Professional Documents
Culture Documents
Depression of the respiratory center (head injury, anesthesia, narcotic overdose), obstruction of respiratory passages (pneumonia, atelectasis), and chronic respiratory problems (chronic obstructive pulmonary disease [COPD]) prevent the normal excretion of CO2 through ventilation.
Compensatory Mechanism
*The kidneys compensate by retaining more HC03- to compensate for the acidosis
Compensatory Mechanism
*The lungs will increase excretion of CO2 to assist the elimination of H+ ions and compensate for the acidosis
Common Causes
Secondary to problems that cause hypoventilation: CNS Depression head injury, sedatives, anesthesia Increased Resistance aspiration, bronchospasm, laryngospasm, prolonged narrowing of the airway (asthma, airway edema) Loss of lung surface Atelectasis, COPD, Pneumonia, Pneumothorax, Chronic Pulmonary Diseases. Neuromuscular Diseases affecting respiratory muscles Guilain-Barre syndrome and myasthenia gravis, Mechanical Hypoventilation increased retention of CO2, Sedative or barbiturate overdose
Common Causes DKA (most common), Lactic acidosis (shock, respiratory or cardiac arrest), Renal failure, Severe diarrhea, Salicylate toxicity, Starvation, Gastrointestinal (GI) fistulas
Signs & Symptoms Kussmaul respirations (deep, rapid), Confusion, Disorientation progressing to coma, Headache and Lethargy, Hypotension, Dysrhythmias secondary to hyperkalemia, Warm flushed skin (peripheral vasodilation), Abdominal pain, Nausea/Vomiting
Urine pH <6 Medical Management Medical Management IV HCO3- for severe acidosis, rapid transition from acidosis to alkalosis can be detrimental. Nursing Management Nursing Management
Administer Bronchodilators, if on a ventilator may need to increase the TIDAL VOLUME to facilitate maximum volume and gas exchange to increase expiration of CO2,
Semi-Fowler position (to facilitate ventilation), Incentive spirometer, Turn Cough Breathe deeply, Assess for tachycardia secondary to hypoxia, Monitor for Bradypnea, Initiate seizure precautions, Encourage ambulation.
ID the cause, History (diabetes, alcohol, renal disease, excessive GI fluid loss, lactic acidosis), Assess serum results: Blood Urea Nitrogen (BUN) and creatinine for renal function, Electrolytes (K+), Glucose levels, Monitor ABGs, Vital signs, Daily weight, Antiemetic (vomiting), Fluid replacement (0.9% or 0.45% sodium chloride [NaCl] for hydration therapy), Antidiarrheal meds (excessive diarrhea), Skin turgor,
Compensatory Mechanism
*The kidneys excrete more HCO3- to balance the pH
Compensatory Mechanism
*The lungs retain more CO2 to balance the pH
Common Causes
Hyperventilation syndrome (anxiety, fear, hysteria), Hyperventilation is caused by: Hypoxia, Pulmonary emboli, Pain, Fever, CNS problems (encephalitis, head injury), Mechanical hyperventilation (tidal volume is TOO HIGH and respiratory rate is TOO RAPID)
Common Causes Loss of acid through gastric suctioning or vomiting, Excess alkali intake antacids or sodium HCO3-, Adrenal disease (hyperaldosteronism), Excessive intake of mineralocorticoids, Diuretic therapy Signs & Symptoms Nervousness, Dizziness, Cardiac irritability (Decreased K+, Ventricular Dysrhythmias, Atrial Tachycardia), N/V, Paresthesias in fingers/toes, Tetany and muscle cramps (late signs), Hypoventilation (compensated by the lungs), Hydration status (fluid volume deficit)
Urine pH >6
Medical Management
Assess the need for an antianxiety medication Decrease rate and tidal volume (if on a ventilator)
Medical Management Stop the intake of HCO3Replace fluid loss Nursing Management
History (precipitating cause GI suctioning or vomiting, K+ values (hypokalemia usually occurs, but levels will increase with treatment of the alkalosis) If taking digitalis, monitor pH, digitalis, and K+ levels. Digitalistoxicity may occur with hypokalemia. Monitor repirations, lungs will compensate by retaining CO2. Antiemetic meds for N/V, assess for Paresthesias (numbness and tingling) of toes and fingers.
Nursing Management
Monitor ABGs, Presence of decreased K+, Monitor for dysrhythmias, Relax/Calm encourage slow, deep breathing, guided imagery, Rebreathing Mask (paper sack) to increase CO2 retention, Reduce environmental noise and stimuli, Encourage slowing down respirations, Analgesic Medications (pain), Antipyretic Medications (fever)
Metabolic Acidosis
(Loss of base HCO3- or excessive acid production) Possible Causes: Ketoacidosis Shock Severe Diarrhea Impaired Kidney Function K+ will go up Kidneys will compensate acidosis by increasing the HCO3Diabetes, poor perfusion, poor ventilation, and real failure can all cause ACIDOSIS.
Diabetes, poor perfusion, poor ventilation, and real failure can all cause ACIDOSIS.
K+ goes down with alkalosis. K+ moves into the cells (ICF) and increased renal excretion of K+ occurs as the renal system tries to conserve the H+. If alkalosis is corrected, K+ will shift out of the cells and back into the circulating volume
Hypocapnia decreased levels of CO2. Most commonly seen when hyperventilation secondary to hypoxia as a result of acute pulmonary conditions.