Respiratory Alkalosis
The nurse is preparing a presentation to a group of students about the risk factors for respiratory alkalosis. Which topic will the nurse include in the presentation? (Select all that apply.) A. Anxiety B. Vomiting C. High fever D. Thyrotoxicosis E. Hypoventilation
A. Anxiety C. High fever D. Thyrotoxicosis Rationale: High fever, thyrotoxicosis, and anxiety increase respirations, which increase the amount of CO2 expelled. Hypoventilation will result in retained CO2 and increases acidosis. Vomiting will result in metabolic alkalosis. Hyperventilation, not hypoventilation, causes respiratory alkalosis.
Which would the nurse recognize as the most common cause of respiratory alkalosis? A. Hypoventilation B. Hyperventilation C. Diarrhea D. Diabetes
hyperventilation Rationale: Hyperventilation is the most common cause of respiratory alkalosis, usually brought on by anxiety. Hypoventilation is the most common cause of respiratory acidosis. Diabetes is a common acute cause of metabolic acidosis. Diarrhea is a common cause of metabolic disorders, either alkalosis or acidosis.
A client asks the nurse for ways of identifying and coping with a hyperventilation reaction. Which method would be appropriate for the nurse to recommend? (Select all that apply.) A. Increase exercise. B. Use guided imagery. C. Try not to react with anxiety. D. Completely avoid anything that induces anxiety. E. Recognize situations that can lead to increased anxiety.
A. Increase exercise. B. Use guided imagery. E. Recognize situations that can lead to increased anxiety. Rationale: Increasing exercise by taking walks or doing other enjoyable activities can help alleviate stress and decrease the instances of anxiety reaction. Guided imagery is utilizing relaxation techniques along with meditation to alleviate anxiety, and can prevent hyperventilation. Although all situations that lead to anxiety cannot be completely avoided, trying to identify known triggers for anxiety and hyperventilation reactions can help with making a plan for coping. Advising a client to try not to react with anxiety or to completely avoid anything that induces stress or anxiety is not effective.
The nurse is monitoring a client for development of an acid-base imbalance. When interpreting the client's arterial blood gas (ABG) results, which data is most consistent with uncompensated respiratory alkalosis? A. pH 7.50, PaCO2 = 32 mmHg, HCO3 = 24 mEq/L B. pH 7.32, PaCO2 = 51 mmHg, HCO3 = 24 mEq/L C. pH 7.50, PaCO2 = 35 mmHg, HCO3 = 28 mEq/L D. pH 7.39, PaCO2 = 39 mmHg, HCO3 = 26 mEq/L
A. pH 7.50, PaCO2 = 32 mmHg, HCO3 = 24 mEq/L Rationale: The normal range for pH is 7.35-7.45. A pH of less than 7.35 is reflective of acidosis, while a pH of greater than 7.45 is reflective of alkalosis. The normal range for PaCO2 is 35-45 mmHg. An increased PaCO2 leads to the development of respiratory acidosis, while a decreased PaCO2 leads to the development of respiratory alkalosis. The normal range for HCO3 (bicarbonate) is 24-28 mEq/L. An increased HCO3 leads to the development of metabolic alkalosis, while a decreased HCO3 leads to the development of metabolic acidosis. The ABG results that are most consistent with uncompensated respiratory alkalosis are a pH of 7.50 in conjunction with a decreased PaCO2 level (32 mmHg) and a normal HCO3 level (24 mEq/L).
Which arterial blood gas result shows a resolution to respiratory alkalosis? A. pH 7.39, CO2 60 mmHg B. pH 7.42, CO2 39 mmHg C. pH 7.35, CO2 55 mmHg D. pH 7.44, CO2 24 mmHg
B. pH 7.42, CO2 39 mmHg Rationale: Resolution of respiratory alkalosis is demonstrated by a pH between 7.35dash-7.45 and a CO2 level between 35dash-45 mmHg. A pH of 7.35dash-7.45 with a CO2 less than 35 mmHg does not demonstrate resolution, since the CO2's alkalotic number continues. A pH of 7.35dash-7.45 with a CO2 of greater than 45 mmHg is addressing possible respiratory acidosis, not alkalosis.
