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Respiratory system

Respiratory refresher (continued)

PULMONARY EMBOLISM (CONTINUED)
Key interventions
Assess respiratory status.
Assess cardiovascular status.
Administer O2.

Key treatments
Correction of underlying cause
Increasing CO2 levels (for respiratory alkalosis caused by
hyperventilation) by having the client breathe into a paper bag

RESPIRATORY ACIDOSIS
Key signs and symptoms
Cardiovascular abnormalities, such as tachycardia, hypertension, atrial and ventricular arrhythmias and, in severe acidosis,
hypotension with vasodilation

Key interventions
Assess neurologic, neuromuscular, and cardiovascular
functions.
Monitor ABG and serum electrolyte levels closely, watching
for any variations.

Key test results

ABG measurements confirm respiratory acidosis. PaCO2
exceeds the normal level of 45 mm Hg and pH is usually below
the normal range of 7.35 to 7.45. The clients bicarbonate level is
normal in the acute stage and elevated in the chronic stage.

SARCOIDOSIS
Key signs and symptoms
Initial signs
Arthralgia (in the wrists, ankles, and elbows)
Fatigue
Malaise
Weight loss
Respiratory
Breathlessness
Substernal pain
Cutaneous
Erythema nodosum
Subcutaneous skin nodules with maculopapular eruptions
Ophthalmic
Anterior uveitis (common)
Musculoskeletal
Muscle weakness
Pain
Hepatic
Granulomatous hepatitis (usually asymptomatic)
Genitourinary
Hypercalciuria (excessive calcium in the urine)
Cardiovascular
Arrhythmias (premature beats, bundle-branch block, or
complete heart block)
Central nervous system
Cranial or peripheral nerve palsies
Basilar meningitis (inflammation of the meninges at the base of
the brain)

Key treatments
Treatment of underlying cause
Sodium bicarbonate in severe cases
Key interventions
Closely monitor the clients blood pH level.
Be alert for critical changes in the clients respiratory, central
nervous system (CNS), and cardiovascular functions. Also watch
closely for variations in ABG values and electrolyte status.
Maintain adequate hydration.
If acidosis requires mechanical ventilation, maintain a patent
airway and provide adequate humidification. Perform tracheal
suctioning regularly and vigorous chest physiotherapy if needed.
Continuously monitor ventilator settings and respiratory status.
RESPIRATORY ALKALOSIS
Key signs and symptoms
Agitation
Cardiac arrhythmias that fail to respond to conventional
treatment (severe respiratory alkalosis)
Circumoral or peripheral paresthesia (a prickling sensation
around the mouth or extremities)
Deep, rapid breathing, possibly exceeding 40 breaths/minute
(cardinal sign)
Light-headedness or dizziness (from decreased cerebral blood
flow)
Key test results
ABG analysis confirms respiratory alkalosis and rules out
respiratory compensation for metabolic acidosis. PaCO2 is below
35 mm Hg and pH is elevated in proportion to the fall in PaCO2 in
the acute stage but drops toward normal in the chronic stage.
Bicarbonate level is normal in the acute stage but below normal
in the chronic stage.

313419NCLEX-RN_Chap04.indd 76

Key test results

A positive Kveim-Siltzbach skin test supports the diagnosis.
Key treatments
A low-calcium diet and avoidance of direct exposure to sunlight (in clients with hypercalcemia)
O2 therapy
Systemic or topical steroid, if sarcoidosis causes ocular,
respiratory, CNS, cardiac, or systemic symptoms (such as fever
and weight loss), hypercalcemia, or destructive skin lesions

4/8/2010 6:46:14 PM