Understanding Respiratory Acidosis Symptoms

Hey everyone, it's Nurse Sarah with RegisteredNurseArian.com and in this video I'm going to be going over respiratory acidosis. So let's get started. This condition occurs because we have a decrease in lung ventilation. And whenever we have that, our body starts to retain CO2, carbon dioxide, which is going to drop our blood pH. Now what are some things that can lead to this condition and cause us to retain carbon dioxide? Let's think about this for a moment. Whenever you're breathing, you're breathing in oxygen and you're breathing out carbon dioxide, and you've got to get rid of that carbon dioxide because if you don't, it's going to lower your blood pH. So any conditions that lower our breathing rate, where it causes us to breathe too slow, like bradypnea, and this is a respiratory rate less than 12 breaths per minute in an adult. Also, if we have damage to those gas exchange structures in our lungs, like those alveolar sacs, where we're not having that proper exchange of oxygen and carbon dioxide we can for sure retain too much carbon dioxide and drop our blood pH in addition if we have an issue with the muscles that aid in the respiratory rate for instance our diaphragm is too weak and we start getting into those neuromuscular disorders that will affect our ability to breathe. So to help us really understand this condition, let's go back and talk about carbon dioxide and gas exchange. So with respiratory acidosis, we have established that we have retained carbon dioxide levels. So what is carbon dioxide anyways? Well, carbon dioxide is a waste product that is created from cell metabolism. And your body needs this certain little range of about 35 to 45 millimeters of mercury. too much of it is bad and too little of it is bad. So here in acidosis, we're talking about having a level greater than 45 because we're retaining way too much CO2. So your body must deal with this carbon dioxide. And what it does is it takes it, dumps it into the blood and your blood will take it up through the heart to the lungs where gas exchange is going to occur. And it's really cool how gas exchanges in your body because whenever you're breathing in, you're breathing in oxygen, that oxygen goes in through your nose, down into your lungs, and then it's going to cross over into these little alveoli sac and it's going to go into your blood. And your blood's going to take it, replenish all your organs with oxygen that it desperately needs. Now that waste product that's built up in your blood, that carbon dioxide, it's going to cross over and it's going to go through the alveolar sac, but it's going to go up through your lungs and you're going to exhale it. And your respiratory rate can adjust itself. It can increase its rate or decrease its rate depending on how much CO2 it needs to get rid of. Now let's back up to whenever CO2 is being created from the cell metabolism. So it's created, it's that waste product. So your body takes it, dumps it into the blood. Now when CO2 enters the blood, it's going to find some water molecules and it's actually going to bind with water. So CO2 and H2O, they bind together. When they bind together, we get the creation of carbonic acid. Carbonic acid is a very weak acid. It doesn't stay together for too long So whenever we get the formation of it, it actually breaks apart into like hydrogen ions and bicarb I want you particularly pay attention to hydrogen ions The hydrogen ions is the thing that really affects our blood pH because whenever we measure blood pH We're measuring the concentration of hydrogen ions And hydrogen ions are acidic. So if you have too many hydrogen ions, that is going to drop your blood pH. And remember, a normal blood pH is 7.35 to 7.45. So it's extremely narrow. So whenever you have too many hydrogen ions hanging out in the body, it's going to make your blood pH less than 7.35. It dropped it. But if we don't have a lot of hydrogen ions, we are going to actually increase our blood pH. It's going to be greater than 7.45. But here in acidosis, we have way too many hydrogen ions on board. So we have a blood pH of less than 7.35. So you may be thinking, what's the big deal about carbon dioxide and hydrogen ions? Well, they're extremely related because whenever we get carbon dioxide binding with water, we get the creation of that weak acid, carbonic acid. Since it's... it's a weak acid it breaks apart whenever it breaks apart we get hydrogen ions so if we have a lot of carbon dioxide in our body let's say we have a patient who has a neuromuscular disease they're not breathing very well the respiratory rate is extremely slow what are they retaining a lot of carbon dioxide so we have a lot of carbon dioxide hanging out in the blood that means it's binding with water when it binds with water we get carbonic acid being formed which is going to start giving us a lot of hydrogen ions in our blood when we have a lot of hydrogen ions in our blood that drops our blood pH and makes it acidic, which is why we have respiratory acidosis. So now let's look at some conditions that can lead us to to retain carbon dioxide because we've established that we have a depression in lung ventilation. Either we're breathing too slowly, there's damage to the gas exchange structures in our lungs, or our respiratory muscles are just too weak to help us exhale this carbon dioxide. So to remember those causes, let's remember the word depress. D is for drugs such as opioids and sedatives. Those are really big ones. They depress your respiratory rate, cause your patient not to breathe very fast. So whenever you do give these medications you've definitely going to monitor your patient's breathing rate. Also diseases this goes along with this D diseases of the neuromuscular system such as Guillain-Barre syndrome with that we start to get paralysis that will extend up to our