Which nursing diagnosis is indicated for a client with respiratory alkalosis? A. Airway Clearance, Ineffective B. Fluid Volume, Deficient C. Injury, Risk for D. Breathing Pattern, Ineffective
D. Breathing Pattern, Ineffective Rationale: An impaired breathing pattern is a problem in respiratory alkalosis. Respiratory rate is the most likely determinant of respiratory alkalosis, so an impaired breathing pattern, such as hyperventilation, can lead to this condition. Mental status and neurologic function are affected by metabolic acidosis, increasing the likelihood of a nursing diagnosis of Injury, Risk for. Fluid volume excess is a potential problem for a client with metabolic acidosis, not fluid volume loss. Retained respiratory secretions is a problem in respiratory acidosis, not metabolic acidosis. (NANDA-I ©2014)
Which instruction should the nurse provide as education about self-control of a hyperventilation reaction? A. All hyperventilation is related to anxiety. B. Breathing into a paper bag is always the best first reaction. C. Hyperventilation will eventually correct itself, so immediate treatment is not necessary. D. If chest pain is present along with rapid breathing, seek medical attention.
D. If chest pain is present along with rapid breathing, seek medical attention. Rationale: Anxiety is not the only cause of hyperventilation. If chest pain or other symptoms are present, the client may be experiencing a myocardial infarction or pulmonary embolism. If the hyperventilation is not precipitated by anxiety, the client should seek medical attention to rule out other causes. Breathing into a paper bag can worsen shortness of breath caused by an underlying medical problem, and should not be attempted by the client if other symptoms such as chest pain or dizziness occur. Hyperventilation can lead to tetany, syncope, and stroke if left untreated.
Which setting would the nurse caring for a client on a ventilator recognize as having the highest potential of contributing to respiratory alkalosis? A. FiO2 B. Rate C. PEEP D. Pressure support
Rate Rationale: A ventilator rate that is too high will essentially be an induced hyperventilation, which causes respiratory alkalosis. Positive end-expiratory pressure support is used to increase the pressure of inhalation, and does not contribute to respiratory alkalosis. FiO2 is the fraction of the volume that is oxygen that is inhaled, and does not contribute to respiratory alkalosis. Pressure support is an assisted mode of breathing in which the client controls the rate; this does not contribute to respiratory alkalosis.
A client has been stabilized in the emergency department after experiencing respiratory alkalosis secondary to hyperventilation. The client states this has occurred before, and she asks the nurse how to recognize a hyperventilation reaction to anxiety. Which clinical manifestation should the nurse instruct the client to watch for? (Select all that apply.) A. Increased anxiety B. Irritability and restlessness C. Chest tightness and heaviness D. Increased breathing rate the client cannot control E. A loss of interest in social activities and feeling withdrawn
A. Increased anxiety C. Chest tightness and heaviness D. Increased breathing rate the client cannot control Rationale: Hyperventilation reactions often occur as a result of anxiety. The client should be instructed to be aware of increased feelings of anxiety. The anxiety may progress to a feeling of chest heaviness or tightness. In response to this, the client may begin to increase the rate of breathing, which further progresses the feeling of anxiety. Anxiety is not usually accompanied by irritability and restlessness. Loss of interest in activities and feeling withdrawn are more closely associated with depression than anxiety.
Which vital sign would the nurse assess to determine if a client is possibly in a state of respiratory alkalosis? (Select all that apply.) A. Increased pulse B. Irregular pulse rate C. Increased temperature D. Decreased blood pressure E. Increased respiratory rate
A. Increased pulse C. Increased temperature E. Increased respiratory rate Rationale: Respiratory alkalosis is caused by an increase in blood pH due to a decrease in CO2 in the blood. Increased temperature causes an increase in respiratory rate and temperature. Increased respiratory rate indicates the body is losing too much CO2. An increased respiratory rate is often accompanied by an increased heart rate. Blood pressure and irregularity of the pulse are not vital assessment findings critical to respiratory alkalosis.
