Acid-Base Balance: Respiratory Acidosis/Alkalosis

Medial Management of Respiratory Acidosis

-Administer bronchodilators -If the client is on a ventilator, it may be necessary to increase the tidal volume to facilitate maximum volume and gas exchange to increase expiration of CO2 -Correct the precipitating cause of hypoxia or respiratory problem if possible.

Medical Management of Respiratory Alkalosis

-Assess the need for an antianxiety medication -If necessary, decrease the rate and tidal volume if the client is on a ventilator

Signs and symptoms of Respiratory Acidosis

-Dyspnea -Hypoventilation resulting in hypoxia -Restlessness progressing to lethargy -Drowsiness, confusion, and coma -Tachycardia and tachypnea -Dysrhythmias associated with hypoxia and hyperkalemia -Seizures -Pale to cyanotic and dry skin -Hypercapnia (elevated CO2 level), which will cause cerebral vasodilation and increase problems with increased intracranial pressure -pH<7.35, urine pH<6

Signs and symptoms of Respiratory Alkalosis

-Hyperventilation (hyperpnea): Hallmark sign -Possible lightheadedness -Dysrhythmias and tachycardia -Confusion -Epigastric pain and nausea -Numbness in fingers and toes (may progress to tetany or seizures) -pH>7.45, Urine pH>6

Common Causes of Respiratory Alkalosis

-Hyperventilation syndrome (anxiety, fear, and hysteria) -Hyperventilation caused by: hypoxia, pulmonary emboli, pain, fever, CNS problems (encephalitis and head injury), mechanical hyperventilation (tidal volume is too high and respiratory rate is too rapid)

Nursing Management of Respiratory Alkalosis

-Identify and correct the precipitating cause -Monitor ABG's -Check for the presence of decreased K+; monitor for dysrhythmias -Try to relax or calm client, encourage slow, deep breathing; may use relaxation techniques such as guided imagery -Encourage breathing into a paper sack or rebreathing mask to increase retention of CO2 -Reduce environmental noise and stimuli -Encourage the client to slow down respiratory rate

Nursing Management of Respiratory Acidosis

-Use semi-fowler position to facilitate ventilation -Suction as needed to remove excess mucus -Teach the client to use an incentive spirometer -Encourage the client to turn, cough, and breathe deeply -Have an artificial airway available -Assess patency of the airway-respiratory rate and breath sounds -Assess for tachycardia secondary to hypoxia -Initiate seizure precautions

Significance of Respiratory Acidosis

Occurs when an excess of CO2 is in the blood. It is the most common of the acid-base imbalances. Acidosis will occur when the client does not have an adequate gas exchange. Respiratory depression (hypoventilation) will precipitate hypoxia and hypercapnia (too much CO2). It is the excess CO2 that causes the respiratory acidosis.

Significance of Respiratory Alkalosis

Occurs when the client hyperventilates, causing an excessive loss of CO2 (hypocapnia or decreased levels of CO2). The condition is most commonly seen in clients who are hyperventilating secondary to hypoxia as a result of acute pulmonary conditions. Most often, the decrease in CO2 occurs rapidly and does not allow time for renal compensation to occur. Clients with chronic respiratory alkalosis may have some renal compensation.

Common Causes of Respiratory Acidosis

Respiratory acidosis occurs secondary to problems that cause hypoventilation: -CNS depression: head injury, sedatives, and anesthesia -Increased resistance: aspiration, bronchospasm, laryngospasm, and prolonged narrowing of the airway such as asthma or airway edema. -Loss of lung surface: atelectasis, COPD, pneumonia, pneumothorax, and chronic pulmonary disease -Neuromuscular diseases affecting respiratory muscles: Guillain-Barre syndrome and myasthenia gravis -Mechanical hypoventilation: increased retention of CO2 -Sedative or barbiturate overdose