respiratory system which will cause your patient not to be able to use the respiratory muscles to breathe which again will cause us to retain CO2. E is for edema particularly pulmonary edema this is where we have fluid in the lungs whenever we have fluid hanging out around those alveolar sacs, it's going to prevent proper gas exchange from occurring, which also happens with the P of our mnemonic, pneumonia. And then we have R for the respiratory center of the brain is damaged. This can occur in patients who have experienced a stroke. So your breathing rate is really controlled a lot in your brain and if someone's had ischemia to particular parts of their brain that control the respiratory rate, it can affect how well they're able to ventilate. E is for emphysema. This is where the patient has over inflated alveoli sacs. So we're impairing gas exchange. S is for spasms of the bronchial tubes, like an asthma, again, impairing gas exchange. And then lastly is sac elasticity of alveolar sacs are damaged. And these are in patients who experience COPD. And in patients who have COPD, they are known as being CO2 retainers because we are not having that proper gas exchange. in their sac. So one thing you want to remember about patients who have chronic COPD, meaning they've had this condition for a very long time, they are in this chronic state of acidosis because they retain CO2. And because they've been retaining the CO2 for a long time, their body has adjusted to this. So we have to be extremely careful with the amount of oxygen that we administer to these patients, which we're going to talk about in nursing interventions. Now let's talk about how you can know if your patient is experiencing respiratory acidosis. One big way is to look at those arterial blood gas values. So let's quickly go over that. So whenever we're talking about respiratory acidosis, the first thing you want to look at is that blood pH. A normal blood pH, as I said before, is 7.35 to 7.45 and again that was the measurement of those hydrogen ion concentration in our blood. So we have a very acidic blood level so what do you think that blood pH is going to be in respiratory acidosis? It's going to be less than 7.35. Then we want to look at that PaCO2 level. That is the amount of carbon dioxide in the arterial blood. A normal level is 35 to 45 millimeters of mercury. So with this condition, we have established that we are retaining carbon dioxide. So what is our level going to be in respiratory acidosis? It's going to be greater than 45 millimeters of mercury. And then another thing we want to look at is the bicarb. This is represented as HCO3. And a normal level is about 22 to 26 milliequivalents per liter. So in respiratory acidosis, you can have a normal bicarb level. If this was the case, that would mean that you have no compensation going on. So it would be uncompensated. or if we had partial compensation going on, that bicarb level would be greater than 26 because a level that is greater than 26 on that high side is considered alkaline, and a level less than 22 is considered acidic. So if we have acidosis going on, our body's... in an acid state. So to help compensate our bicarb can come in because it is a base and it can help put itself on the alkaline side by reserving more bicarb like our kidneys retaining more bicarb. So hopefully becoming more alkaline, this will help that pH to increase a little bit and get out of that acidic range. Therefore, with this bicarb, our kidneys can play a role with helping conserve some of that bicarb and excrete some of those hydrogen ions so we can get that pH normalized. So we just talked about what arterial blood gases are going to look like on a patient with respiratory acidosis. Now let's actually solve an ABG problem. So we're going to be working this ABG problem with the tic-tac-toe method. And this particular problem actually comes from my ABG workbook I just released that has a lot of practice problems and cheat sheet style notes to help you understand these acid base imbalances. So here with this problem, we have a patient who has a blood pH of 7.26. We have a PaCO2 of 47. and a bicarb hc03 of 28. So first thing what we're going to do is set up our tic-tac-toe grid. We have acid over there on the left, we have normal in the middle, and then base here on the right. First thing what we want to do is we want to analyze that blood pH. Normal was 7.35 to 7.45. We have 7.26. So that's on the acid side. So we're going to put pH under acid. Now let's look at the PaCO2. It's 47. Normal is 35 to 45. This is on the high side. It's acidic. So we're going to put it under acid. So PaCO2 under there. And then lastly, let's look at that bicarb, the HCO3. It is 28. A normal is 22 to 26. So this is on that basic alkaline side. So we're going to put HCO3 under base. So what we're looking for is a vertical three in a row. Do we have one? We do. We have it. with the acid the ph and the pa co2 which represents our respiratory system so when we put all that together we get respiratory acidosis so we need to determine do we have compensation going on first we can say do we have full compensation the answer is no we do not whenever you use the tic-tac-toe method how you can tell is that you won't have any vertical three in a row and then you look at that blood ph is it normal it is not normal it is acidic so we can go ahead roll out full compensation. But now we have to determine do we have uncompensation or do we have partial? So let's look at the bicarb because we've established we have respiratory acidosis. So is there other system or metabolic system trying to help us out by bringing up that blood pH? Let's see. It is on the basic side, it's alkaline. So it has thrown itself into an abnormal range and hoping to make by being more basic, by balancing out the acidicness that we have going on in our body. But it