What strategy should the nurse suggest to the client for reducing clinical manifestations of a hyperventilation reaction? (Select all that apply.) A. Meditation B. Guided imagery C. Removing themselves from the situation D. Telling the nurse immediately so medication can be given E. Maintaining a calm, pleasant environment and participating in enjoyable activities
A. Meditation B. Guided imagery E. Maintaining a calm, pleasant environment and participating in enjoyable activities Rationale: Managing anxiety and a hyperventilation reaction to anxiety are the correct ways of preventing or stopping respiratory alkalosis. Use of meditation and guided imagery can facilitate relaxation and alleviate anxiety. Maintaining an overall calm, relaxing environment can also prevent hyperventilation reaction. Removal from a stressful situation may not always be possible. Immediate administration of antianxiety medications is not always possible, and does not enable the client to self-manage symptoms.
Which clinical manifestation would the nurse expect to observe in a client experiencing respiratory alkalosis? (Select all that apply.) A. Panic B. Tinnitus C. Dizziness D. Palpitations E. Hypoventilation
A. Panic B. Tinnitus C. Dizziness D. Palpitations Rationale: Clinical manifestations of respiratory alkalosis include dizziness, palpitations, tinnitus, and panic. Hypoventilation is not a clinical manifestation of respiratory alkalosis.
Which statement indicates the nurse understands the effect of respiratory alkalosis on calcium? A. "Ionized calcium binds with albumin, resulting in tetany or arrhythmias." B. "Decreased calcium increases hydrogen ions." C. "Ionized calcium binds freely with skeletal muscle, and will not bind with albumin." D. "Increased serum calcium causes an increase in pH in the blood."
A. "Ionized calcium binds with albumin, resulting in tetany or arrhythmias. Rationale: Ionized calcium normally functions by binding with smooth muscle and facilitating the sodium-potassium exchange in muscles. If calcium binds more freely with albumin, this decreases the calcium level in the blood, which impedes the exchange of sodium and potassium in muscle, resulting in tetany or, in cardiac muscle, arrhythmias. Calcium has no effect on hydrogen ions. Increased serum calcium also does not increase pH. Ionized calcium will bind more easily with albumin, which results in tetany.
Which action should a nurse take to reduce the likelihood of a client developing hyperventilation and respiratory alkalosis? A. Promote continuous interaction with visitors. B. Decrease lights and noise. C. Administer medications to prevent hyperventilation. D. Set a schedule of exercise and activity.
B. Decrease lights and noise. Rationale: Maintaining a quiet, restful environment can help alleviate anxiety and prevent a hyperventilation reaction in a susceptible client. Setting a structured schedule is not particularly beneficial in preventing anxiety. Promoting interaction can increase stimulation and pressure and can actually contribute to anxiety. Administering medications is an appropriate intervention, but this is pharmacologic management of anxiety and not a nursing-related initiative.
A client has presented to the emergency department with hyperventilation. The client is anxious and breathing approximately 60 breaths per minute. What is the correct initial action the nurse should take? A. Notify the physician and order labs to determine whether the client is in respiratory alkalosis. B. Give the client a paper bag and have her breathe into it. C. Apply oxygen. D. Have the client lie flat.
B. Give the client a paper bag and have her breathe into it. Rationale: Hyperventilation, or rapid breathing, results in the rapid expulsion of CO2 from the body. The diminished CO2 results in an increase in pH, which is respiratory alkalosis. If the client breathes into a paper bag, the CO2 is reinhaled, preventing the drop in CO2 and alleviating the alkalosis. Having the client lie flat may be difficult, especially if the client is anxious, since the client may resist this position. Applying oxygen will not alleviate the decreased CO2. Obtaining an order for labs may be part of the assessment, but it is not an appropriate initial action.
The nurse is caring for a client who is receiving oxygen by a partial nonrebreather mask for the treatment of respiratory alkalosis. What is the rationale for administering oxygen in this manner? A. It allows the client to get rid of extraneous O2. B. It increases CO2 levels. C. It is the treatment of choice for myocardial infarction. D. It promotes relaxation.
