Respiratory Acidosis Nursing Care Plan

Respiratory Acidosis Nursing Care Plan an elevation in the PaCO2 level, is caused by hypoventilation with resultant excess carbonic acid. Acidosis can be due to or associated with primary defects in lung function or changes in normal respiratory pattern. The disorder may be acute or chronic.

Respiratory acidosis is a condition that occurs when the lungs can’t remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic. Normally, the body is able to balance the ions that control acidity. This balance is measured on a pH scale from 0 to 14. Acidosis occurs when the pH of the blood falls below 7.35 (normal blood pH is between 7.35 and 7.45).

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Respiratory acidosis is typically caused by an underlying disease or condition. This is also called respiratory failure or ventilator failure.

Normally, the lungs take in oxygen and exhale CO2. Oxygen passes from the lungs into the blood. CO2 passes from the blood into the lungs. However, sometimes the lungs can’t remove enough CO2. This may be due to a decrease in respiratory rate or decrease in air movement due to an underlying condition such as:

  • Asthma
  • COPD
  • Pneumonia
  • Sleep apnea

Forms of respiratory acidosis

There are two forms of respiratory acidosis: acute and chronic.

Acute respiratory acidosis occurs quickly. It’s a medical emergency. Left untreated, symptoms will get progressively worse. It can become life-threatening.

Chronic respiratory acidosis develops over time. It doesn’t cause symptoms. Instead, the body adapts to the increased acidity. For example, the kidneys produce more bicarbonate to help maintain balance.

Chronic respiratory acidosis may not cause symptoms. Developing another illness may cause chronic respiratory acidosis to worsen and become acute respiratory acidosis.

Symptoms of respiratory acidosis

Initial signs of acute respiratory acidosis include:

  • Headache
  • Anxiety
  • Blurred vision
  • Restlessness
  • Confusion

Without treatment, other symptoms may occur. These include:

  • Sleepiness or fatigue
  • Lethargy
  • Delirium or confusion
  • Shortness of breath
  • Coma

The chronic form of respiratory acidosis doesn’t typically cause any noticeable symptoms. Signs are subtle and nonspecific and may include:

  • Memory loss
  • Sleep disturbances
  • Personality changes

Common causes of respiratory acidosis

The lungs and the kidneys are the major organs that help regulate your blood’s pH. The lungs remove acid by exhaling CO2, and the kidneys excrete acids through the urine. The kidneys also regulate your blood’s concentration of bicarbonate (a base).

Respiratory acidosis is usually caused by a lung disease or condition that affects normal breathing or impairs the lungs’ ability to remove CO2. Some common causes of the chronic form are:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Acute pulmonary edema
  • Severe obesity (which can interfere with expansion of the lungs)
  • Neuromuscular disorders (such as multiple sclerosis or muscular dystrophy)
  • Scoliosis

Some common causes of the acute form are:

  • Lung disorders (COPD, emphysema, asthma, pneumonia)
  • Conditions that affect the rate of breathing
  • Muscle weakness that affects breathing or taking a deep breath
  • Obstructed airways (due to choking or other causes)
  • Sedative overdose
  • Cardiac arrest

How is respiratory acidosis diagnosed?

The goal of diagnostic tests for respiratory acidosis is to look for any pH imbalance, to determine the severity of the imbalance, and to determine the condition causing the imbalance. Several tools can help doctors diagnose respiratory acidosis.

Blood gas measurement

Blood gas is a series of tests used to measure oxygen and CO2 in the blood. A healthcare provider will take a sample of blood from your artery. High levels of CO2 can indicate acidosis.

Electrolytes

Electrolyte testing is a group of tests that measure levels of Na+ (sodium), K+ (potassium), Cl- (chloride), and bicarbonate. One or more of the electrolytes will be increased or decreased in people with acid-base disorders such as respiratory acidosis.

Lung function tests

Many people with this condition have reduced lung function.

Chest X-ray

X-rays can help doctors see injuries or other problems likely to cause acidosis.

Other tests

Based on these tests, your doctor may also perform other tests to help diagnose the underlying condition that’s causing the acidosis. (Another condition, known as metabolic acidosis, may cause similar symptoms, and the doctor may order tests to be sure the problem is solely respiratory. These tests measure the amount of acid in your body, which may be caused by kidney failure, diabetes, or other conditions, and includes glucose, lactate, and ketones.) Other tests include drug testing, a complete blood count (CBC), and a urinalysis (urine test).

Treating respiratory acidosis

There are several different treatments for respiratory acidosis.

Acute form

Treating acute acidosis usually means addressing the underlying cause. For example, your airway may need to be cleared. This must be done as soon as possible. Artificial ventilation may also be needed.

Chronic form

If you have the chronic form of this disease, your treatment will focus on managing any underlying conditions. The goal is to improve airway function. Some strategies include:

  • Antibiotics (to treat infection)
  • Diuretics (to reduce excess fluid affecting the heart and lungs)
  • Bronchodilators (to expand the airways)
  • Corticosteroids (to reduce inflammation)
  • Mechanical ventilation (in severe cases)

What’s the typical outlook for someone with respiratory acidosis?

Respiratory acidosis has many causes, so it’s difficult to generalize about a long-term outlook. Your outlook largely depends on what’s causing your disease, and your doctor should be able to give you an idea of what to expect.

