Nursing

Management
Respiratory Acidosis
• Remain alert for critical changes in patient’s respiratory, CNS
and cardiovascular functions. Report such changes as well as
any variations in ABG values or electrolyte status immediately.

• Maintain adequate hydration.

• Maintain patent airway and provide humidification if acidosis

requires mechanical ventilation. Perform tracheal suctioning
frequently and vigorous chest physiotherapy, if ordered.

• Institute safety measures and assist patient with positioning.

• Continuously monitor arterial blood gases.

Respiratory Alkalosis
• Be alert for signs of changes in neurologic, neuromuscular or cardiovascular functions.

• Institute safety measures for the patient with vertigo or the unconscious patient.

• Encourage the anxious patient to verbalize fears

• Administer sedation as ordered to relax the patient

• Keep the patient warm and dry

• Encourage the patient to take deep, slow breaths or breathe into a brown paper bag
(inspire CO2).

• Monitor vital signs

• Monitor ABGs, primarily PaCO2; a value less than 35 mmHg indicates too little CO2
(carbonic acid)
Metabolic Acidosis
• Keep sodium bicarbonate ampules handy for emergency administration.

• Monitor vital signs, laboratory results and level of consciousness frequently.

• Watch out for signs of decreasing level of consciousness.

• Record intake and output accurately to monitor renal function.

• For management of vomiting (common to metabolic acidosis), position the patient

to prevent aspiration.

• Prepare for possible seizures and administer appropriate precautions.

• Provide good oral hygiene after incidences of vomiting. Use sodium bicarbonate
washes to neutralize acid in the patient’s mouth.
Metabolic Alkalosis
• Monitor respiratory rate, rhythm, and depth.

• Assess level of consciousness and neuromuscular status, strength, tone, movement; note
presence of Chvostek’s or Trousseau’s signs.
• Monitor heart rate and rhythm.

• Record amount and source of output. Monitor intake and daily weight.

• Restrict oral intake and reduce noxious environmental stimuli; use intermittent and low
suction during NG suctioning; irrigate gastric tube with isotonic solutions rather than water

• Provide seizures and safety precautions as indicated. Pad side rails, protect the airway,
put bed in low position and frequent observation.

• Encourage intake of foods and fluids high in potassium and possibly calcium (dependent
on blood level), canned grapefruit and apple juices, bananas, cauliflower, dried peaches,
figs, and wheat germ.
Metabolic Alkalosis
• Review medication regimen for use of diuretics,, such as thiazides (Diuril, Hygroton),
furosemide (Lasix), and ethacrynic acid (Edecrin).

• Instruct patient to avoid use of excessive amounts of sodium bicarbonate.

• Assist with identification and treatment of underlying disorder.

• Monitor laboratory studies as indicated: ABGs/pH, serum electrolytes (especially

potassium), and BUN.

• Avoid or limit use of sedatives or hypnotics.

• Administer supplemental O2 as indicated and respiratory treatments to improve

ventilation.

• Prepare patient for and assist with dialysis as needed

Reference:
https://nurseslabs.com/