Nursing: A Concept-Based Approach To Learning: Volume One, Third Edition

Nursing: A Concept-Based Approach to
Learning
Volume One, Third Edition
Module 1
Acid–Base Balance
Copyright © 2019, 2015, 2011 Pearson Education, Inc. All Rights Reserved
Exemplar 1.C
Respiratory Acidosis
Exemplar Learning Outcomes
Analyze metabolic acidosis as it relates to acid–base balance.
 Describe the pathophysiology of respiratory acidosis.
 Describe the etiology of respiratory acidosis.
 Compare the risk factors and prevention of respiratory acidosis.
 Identify the clinical manifestations of respiratory acidosis.
 Summarize diagnostic tests and therapies used by interprofessional teams in the

collaborative care of an individual with respiratory acidosis.
 Differentiate care of patients with respiratory acidosis across the lifespan.
 Apply the nursing process in providing culturally competent care to an individual with
respiratory acidosis.
Overview
• Respiratory acidosis
– Caused by excess of carbonic acid
– Characterized by a pH <7.35
– PaCO2 >45 mmHg
– May be acute or chronic
– In chronic respiratory acidosis, bicarbonate is >26 mEq/L
– Kidneys compensate by retaining bicarbonate
Pathophysiology and Etiology
• Both acute and chronic respiratory acidosis result from CO 2 retention
– Caused by alveolar hypoventilation
• Hypoxemia frequently accompanies respiratory acidosis
Acute Respiratory Acidosis
• Results from sudden failure of ventilation
– Chest trauma
– Aspiration of foreign body
– Acute pneumonia
– Overdose of narcotics or sedatives
• PaCO2 rises rapidly
• pH falls markedly
• pH ≤7 can occur within minutes
• Hypercapnia
Chronic Respiratory Acidosis
• Associated with chronic respiratory or neuromuscular conditions that affect alveolar
ventilation
• Majority have COPD → bronchitis, emphysema
• PaCO2 increases over time, remains high
• Kidneys retain bicarbonate
• pH often close to normal
• Acute hypercapnia may not develop when CO2 levels rise gradually
• Risk of carbon dioxide narcosis
Risk Factors
• Acute lung disease
• Chronic lung disease
• Trauma
• Narcotic analgesics
• Airway obstruction
• Neuromuscular disease
Clinical Manifestations (1 of 2)
• Acute respiratory acidosis
– PaCO2 levels rise rapidly
– Cause manifestations of hypercapnia
▪ Cerebral vasodilation
▪ LOC progressively decreases
– Rapid changes in ABGs
– Skin warm, flushed
– Pulse elevated
Clinical Manifestations (2 of 2)
• Chronic respiratory acidosis
– Weakness
– Dull headache
– Sleep disturbances
– Impaired memory
– Personality changes
Collaboration
• Care requires healthcare team
– Respiratory therapist
– Pharmacist
– Primary care provider
– Dietitian
Diagnostic Tests (1 of 2)
• ABGs
– pH <7.35
– PaCO2 >45 mmHg
– Acute respiratory acidosis
▪ Bicarbonate level initially in normal range
▪ Increases to >26 mEq/L if condition persists
– Chronic respiratory acidosis
▪ PaCO2 may be significantly elevated
▪ HCO3 may be significantly elevated
Diagnostic Tests (2 of 2)
• Serum electrolytes
– Chloride level <98 mEq/L
• Pulmonary function tests

– Determine whether chronic lung disease is cause of respiratory acidosis
• Other tests to identify underlying cause

– Chest x-ray
– Sputum studies
– Serum levels of suspected drugs
Pharmacologic Therapy
• Bronchodilator drugs
• Antibiotics for respiratory infections
• Narcotic antagonists
Respiratory Support
• Focus on improving alveolar ventilation, gas exchange
• Severe acidosis and hypoxemia

