Respiratory Acidosis - EXAM 3

Question 1

Normal pH

Answer 1

7.35-7.45

Question 2

Normal PaCO2

Answer 2

35-45

Question 3

Normal HCO3 (bicarbonate)

Answer 3

24-30

Question 4

Normal PaO2

Answer 4

75-100

Question 5

Hypoxemic Respiratory Failure

Answer 5

• Inadequate transfer between alveoli and pulmonary capillary beds
• PaO2 less than or equal to 60 mm Hg on 60% O2

Question 6

Room air oxygen level

Answer 6

21%

Question 7

Hypercapnic Respiratory Failure

Answer 7

• Most common ABG abnormality
• Insufficient CO2 removal
• PaCO2 greater than 45 mm Hg
• pH less than 7.35

Question 8

Causes of Hypoxemic Respiratory Failure

Answer 8

• Intrapulmonary shunting
• Pneumonia
• Smoke inhalation
• Shock
• ARDS
• V-Q mismatch
• PE

Question 9

Intrapulmonary shunting

Answer 9

Blood exits lung without participating in gas exchange

• Pnrumonis secretions
• Mucus Plug
• Blood clot from PE
• ARDS: Acute Respiratory Distress Syndrome

Question 10

Hypercapnic Respiratory Failure

Answer 10

• Obstructive airway diseases (asthma, COPD, difficulty getting air out)
• CNS impairment
• Chest wall dysfunction (problems getting air in)
• Neuromuscular dysfunction
• Narcotics, sedatives, barbiturates

Question 11

What is the respiratory compensatory component?

Answer 11

carbonic acid

Question 12

What is the renal compensatory component?

Answer 12

bicarb

Question 13

Respiratory center

Answer 13

In brain. Detects lungs to increase or decrease RR and depth in a response to the amount of CO2. CO2 is retained or blown off.

Question 14

How fast does compensation occur?

Answer 14

System is extremely sensitive to changes in pH and compensation begins in seconds to minutes

Question 15

Renal Regulation of Acid Base Balance

Answer 15

• Control buffer NaHCO3 (sodium bicarb)
• Takes several hours to days to kick in
• Can control HCO3 (bicarb) by either reabsorbing or excreting H+ ions

Question 16

Respiratory Acidosis Diagnostic Findings

Answer 16

• pH below 7.35
• PaCO2 above 45 mm Hg
• HCO3 is normal (24-30)
• Hyperkalemia
• Hypercalcemia
• Lactic acid accumulation
• Low PaO2

Question 17

Pulmonary Function Tests

Answer 17

• Decreased tidal volume
• Decreased FVC
• Decreased FEV 1
• Decreased minute ventilation
• End tidal CO2 (ETCO2)

Question 18

Respiratory acidosis assessment data

Answer 18

• Change in LOC/altered MS/headache
• Progressive sleepiness as CO2 levels increase
• Dyspnea
• Rapid, shallow breathing with increased work of breathing (hypoventilation in the end)
• Patient with HOB up at least 45 degrees
• Leading to decreased RR and respiratory muscle fatigue (emergency)
• Hypertension
• Tachycardia
• Dysrhythmia

Question 19

Acid-Base Compensation

Answer 19

• The respiratory system attempts to compensate for respiratory acidosis
• Increased the rate and depth of respirations to blow off CO2
• The renal system also attempts to compensate for respiratory acidosis…slower process
• Kidneys begin eliminating H+ ions and retaining HCO3
• HCO3 levels rise to buffer
• If no renal compensation is evident in the ABG analysis, the resp. problem is acute
• Over time, the kidneys compensate by retaining bicarbonate and secreting hydrogen ions
• If compensation is evident in the ABG analysis, the resp. problem is chronic
• A compensated ABG differs from a normal ABG in that PaCO2 and HCO3 will both be abnormal and the pH with be normal

Question 20

What’s the relationship between acid-base compensation and correction?

Answer 20

• Acidosis can be temporarily corrected by the medical team by administering NaHCO3
• Compensation occurs within the body through the effects of the respiratory and renal systems

Question 21

Medical Supportive Therapy

Answer 21

• Correct underlying cause of resp. failure
• Manage and maintain adequate cardiac output
• Maintenance of adequate hemoglobin concentration

Question 22

Respiratory Therapy

Answer 22

• Intubation with mechanical ventilation (R. failure)
• Non-invasive positive pressure ventilation
• O2 therapy
• Pulmonary toliet = effective cough, incentive spirometry, hydration/humidification, cchest physiotherapy, airway suctioning

Question 23

Medication Therapy

Answer 23

• Relief of bronchospasm
• Reduction of airway inflammation
• Reduction of pulmonary congestion (lasix)
• Treatment of pulmonary infections
• Reduction of severe anxiety (lorazepam)

Question 24

Nutritional Therapy

Answer 24

• Parenteral nutritional support
• Enteral nutritional support
• Need adequate calories and protein
• May need to limit carbohydrates in patient who retains CO2

Question 25

Therapeutic Nursing Interventions

Answer 25

• Assess LOC
• Monitor adequacy of ventilation respiratory status: administer supplemental O2
• Monitor cardiovascular status
• Adequate fluids to liquefy secretions and maintain cardiac output
• Encourage patient to cough/augment cough/suction (pulmonary toliet)
• Administer and monitor response to medication therapy
• Administer and assess safe nutritional intake
• Prevent infection
• Support patient and family
• Education

Question 26

Gerontological Considerations

Answer 26

• Physiologic aging of lung brings loss of effective alveoli and loss of surface area for gas exchange in alveoli
• Decrease in ciliary activity
• Decrease in resp. muscle strength
• Greater vulnerability for resp. acidosis and resp. failure