hasn't. accomplished it yet fully so we don't have full compensation like we've already said but we have partial compensation Now you may be wondering how would I know if it was uncompensated? It would be uncompensated if that bicarb was normal within that 22 to 26 range because it's not trying to do anything so we would say was uncompensated. Now let's look at the signs and symptoms of respiratory acidosis. So a big thing that you're going to see with these patients is that they are going to have some neuro status changes where before they may have been alert and oriented but all of a sudden you're noticing that they're getting confused. They're not responding to you properly or while you're actually talking to them they're falling asleep so they're getting drowsy and they can report a headache. Plus, they're going to be hypoxic where they have low oxygen in their blood. And that goes back to how we were talking about with the patho. Because of how they're breathing, let's say that their respiratory rate has slowed down, they're not taking in a lot of oxygen. Or if they have damage to their alveolar sacs, we're not having the gas exchange occurring properly where the oxygen is crossing over into the blood. So we're dropping those. oxygen levels. And because we're dropping our oxygen levels, our body is going to sense this. So it's going to increase that heart rate in hopes of trying to get more oxygen throughout our body because it desperately needs it. Plus they can have a low blood pressure. Now in clinical practice, whenever I've seen patients with respiratory acidosis, I have noticed the neuro changes and the hypoxia as one of the biggest signs that tip me off that we might have an acid-base imbalance. For example, I had a patient come back from surgery and the patient before they left for surgery was alert, oriented, normal and whenever they came back, you know, I knew they were gonna be a little bit drowsy but as they were supposed to be coming off the sedation and recovering, they were starting to progressively get worse. They were getting confused, didn't really know where they were. In addition, while they were talking to me, they would just completely just nod off and fall asleep and it was very just outwardly told me something was going wrong. And then whenever I had them on their O2 sat monitor, their oxygen was just plummeting downwards. So notify the doctor, got an arterial blood gas, and yes, the patient was in respiratory acidosis. So really pay attention to that neuro status and their oxygen status if they have an O2 monitor. Now let's talk about our role as a nurse where we're providing care to a patient with respiratory acidosis. So we've established that these patients are going to have a low oxygen level because we're retaining carbon dioxide, we have issues with ventilation, gas exchange. So the doctor may order us to administer oxygen. Now with this, you want to be really careful with what patients you're administering oxygen to and how much. So look at your patient's health history because as we were talking about in our mnemonic, that last part, when we were talking about patients who have COPD, whenever a patient has chronic COPD, they are in this... chronic state of acidosis because they are retaining co2 and their body has actually compensated for this and has become used to these high co2 levels so a low oxygen level actually guides their respiratory function so you want to be really careful that you don't go too high with our oxygen levels because it could decrease their breathing rate In addition, whenever we have a patient with respiratory acidosis, we want to make sure we are paying attention to their respiratory status. How are they breathing? What's their rate? And we want to look at their neuro status because again, as I was talking about with signs and symptoms, that is one of the most subtle changes that I have seen whenever a patient starts to experience this condition. Plus, if your patient, let's say has pneumonia or they have some type of issue going on with gas exchange. Coughing and deep breathing using that incentive spirometer can help improve gas exchange so we want to educate the patient on that this and how to do it and if your patient has a lot of fluid in the lungs suctioning could be helpful along with providing mouth care because studies have shown that the bacteria in our mouth if it gets down into our lungs it could lead to pneumonia so we want to make sure that we're routinely cleaning that mouth from those secretions. And bronchodilators can be beneficial. So administering a breathing treatment can go in there, dilate those airways so we can improve gas exchange, and holding any medications that could decrease their respiratory rate. So if you have a patient with respiratory acidosis, go look at their medication history or their what they're currently receiving and ask yourself, is there anything in this list that could be decreasing their breathing rate? We don't want to give that to them right now. And we want to make sure that we're monitoring their electrolytes because whenever acidosis presents, it can affect potassium levels because it will cause potassium to leave the inside of the cell and go to the outside of the cell, the extracellular compartment, which is our blood plasma, which could lead to hyperkalemia. And if we get hyperkalemia, this can affect our heart, causing dysrhythmia. So we want to make sure we're watching the ECG as well. And then lastly, if the patient's CO2 levels are getting really too high, they may need some help blowing off that carbon dioxide. So they may be intubated so they can get mechanical ventilation where we can actually decrease those CO2 levels. So you want to help get your patient prepped for that. Okay, so that wraps up this review over respiratory acidosis. And don't forget to check out the other videos in this series.