B. It increases CO2 levels. Rationale: Using a partial nonrebreather oxygen mask causes the client to rebreathe exhaled carbon dioxide and increases the CO2 level while still allowing oxygen to be administered. This is not the treatment of choice for clients with myocardial infarction, and it does not promote relaxation.
Which is an appropriate goal when caring for a client with respiratory alkalosis? (Select all that apply.) A. The client will not hyperventilate. B. The client will maintain a pH of 7.35-7.45 for daily lab draws. C. The client will utilize anxiety-reduction strategies to prevent hyperventilation. D. The nurse will provide education to the client about preventing hyperventilation. E. The client will implement relaxation techniques if a hyperventilation reaction occurs.
B. The client will maintain a pH of 7.35-7.45 for daily lab draws. C. The client will utilize anxiety-reduction strategies to prevent hyperventilation. E. The client will implement relaxation techniques if a hyperventilation reaction occurs. Rationale: Goals must be measurable and client oriented. Stating that the client will not hyperventilate is an incomplete goal and cannot be measured. Maintaining a normal blood pH is a measurable and attainable goal for a client with alkalosis. Implementing strategies to reduce anxiety and self-manage a hyperventilation reaction are client-centered and measurable. A goal of the nurse providing education is not client centered.
Which key concern would the nurse have in administering an antianxiety medication to an older adult client to prevent hyperventilation? (Select all that apply.) A. There is a potential for problems with addiction. B. There is concern about interaction with other medications. C. Slowed metabolic function can lead to suppressed respiratory effort. D. Older adult clients may not fully understand how to correctly take medications. E. Use of antianxiety medications is not correcting the underlying cause of anxiety.
B. There is concern about interaction with other medications. C. Slowed metabolic function can lead to suppressed respiratory effort. Rationale: As people age, metabolism of medications slows. The potential for a cumulative effect of medication increases. Antianxiety medications may slow respiratory rate. If the rate is slowed too significantly, the effort of breathing may be compromised. There is also a possibility of interaction with other medications, because many older adult clients have other underlying medical conditions. Potential for addiction is not a reason to not prescribe antianxiety medications to older adult clients, and older adult clients who have no cognitive dysfunction should be able to understand how to correctly take their medications. The underlying cause of the anxiety should be treated as a separate issue when the anxiety is producing hyperventilation or other concerning symptoms.
A 6-year-old child is very frightened in a healthcare provider's office. The child begins to breathe rapidly, about 80 breaths per minute. What intervention should the nurse use to prevent respiratory alkalosis from developing? (Select all that apply.) A. Firmly tell the child to calm down. B. Ask the parent to leave the room. C. Give the child a balloon to blow up. D. Speak in a low, calm voice and try to soothe the child. E. Leave the room until the parents are able to calm the child.
C. Give the child a balloon to blow up. D. Speak in a low, calm voice and try to soothe the child. Rationale: Blowing up a balloon is a good distraction that also forces slow, deep breaths. This will prevent the effects of hyperventilation. Also, speaking slowly in a low, calm voice will help provide reassurance and not escalate the hyperventilation, which can lead to respiratory alkalosis. Commanding the child to calm down could increase the anxiety, as could asking the parents to leave the room. The goal is to calm the child and prevent respiratory alkalosis. Leaving the room until the child is calmer may temporarily assist in the situation, but it is not managing or preventing hyperventilation.
Which arterial blood gas results indicate compensated respiratory alkalosis? A. pH 7.45, CO2 44 mmHg, HCO3 24 mEq/L B. pH 7.48, CO2 22 mmHg, HCO3 20 mEq/L C. pH 7.43, CO2 25 mmHg, HCO3 20 mEq/L D. pH 7.32, CO2 64 mmHg, HCO3 32 mEq/L
C. pH 7.43, CO2 25 mmHg, HCO3 20 mEq/L Rationale: Respiratory alkalosis is characterized by a higher-than-normal blood pH, of which the normal range is 7.35-7.45, and a lower-than-normal CO2, of which the normal range is 35dash-45 mmHg. When the alkalosis is compensated, the pH returns to the normal range, and the CO2 remains low. Therefore, a pH of 7.43 is within normal range, and CO2 is low, which is characteristic of compensated respiratory alkalosis.
