Improving nurse understanding of blood gas analysis

According to the nurse authors of this valuable review article, nurses working in intensive care units often have difficulty understanding the intricacies of acid-base balance as well as interpreting the results of blood gas analysis relating to the critically ill patients in their care. To address this issue and enhance nurse understanding of blood gas analysis, they chose a case review approach. 

The focus of the article is a set of blood gas results from a 48-year-old patient (“Tony”) who presented at the emergency department complaining of fever, shortness of breath and productive cough. In a clear and quite detailed case presentation, the authors describe Tony’s rapid decline and admission to the medical intensive care unit, following a diagnosis of severe sepsis due to community-acquired pneumonia. 

On admission to intensive care, blood was sampled for a range of tests, including blood gas analysis, which revealed hypoxemia and two acid-base disturbances: respiratory acidosis and metabolic acidosis. 

A large part of the article is devoted to successfully explaining how systematic analysis of the ”raw” blood gas results enabled diagnosis of Tony’s complex acid-base disturbance, as well as how these acid-base disturbances and associated hypoxemia relate to the clinical presentation of severe sepsis in Tony’s case. 

Included in the article is a discussion of some formulae used to manipulate blood gas results in order to help confirm the nature of acid-base disorders and identify their cause. Other topics considered include the anion gap and the differential diagnosis of metabolic acidosis. 

Irrespective of its value as an easily comprehended educative tool for better understanding of blood gas results, the article provides a quite comprehensive case presentation of a condition – severe sepsis due to community-acquired pneumonia – commonly seen in medical intensive care units. Along with its 30 cited references, this review article provides an excellent learning resource for intensive and emergency care nurses.