Respiratory Acidosis
Other Diagnostic Clues
serum electrolytes; K, Mg, Ca chest x-ray drug screen; determine if drugs that could already have an effect on resp acidosis are currently in the system (such as; anesthetics, hypnotics, opioids, sedatives) EKG; hyperkalemia could cause arrhythmias
Causes of Respiratory Acidosis
acute chronic
In a patient with respiratory acidosis you will see...
decreased pH & increased CO2 hypoventilation rapid, shallow respirations increased BP dyspnea headache hyperkalemia disorientation increased cardiac output muscle weakness hyppoxia
Medical Management
improve respiratory ventilation via: -mechanical ventilation -bronchodilators, antibiotics, anticoagulants -pulmonary hygiene; coughing, turning, deep breathing INCENTATIVE SPIROMETER postural drainage -adequate hydration -supplemental oxygen (beware if chronic hypercapnia) *COPD pt's are accustomed to increased CO2 levels; a lack of O2 called hypoxic drive stimulates these pt's to breathe -monitor I&O, VS (always include O2 sat), ABGs
Respiratory Acidosis
inadequate ventilation -> decreased excretion of CO2 hercapnia carbonic acid excess -> pH below 7.35 *resp system can't rid the body of enough CO2 to maintain the pH balance; sometimes caused by decreased respirations or inadequate gas exchange
*Respiratory Acidosis*
* decreased pH *increased CO2 *increased HCO3
Acute Causes
-airway obstruction; food, foreign body, cardiac/resp arrest, pulmon. edema, acute bronchitis, atelectasis, ARDS, pneumonia (anything that constricts/occludes airway preventing exhalation) -drugs; over dose of anesthetics, sedatives, narcotics -head injuries; can interfere with signals from brain to lungs -neuromuscular; impaired muscles round lungs prevent chest expansion -mechanical ventilator; increase respirations
Signs & Symptoms
-breathing; slowed or difficult, retain CO2, late signs = cyanosis -CNS; HA, drowsy, restless, tremor, cofusion, disorientation -> COMA (cerebral vasodilation, increased bloodflow to brain) & death -increased HR, lack of energy, weakness -hyperkalemia (as H+ moves into cells to compensate) *always physically ASSESS the pt; listen to pt's family for clues to pt's normal
Know if the patient has...
-respiratory treatments ordered; know when and how -received a treatment and when; know when they last had treatment in case resp therapy couldn't get there in time to give next treatment; if pt is having dyspnea you need to know how long it's been since last treatment *know what your patient sounded like before to compare to after; could sound clearer or could hear improved, more definitive crackles
Diagnostic Findings
ABG's pH decreased; CO2 increased kidneys attempt to compensate by holding HCO3 and excreting H+ (2-3 days)
Chronic Causes
COPD obstructive sleep apnea obesity *the pH may be more to normal level *CO2 will be increased *if compensated, bicarb increased as well