– Intubation and mechanical ventilation
• PaCO2 level lowered slowly
• O2 administered cautiously
• Pulmonary hygiene
• Adequate hydration
Lifespan Considerations (1 of 3)
• Infants and children
– Risk factors
▪ Asthma
▪ Pneumonia
▪ Airway obstruction
▪ Acute pulmonary edema
▪ ARDS
▪ Head trauma
▪ Poisoning
– Critical ABG result is increased PaCO2
• Infants and children
– Clinical manifestations similar to those in adults
– Nursing management
▪ Assess mental, respiratory status
▪ Positioning
▪ Suctioning as needed
▪ Encouraging deep breathing
• Older adults
– Risk factors
▪ COPD
▪ Chest wall abnormalities
▪ Pneumonia
▪ Respiratory muscle weakness
– HCO3 retention by kidneys in compensation for CO2 retention from
hypoventilation
– Outcome depends on nature of illness, early diagnosis/treatment
Patient Teaching: Instructions for Parents
• Children with asthma, airway obstruction, influenza, and pneumonia are at risk
• Teach parents prevention methods

– Deep breathing (several times/day)
– Signs of infection
– Positioning to facilitate chest expansion
– Medication administration (as appropriate)
– Use of ordered devices (e.g., home respirators, nebulizers)
Nursing Process
• Primary focus
– Improving breathing patterns
– Maintaining patent airway
• Teach patients how to make healthy lifestyle choices
Assessment (1 of 2)
• Observation and patient interview
– Current manifestations
– Duration of symptoms
– Precipitating factors
– Chronic disease
– Current medications
Assessment (2 of 2)
• Physical examination
– Mental status and LOC
– Vital signs
– Skin color and temperature
– Rate and depth of respirations
– Pulmonary excursion
– Lung sounds
Diagnosis
• Possible nursing diagnoses include
– Airway Clearance, Ineffective
– Anxiety
– Breathing Pattern, Ineffective
– Cardiac Output, Decreased
– Gas Exchange, Impaired
(NANDA-I ©2014, 2015–2017)
Planning
• Desired outcomes may include
– Adequate fluid intake
– Oxygenation saturation >90%
– Normal PaCO2 level
– pH balance
Implementation (1 of 6)
• Nursing interventions include frequent assessment of
– Respiratory status
– Oxygen saturation levels
– LOC
• Promote gas exchange
– Promptly evaluate and report ABG results
– Place in semi-Fowler or Fowler position as tolerated
– Administer O2 as ordered
– Monitor response to O2
– Immediately report increasing somnolence
• Promote effective airway clearance
– Frequently auscultate breath sounds
– Encourage pursed-lip breathing
– Frequently reposition and encourage ambulation
– Encourage fluid intake
– Administer medications
– Provide percussion, vibration, postural drainage as ordered
• Reduce anxiety levels
– Result of hypoxia and hypercapnia
– Remain with patient and monitor
– Explain procedures and treatments
– Reduce environmental stimuli
– Use calm, reassuring manner
– Allow supportive family members to remain with patient as much as possible
• Reduce risk for injury
– Patients may experience blurred vision and altered LOC
– Assess LOC, mental status, orientation frequently
– Place call alarm controls within reach
– Manage rest, activity patterns
– Administer supplemental O2 as needed
• Plan for discharge
– Teach patient and family about preventive measures and equipment
– Refer patient to substance abuse treatment if needed
– Encourage patient to receive immunizations
– Provide instructions when respiratory status is compromised
– Alert to early symptoms that warrant immediate attention
Evaluation
• Expected outcomes may include
– Patient maintains patent airway
– Patient maintains appropriate breathing patterns to meet O 2 demands
– Patient remains conscious
– Patient does not display anxiety indicating potential hypoxia
– ABGs reflect pH and PaCO2 within acceptable range for patient

Nursing: A Concept-Based Approach To Learning: Volume One, Third Edition

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nursing: A Concept-Based Approach To Learning: Volume One, Third Edition

Uploaded by

Copyright:

Available Formats

Nursing: A Concept-Based Approach to

 Describe the pathophysiology of respiratory acidosis.

 Describe the etiology of respiratory acidosis.

 Compare the risk factors and prevention of respiratory acidosis.

 Identify the clinical manifestations of respiratory acidosis.

 Summarize diagnostic tests and therapies used by interprofessional teams in the

 Differentiate care of patients with respiratory acidosis across the lifespan.

• Hypoxemia frequently accompanies respiratory acidosis

• PaCO2 rises rapidly

• pH ≤7 can occur within minutes

• Chronic lung disease

• Pulmonary function tests

• Other tests to identify underlying cause

• Antibiotics for respiratory infections

• Severe acidosis and hypoxemia

• PaCO2 level lowered slowly

• Teach parents prevention methods

• Teach patients how to make healthy lifestyle choices

You might also like