Respiratory Acidosis (retention of CO2)

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.

Metabolic Acidosis (deficit or loss of base

HCO3- or excessive acid production) Diabetic ketoacidosis (DKA), renal failure, lactic acidosis (shock, cardiac arrest), and loss of HCO3- through diarrhea or intestinal fistulas, in these conditions an EXCESSIVE LOSS of HCO3- or alkaline fluids occurs.

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

Dyspnea, Hypoventilation resulting in Hypoxia, Restlessness progressing to lethargy, Drowsiness, Confusion, Coma, Tachycardia, Tachypnea, Dysrhythmias associated with hypoxia and hyperkalemia, Seizures, Pale to cyanotic and dry skin, Hypercapnia (elevated CO2 level), which will cause cerebral vasodilation and increase problems with increased intracranial pressure (ICP) Urine pH is <6

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,

Respiratory Alkalosis (loss of CO2)

Nervous and breathing too rapidly (hyperventilation) and excrete excessive amounts of CO2, may also be caused by CNS problems (affecting the respiratory center).

Metabolic Alkalosis (loss of acid)

Excessive retention of HCO3- or a loss of acid, may occur if too much HCO3- was given during resuscitation, gastric suctioning or prolonged vomiting and diarrhea.

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

Signs & Symptoms

Hyperventilation (hyperpnea) *HALLMARK SIGN* Possible lightheadedness, Dysrhythmias, Tachycardia (K+ may be decreased), Confusion, Epigastric pain and nausa, Numbness in fingers and toes (may progress to tetany or seizures) 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)

Respiratory Acidosis (hypoventilation)

Possible Causes: Over Sedation Brainstem Trauma Immobility Respiratory muscle paralysis

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.

K+ will go up Lungs will compensate acidosis by decreasing the CO2

Diabetes, poor perfusion, poor ventilation, and real failure can all cause ACIDOSIS.

Respiratory Alkalosis (hyperventilation)

Possible Causes: Hyperventilation with anxiety Pulmonary Disease High Altitudes Ventilator setting TOO HIGH or TOO FAST

Metabolic Alkalosis (loss of acid)

Possible Causes: Nasogastric (gastric) suctioning Prolonged vomiting Thiazide diuretic use Overdose of Bicarbonates with CPR Excessive antacids

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.