Changing Patient Conditions: Your Role as a UAA

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The PCA's Role in Changing Patient Conditions

Changing Patient Conditions: Your Role as a UAA

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

7.26

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

7.32

(7.35-7.45)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

7.49

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

7.51

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

Changing Patient Conditions: Your Role as a UAA

By Camille Asamoah, MSN, RN-BC

3 MIN READ

Wow, it has been a pretty good day on the unit so far. You even venture so far as to let that forbidden word creep into your head. “It’s been so nice and quiet today,” you think to yourself as you sit at the desk and take a breath. Suddenly, a loud alarm pierces through the stillness of the unit. Oh no, it sounds like someone has pressed the code blue button in room 15. After you kick yourself for even thinking the “Q” word, you pick up the call system receiver to call into room 15 to check the status. Is this a code situation? As a Unit Administrative Assistant (UAA), your role is vital when it comes to situations like this where patient condition changes.

In the scenario above, the UAA is a highly important link in the chain of getting the patient the help they need as quickly as possible. When it has been determined that the patient needs to be coded, the code blue button is pressed in the room to alert the unit that help is needed. At this time, the UAA calls into the room quickly to verify the button was pressed purposefully because accidental pressing has been known to happen. As soon as the UAA has confirmed that it is a genuine code, the Code Blue/CERT number should be called. This number is (713)-441-4444 or 1-4444. The operator will then ask the UAA for some basic information about the code such as the unit and room number. This will let the hospital’s code blue operator call the code over the hospital loudspeaker and alert the Code Blue team on where they are needed. Technology is even more advanced these days when it comes to Code Blues or CERTs. With the use of the Vocera device, the nurse, PCA, or UAA can also activate the Code Blue or CERT just by using the voice commands “Call CODE BLUE” or “Call CERT.”

It is very helpful if the UAA checks the chart to make sure it is ready for emergencies. To prepare for the code or CERT, the UAA should print more labels if needed, bring the physical chart to the bedside for the code or CERT team to utilize, and listen for anything else that may be needed. Again, the UAA plays an important role in helping things move along smoothly, especially during the frenzy that can occur during a change in patient condition situation.

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The PCA's Role in Changing Patient Conditions

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