Whenever you're breathing, you're breathing in oxygen and you're breathing out carbon dioxide, and you've got to get rid of that carbon dioxide because if you don't, it's going to lower your blood pH. So any conditions that lower our breathing rate, where it causes us to breathe too slow, like bradypnea, and this is a respiratory rate less than 12 breaths per minute in an adult. Also, if we have damage to those gas exchange structures in our lungs, like those alveolar sacs, where we're not having that proper exchange of oxygen and carbon dioxide we can for sure retain too much carbon dioxide and drop our blood pH in addition if we have an issue with the muscles that aid in the respiratory rate for instance our diaphragm is too weak and we start getting into those neuromuscular disorders that will affect our ability to breathe. So to help us really understand this condition, let's go back and talk about carbon dioxide and gas exchange.

So with respiratory acidosis, we have established that we have retained carbon dioxide levels. So what is carbon dioxide anyways? Well, carbon dioxide is a waste product that is created from cell metabolism. And your body needs this certain little range of about 35 to 45 millimeters of mercury.

too much of it is bad and too little of it is bad. So here in acidosis, we're talking about having a level greater than 45 because we're retaining way too much CO2. So your body must deal with this carbon dioxide.

And what it does is it takes it, dumps it into the blood and your blood will take it up through the heart to the lungs where gas exchange is going to occur. And it's really cool how gas exchanges in your body because whenever you're breathing in, you're breathing in oxygen, that oxygen goes in through your nose, down into your lungs, and then it's going to cross over into these little alveoli sac and it's going to go into your blood. And your blood's going to take it, replenish all your organs with oxygen that it desperately needs. Now that waste product that's built up in your blood, that carbon dioxide, it's going to cross over and it's going to go through the alveolar sac, but it's going to go up through your lungs and you're going to exhale it. And your respiratory rate can adjust itself.

