Respiratory Acidosis

Reported by: Melissa Gutierrez BSN 4A

Respiratory Acidosis
Also called Carbonic Acid Excess Is a clinical disorder in which the pH< 7.35 & the partial pressure of arterial carbon dioxide (PaCO2) is >42 mm Hg. It may be either acute or chronic.

 Obstructive/

Restrictive Lung Diseases Impaired movement of Thoracic Cage Depressed Respiratory Centers Neuromuscular Diseases

Hypoventilation
Hypercapnia (elevated PaCO2)

Low Blood pH
Alter mental status Low oxygen concentration

Headache Anxiety confusion

Muscle weakness

Ineffective tissue perfusion

Hypoxia

clammy skin a rapid and weak heartbeat shallow breathin blue fingernails and lips

Narcosis

Muscle dysfunction

Organ Failure

Respiratory Failure

Shock

Diagnostic Evaluation
Acute Respiratory Acidosis
Arterial blood gas evaluation
pH< 7.35 PaCO2 >42 mmHg

When compensation (renal retention of bicarbonate ) has fully occurred,

Arterial pH may be within the LOWER limits of normal.

 Other diagnostic measures:

Serum electrolyte evaluation Chest x-ray det. any respiratory disease Drug screen if an overdose is suspected ECG to identify cardiac involvement as a result of COPD may be indicated as well

Treatment and Management

Pharmacologic agents
Brochodilators reduce bronchial spasm Antibiotics respiratory infections

Pulmonary hygiene measures

To clear the respiratory tract mucus and purulent drainage.

Adequate hydration
2-3 L/day , to keep mucous membranes moist and thereby facilitate removal of secretions

 Supplemental oxygen
Mechanical ventilation improve pulmonary ventilation CAUTION: Overzealous use of a mechanical ventilator cause such rapid excretion of carbon dioxide that the kidneys will be unable to eliminate excess bicarbonate quickly enough to prevent alkalosis and seizures. For this reason , the elevated PaCO2 must be decreased slowly.

Semi-Fowlers position
To facilitate expansion of the chest wall.

Nursing Interventions
1. Monitor respiratory rate, depth, and effort.
Rationale: Alveolar hypoventilation and associated hypoxemia lead to respiratory failure.

2. Auscultate breath sounds.

Rationale: Identifies area(s) of decreased ventilation, such as atelectasis, or airway obstruction and changes as client deteriorates or improves, reflecting effectiveness of treatment and dictating therapy needs.

 3. Note declining level of awareness or consciousness.

Rationale: Signals severe acidotic state, which requires immediate attention. Note: In recovery, sensorium clears slowly because hydrogen ions are slow to cross the blood-brain barrier and clear from cerebrospinal fluid (CSF) and brain cells.

 4. Monitor heart rate and rhythm.

Rationale: Tachycardia develops early because the sympathetic nervous system is stimulated, resulting in the release of catecholamines, epinephrine, and norepinephrine in an attempt to increase oxygen delivery to the tissues. Dysrhythmias that may occur are due to hypoxia (myocardial ischemia) and electrolyte imbalances.

 5. Note skin color, temperature, and moisture. Rationale: Diaphoresis, pallor, and cool, clammy skin are late changes associated with severe or advancing hypoxemia.

 6. Encourage and assist with deepbreathing exercises, turning, and coughing. Suction as necessary. Provide airway adjunct as indicated. Place in semi-Fowlers position. Rationale: These measures improve lung ventilation and reduce or prevent airway obstruction associated with accumulation of mucus.

 7. Restrict use of hypnotic sedatives or tranquilizers.

Rationale: In the presence of hypoventilation, respiratory depression and CO2 narcosis may develop.

8. Discuss cause of chronic condition, when known, and appropriate interventions and self-care activities.
Rationale: Promotes participation in therapeutic regimen and may reduce recurrence of disorder.

 9. Assist with identification and treatment of underlying cause.

Rationale: Treatment of disorder is directed at improving alveolar ventilation. Multiple team management, including physicians, pulmonologist and respiratory therapists, or neurologists, may be required to address the underlying condition, such as oversedation, brain trauma, COPD, pulmonary edema, aspiration, and promote correction of the acid-base disorder.

 10. Monitor and graph serial ABGs and pulse oximetry readings.
Rationale: Evaluates therapy needs and effectiveness. Note: Pulse oximetry monitoring is used to monitor and show early changes in oxygenation, which can occur before other signs or symptoms are observed.

THANK YOU !
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