tongue and skin; flushed skin; increased body temperature

Causes Dehydration, starvation

Hypokalemia (less than 3.5 mEq/L)

Signs and symptoms Weakness, fatigue, anorexia, abdominal distention, arrhythmias, decreased bowel sounds

Causes Diarrhea, diuretics, alkalosis, polyuria

Hyperkalemia (greater than 5 mEq/L)

Signs and symptoms Anxiety, arrhythmias, increased bowel sounds

Causes Burns, renal failure, dehydration, acidosis

Hypocalcemia (less than 8.3 mEq/L)

Signs and symptoms Abdominal cramps, tingling, muscle spasms, convulsions; assess magnesium level

Causes Parathyroid dysfunction, vitamin D deficiency, pancreatitis.

Hypercalcemia (greater than 10 mEq/L)

Signs and symptoms Deep bone pain, nausea, vomiting, constipation; assess magnesium level

Causes Parathyroid tumor, bone cancer or metastasis, osteoporosis

Hypomagnesemia (less than 1.3 mEq/L)

Signs and symptoms Tremors, muscle cramps, tachycardia, hypertension, confusion; assess calcium level

Causes Parathyroid dysfunction, cancer, chemotherapy, polyuria

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