It can increase its rate or decrease its rate depending on how much CO2 it needs to get rid of. Now let's back up to whenever CO2 is being created from the cell metabolism. So it's created, it's that waste product.

So your body takes it, dumps it into the blood. Now when CO2 enters the blood, it's going to find some water molecules and it's actually going to bind with water. So CO2 and H2O, they bind together. When they bind together, we get the creation of carbonic acid. Carbonic acid is a very weak acid.

It doesn't stay together for too long So whenever we get the formation of it, it actually breaks apart into like hydrogen ions and bicarb I want you particularly pay attention to hydrogen ions The hydrogen ions is the thing that really affects our blood pH because whenever we measure blood pH We're measuring the concentration of hydrogen ions And hydrogen ions are acidic. So if you have too many hydrogen ions, that is going to drop your blood pH. And remember, a normal blood pH is 7.35 to 7.45. So it's extremely narrow.

So whenever you have too many hydrogen ions hanging out in the body, it's going to make your blood pH less than 7.35. It dropped it. But if we don't have a lot of hydrogen ions, we are going to actually increase our blood pH. It's going to be greater than 7.45. But here in acidosis, we have way too many hydrogen ions on board.

So we have a blood pH of less than 7.35. So you may be thinking, what's the big deal about carbon dioxide and hydrogen ions? Well, they're extremely related because whenever we get carbon dioxide binding with water, we get the creation of that weak acid, carbonic acid. Since it's... it's a weak acid it breaks apart whenever it breaks apart we get hydrogen ions so if we have a lot of carbon dioxide in our body let's say we have a patient who has a neuromuscular disease they're not breathing very well the respiratory rate is extremely slow what are they retaining a lot of carbon dioxide so we have a lot of carbon dioxide hanging out in the blood that means it's binding with water when it binds with water we get carbonic acid being formed which is going to start giving us a lot of hydrogen ions in our blood when we have a lot of hydrogen ions in our blood that drops our blood pH and makes it acidic, which is why we have respiratory acidosis.

So now let's look at some conditions that can lead us to to retain carbon dioxide because we've established that we have a depression in lung ventilation. Either we're breathing too slowly, there's damage to the gas exchange structures in our lungs, or our respiratory muscles are just too weak to help us exhale this carbon dioxide. So to remember those causes, let's remember the word depress. D is for drugs such as opioids and sedatives. Those are really big ones.

They depress your respiratory rate, cause your patient not to breathe very fast. So whenever you do give these medications you've definitely going to monitor your patient's breathing rate. Also diseases this goes along with this D diseases of the neuromuscular system such as Guillain-Barre syndrome with that we start to get paralysis that will extend up to our respiratory system which will cause your patient not to be able to use the respiratory muscles to breathe which again will cause us to retain CO2.

E is for edema particularly pulmonary edema this is where we have fluid in the lungs whenever we have fluid hanging out around those alveolar sacs, it's going to prevent proper gas exchange from occurring, which also happens with the P of our mnemonic, pneumonia. And then we have R for the respiratory center of the brain is damaged. This can occur in patients who have experienced a stroke.

So your breathing rate is really controlled a lot in your brain and if someone's had ischemia to particular parts of their brain that control the respiratory rate, it can affect how well they're able to ventilate. E is for emphysema. This is where the patient has over inflated alveoli sacs.

So we're impairing gas exchange. S is for spasms of the bronchial tubes, like an asthma, again, impairing gas exchange. And then lastly is sac elasticity of alveolar sacs are damaged. And these are in patients who experience COPD.

And in patients who have COPD, they are known as being CO2 retainers because we are not having that proper gas exchange. in their sac. So one thing you want to remember about patients who have chronic COPD, meaning they've had this condition for a very long time, they are in this chronic state of acidosis because they retain CO2.

And because they've been retaining the CO2 for a long time, their body has adjusted to this. So we have to be extremely careful with the amount of oxygen that we administer to these patients, which we're going to talk about in nursing interventions. Now let's talk about how you can know if your patient is experiencing respiratory acidosis. One big way is to look at those arterial blood gas values. So let's quickly go over that.

