Condition

Results from

Respiratory acidosis
-respiratory depression
=Increased CO2
from poisons,
=Increased H+ concentration anesthetics, trauma, or
neurological diseases
(myasthenia gravis,
Guillain-Barre)
-inadequate chest
expansion due to muscle
weakness,
pneumothorax/hemothor
ax/ flail chest, obesity,
tumors, or deformities
-Airway obstruction that
occurs in laryngospasm,
asthma, and some
cancers
-Alveolar-capillary
blockage secondary to a
pulmonary embolus,
thrombus, cancer or PE
-Inadequate mechanical
ventilation
Respiratory alkalosis
-Hyperventilation due to
=decreased CO2
fear, anxiety,
=decreased H+
intercerebral trauma,
concentration
salicylate toxicity, or
excessive mechanical
ventilation
-Hypoxemia from
asphyxiation, high
altitudes, shock, or earlystage asthma or
pneumonia

Subjective and
objective data

Nursing Actions

-VS: tachycardia (severe

acidosis may lead to
bradycardia), tachypnea
-Dysrhythmias
-Neuro: anxiety,
irritability, confusion,
coma
-Respiratory: ineffective,
shallow, rapid breathing
-Skin: pale or cyanotic

Oxygen therapy
Maintain patent airway
Enhance gas exchange
(positioning and breathing
techniques, ventilatory
support, bronchodilators,
mucolytics)

-VS: tachypnea
-neuro: anxiety, tetany,
convulsions, tingling,
numbness
-cardiovascular:
palpitations, chest pain,
dysrhythmias
-respiratory: rapid, deep
respirations

Oxygen therapy
Anxiety reduction
interventions
Rebreathing techniques

Metabolic acidosis
-Excess production of
=decreased HCO3hydrogen ions:
=increased H+ concentration -DKA
-lactic acidosis
-starvation
-heavy exercise
-seizure activity
-fever
-hypoxia
-intoxication with ethanol
or salicylates

-VS: bradycardia, weak

peripheral pulses,
hypotension, tachypnea
-dysrhythmias
-neuro: muscle
weakness, hyporeflexia,
flaccid paralysis, fatigue,
confusion
-respiratory: rapid, deep
respirations (Kussmaul
respirations)
-Skin: warm, dry, flushed

Varies with causes

-if DKA, administer insulin
-if related to GI losses,
administer antidiarrheals and
provide rehydration
-if serum bicarbonate is low,
administer sodium
bicarbonate [1 mEq/kg]

-VS: tachycardia,
normotensive or
hypotensive
-dysrhythmias
-neuro: numbness,
tingling, tetany, muscle
weakness, hyperreflexia,
confusion, convulsion
-respiratory: depressed
skeletal muscles

Varies with cause

-if GI losses, administer
antiemetics, fluids and
electrolyte replacements
-if related to potassium
depletion, discontinue
causative agent

-Inadequate elimination
of hydrogen ions: kidney
failure
-inadequate production
of bicarbonate:
-kidney failure
-pancreatitis
-liver failure
-dehydration

Metabolic alkalosis
= increased HCO3= decreased H+
concentration

-excess elimination of
bicarbonate:
-diarrhea, ileostomy
-base excess:
-oral ingestion of bases
(antacids)
-venous administration of
bases (blood
transfusions, total
parenteral nutrition, or
sodium bicarbonate)
-acid deficit:
-loss of gastric secretions

through prolonged
resulting in ineffective
vomiting or NG suction
breathing
-K depletion (due to
thiazide diuretics,
laxative abuse, Cushings
syndrome)