The acute form of respiratory acidosis can be fatal. Be sure to seek emergency medical help if you experience a sudden difficulty in breathing or if your airway is obstructed. This is especially important if you already have chronic respiratory acidosis or any of the underlying lung diseases.

Ways to lower your risk for respiratory acidosis

The best way to prevent acidosis is to avoid causes of the disease.

Choosing to live a smoke-free lifestyle may help. Smokers are at higher risk for chronic respiratory acidosis. Smoking is bad for lung function. It increases the risk of respiratory diseases and can have an adverse impact on overall quality of life.

Maintaining a healthy weight can reduce your risk of this condition.

Use caution when taking sedatives. They can interfere with your ability to breathe. Sedatives depress the central nervous system. Always read and follow the label. Never take more than is recommended. Mixing sedatives with alcohol can be fatal.

Respiratory Acidosis Nursing Care Plan Nursing Care Plan

Below is a nursing care plan and nursing diagnosis for patients with respiratory acidosis.

Impaired Gas Exchange

  • Ventilation perfusion imbalance (altered oxygen-carrying capacity of blood, altered oxygen supply, alveolar-capillary membrane changes, or altered blood flow)

Possibly evidenced by

  • Dyspnea with exertion, tachypnea
  • Changes in mentation, irritability
  • Tachycardia
  • Hypoxia, hypercapnia

Respiratory Acidosis Nursing Care Plan|Desired Outcomes

  • Demonstrate improved ventilation and adequate oxygenation of tissues as evidenced by ABGs within patient’s acceptable limits and absence of symptoms of respiratory distress.
  • Verbalize understanding of causative factors and appropriate interventions.
  • Participate in treatment regimen within level of ability/situation.
Nursing Interventions Rationale
Monitor respiratory rate, depth, and effort. Alveolar hypoventilation and associated hypoxemia lead to respiratory distress or failure.
Auscultate breath sounds. Identifies areas of decreased ventilation (atelectasis) or airway obstruction and changes as patient deteriorates or improves, reflecting effectiveness of treatment, dictating therapy needs.
Note declining level of consciousness. 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 and brain cells.
Monitor heart rate and rhythm. 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.
Note skin color, temperature, moisture. Diaphoresis, pallor, cool or clammy skin are late changes associated with severe or advancing hypoxemia.
Encourage and assist with deep-breathing exercises, turning, and coughing. Suction as necessary. Provide airway adjunct as indicated. Place in semi-Fowler’s position. These measures improve lung ventilation and reduce or prevent airway obstruction associated with accumulation of mucus.
Restrict use of hypnotic sedatives or tranquilizers. In the presence of hypoventilation, respiratory depression and CO2 narcosis may develop.
Discuss cause of chronic condition (when known) and appropriate interventions and self-care activities. Promotes participation in therapeutic regimen, and may reduce recurrence of disorder.
Assist with identification or treatment of underlying cause. Treatment of disorder is directed at improving alveolar ventilation. Addressing the primary condition (oversedation, lung and respiratory system trauma, pulmonary edema, aspiration) promotes correction of the acid-base disorder.
Monitor and graph serial ABGs, pulse oximetry readings; Hb, serum electrolyte levels. Evaluates therapy need and effectiveness. Note: Bedside pulse oximetry monitoring is used to show early changes in oxygenation before other signs or symptoms are observed.
Administer oxygen as indicated. Increase respiratory rate or tidal volume of ventilator, if used. Prevents and corrects hypoxemia and respiratory failure. Note: Must be used with caution in presence of emphysema because respiratory depression or failure may result.
Assist with ventilatory aids: IPPB in conjunction with bronchodilators. Monitor peak flow pressure. Increases lung expansion and opens airways to improve ventilation, preventing respiratory failure.
Maintain hydration (IV/PO) and provide humidification. Assists in correction of acidity and thinning and mobilization of respiratory secretions.
Provide appropriate chest physiotherapy, including postural drainage and breathing exercises. Aids in clearing secretions, which improves ventilation, allowing excess CO2 to be eliminated.
Administer IV solutions such as lactated Ringer’s solution or 0.6 M solution of sodium lactate. May be useful in nonemergency situations to help control acidosis, until underlying respiratory problem can be corrected.
Administer medications as indicated: 
Naloxone hydrochloride (Narcan) May be useful in arousing patient and stimulating respiratory function in presence of drug overdose and sedation, or acidosis resulting from cardiac arrest.
Sodium bicarbonate (NaHCO3) May be given in small IV doses in emergency situations to quickly correct acidosis if pH is less than 7.25 and hyperkalemia coexists. Note: Rebound alkalosis or tetany may occur.
Potassium chloride (KCl) Replaces potassium that shifts out of cells during acidotic state. Correction of the acidosis may cause a relative serum hypokalemia as potassium shifts back into cells. Potassium imbalance can impair neuromuscular or respiratory function, causing generalized muscle weakness and cardiac dysrhythmias.
Bronchodilators Helps open constricted airways to improve gas exchange.
Provide low-carbohydrate, high-fat diet (Pulmocare feedings), if indicated. Helps reduce CO2 production and improves respiratory muscle function and metabolic homeostasis.

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