So whenever we're talking about respiratory acidosis, the first thing you want to look at is that blood pH. A normal blood pH, as I said before, is 7.35 to 7.45 and again that was the measurement of those hydrogen ion concentration in our blood. So we have a very acidic blood level so what do you think that blood pH is going to be in respiratory acidosis? It's going to be less than 7.35. Then we want to look at that PaCO2 level. That is the amount of carbon dioxide in the arterial blood.

A normal level is 35 to 45 millimeters of mercury. So with this condition, we have established that we are retaining carbon dioxide. So what is our level going to be in respiratory acidosis? It's going to be greater than 45 millimeters of mercury. And then another thing we want to look at is the bicarb.

This is represented as HCO3. And a normal level is about 22 to 26 milliequivalents per liter. So in respiratory acidosis, you can have a normal bicarb level. If this was the case, that would mean that you have no compensation going on.

So it would be uncompensated. or if we had partial compensation going on, that bicarb level would be greater than 26 because a level that is greater than 26 on that high side is considered alkaline, and a level less than 22 is considered acidic. So if we have acidosis going on, our body's...

in an acid state. So to help compensate our bicarb can come in because it is a base and it can help put itself on the alkaline side by reserving more bicarb like our kidneys retaining more bicarb. So hopefully becoming more alkaline, this will help that pH to increase a little bit and get out of that acidic range. Therefore, with this bicarb, our kidneys can play a role with helping conserve some of that bicarb and excrete some of those hydrogen ions so we can get that pH normalized. So we just talked about what arterial blood gases are going to look like on a patient with respiratory acidosis.

Now let's actually solve an ABG problem. So we're going to be working this ABG problem with the tic-tac-toe method. And this particular problem actually comes from my ABG workbook I just released that has a lot of practice problems and cheat sheet style notes to help you understand these acid base imbalances. So here with this problem, we have a patient who has a blood pH of 7.26.

We have a PaCO2 of 47. and a bicarb hc03 of 28. So first thing what we're going to do is set up our tic-tac-toe grid. We have acid over there on the left, we have normal in the middle, and then base here on the right. First thing what we want to do is we want to analyze that blood pH. Normal was 7.35 to 7.45.

We have 7.26. So that's on the acid side. So we're going to put pH under acid.

Now let's look at the PaCO2. It's 47. Normal is 35 to 45. This is on the high side. It's acidic.

So we're going to put it under acid. So PaCO2 under there. And then lastly, let's look at that bicarb, the HCO3. It is 28. A normal is 22 to 26. So this is on that basic alkaline side.

So we're going to put HCO3 under base. So what we're looking for is a vertical three in a row. Do we have one?

We do. We have it. with the acid the ph and the pa co2 which represents our respiratory system so when we put all that together we get respiratory acidosis so we need to determine do we have compensation going on first we can say do we have full compensation the answer is no we do not whenever you use the tic-tac-toe method how you can tell is that you won't have any vertical three in a row and then you look at that blood ph is it normal it is not normal it is acidic so we can go ahead roll out full compensation. But now we have to determine do we have uncompensation or do we have partial? So let's look at the bicarb because we've established we have respiratory acidosis.

So is there other system or metabolic system trying to help us out by bringing up that blood pH? Let's see. It is on the basic side, it's alkaline.

So it has thrown itself into an abnormal range and hoping to make by being more basic, by balancing out the acidicness that we have going on in our body. But it hasn't. accomplished it yet fully so we don't have full compensation like we've already said but we have partial compensation Now you may be wondering how would I know if it was uncompensated?

It would be uncompensated if that bicarb was normal within that 22 to 26 range because it's not trying to do anything so we would say was uncompensated. Now let's look at the signs and symptoms of respiratory acidosis. So a big thing that you're going to see with these patients is that they are going to have some neuro status changes where before they may have been alert and oriented but all of a sudden you're noticing that they're getting confused.

They're not responding to you properly or while you're actually talking to them they're falling asleep so they're getting drowsy and they can report a headache. Plus, they're going to be hypoxic where they have low oxygen in their blood. And that goes back to how we were talking about with the patho.

Because of how they're breathing, let's say that their respiratory rate has slowed down, they're not taking in a lot of oxygen. Or if they have damage to their alveolar sacs, we're not having the gas exchange occurring properly where the oxygen is crossing over into the blood. So we're dropping those.

oxygen levels. And because we're dropping our oxygen levels, our body is going to sense this. So it's going to increase that heart rate in hopes of trying to get more oxygen throughout our body because it desperately needs it. Plus they can have a low blood pressure.

Now in clinical practice, whenever I've seen patients with respiratory acidosis, I have noticed the neuro changes and the hypoxia as one of the biggest signs that tip me off that we might have an acid-base imbalance. For example, I had a patient come back from surgery and the patient before they left for surgery was alert, oriented, normal and whenever they came back, you know, I knew they were gonna be a little bit drowsy but as they were supposed to be coming off the sedation and recovering, they were starting to progressively get worse. They were getting confused, didn't really know where they were.

In addition, while they were talking to me, they would just completely just nod off and fall asleep and it was very just outwardly told me something was going wrong. And then whenever I had them on their O2 sat monitor, their oxygen was just plummeting downwards. So notify the doctor, got an arterial blood gas, and yes, the patient was in respiratory acidosis.

So really pay attention to that neuro status and their oxygen status if they have an O2 monitor. Now let's talk about our role as a nurse where we're providing care to a patient with respiratory acidosis. So we've established that these patients are going to have a low oxygen level because we're retaining carbon dioxide, we have issues with ventilation, gas exchange.

So the doctor may order us to administer oxygen. Now with this, you want to be really careful with what patients you're administering oxygen to and how much. So look at your patient's health history because as we were talking about in our mnemonic, that last part, when we were talking about patients who have COPD, whenever a patient has chronic COPD, they are in this...

chronic state of acidosis because they are retaining co2 and their body has actually compensated for this and has become used to these high co2 levels so a low oxygen level actually guides their respiratory function so you want to be really careful that you don't go too high with our oxygen levels because it could decrease their breathing rate In addition, whenever we have a patient with respiratory acidosis, we want to make sure we are paying attention to their respiratory status. How are they breathing? What's their rate?

And we want to look at their neuro status because again, as I was talking about with signs and symptoms, that is one of the most subtle changes that I have seen whenever a patient starts to experience this condition. Plus, if your patient, let's say has pneumonia or they have some type of issue going on with gas exchange. Coughing and deep breathing using that incentive spirometer can help improve gas exchange so we want to educate the patient on that this and how to do it and if your patient has a lot of fluid in the lungs suctioning could be helpful along with providing mouth care because studies have shown that the bacteria in our mouth if it gets down into our lungs it could lead to pneumonia so we want to make sure that we're routinely cleaning that mouth from those secretions.

And bronchodilators can be beneficial. So administering a breathing treatment can go in there, dilate those airways so we can improve gas exchange, and holding any medications that could decrease their respiratory rate. So if you have a patient with respiratory acidosis, go look at their medication history or their what they're currently receiving and ask yourself, is there anything in this list that could be decreasing their breathing rate?

We don't want to give that to them right now. And we want to make sure that we're monitoring their electrolytes because whenever acidosis presents, it can affect potassium levels because it will cause potassium to leave the inside of the cell and go to the outside of the cell, the extracellular compartment, which is our blood plasma, which could lead to hyperkalemia. And if we get hyperkalemia, this can affect our heart, causing dysrhythmia.

So we want to make sure we're watching the ECG as well. And then lastly, if the patient's CO2 levels are getting really too high, they may need some help blowing off that carbon dioxide. So they may be intubated so they can get mechanical ventilation where we can actually decrease those CO2 levels. So you want to help get your patient prepped for that. Okay, so that wraps up this review over respiratory acidosis.

And don't forget to check out the other videos in this series.

Transcript for:Understanding Respiratory Acidosis Symptoms

Transcript for:
Understanding Respiratory Acidosis Symptoms