Lecture Notes: Respiratory Acidosis

Overview

• Sarah from Register Nurse RN.com discusses respiratory acidosis, part of a series on acid-base imbalances.
• Previous video focused on respiratory alkalosis.
• Key topics:
  • Pathophysiology
  • Causes (mnemonic)
  • Signs and Symptoms
  • Nursing Interventions
  • Arterial Blood Gas (ABG) analysis using the Tic Tac Toe method.

Pathophysiology

• Respiratory Acidosis: Build-up of carbon dioxide (CO2) in the blood causing blood pH to become acidic.
• Normal breathing takes in oxygen and expels CO2.
• Disruption in breathing (e.g., depressed respirations) leads to CO2 retention.
• CO2 buildup causes blood to become acidic (pH < 7.35).
• Compensation by kidneys releasing bicarbonate (HCO3-) to increase pH.
• Normal Values:
  • pH: 7.35 - 7.45
  • pCO2: 35 - 45 mmHg
  • HCO3-: 22 - 26 mEq/L

Causes

• Mnemonic: DEPRESS
  • Drugs: Opioids (e.g., morphine, fentanyl), sedatives cause respiratory depression.
  • Edema: Lung fluid (e.g., pulmonary edema) affects gas exchange.
  • Pneumonia: Excess mucus and pus affect gas exchange.
  • Respiratory center damage: Brain injuries impair breathing.
  • Emboli: Blockages (e.g., fat, air) prevent CO2 expulsion.
  • Spasms: Asthma causes bronchial spasms, blocking airflow.
  • Sac elasticity damage: COPD/emphysema from smoking damages alveoli.

Signs and Symptoms

• Gradual onset of neuro decline: confusion, drowsiness.
• Respiratory depression: < 12 breaths per minute.
• Low blood pressure.

Nursing Interventions

• Administer oxygen; encourage deep breathing and coughing.
• Bronchodilators for asthma.
• Hold sedative/narcotic medications.
• Monitor potassium (K+) levels due to risk of hyperkalemia.
• Antibiotics and incentive spirometry for pneumonia.
• Possible intubation if CO2 > 50 mmHg.

ABG Analysis Using Tic Tac Toe Method

• Example Problem:
  • pCO2 = 48 mmHg (acidic)
  • pH = 7.25 (acidic)
  • HCO3- = 27 mEq/L (basic)
• Steps:
  1. Set up Tic Tac Toe grid: Acid | Normal | Base
  2. Place values: pCO2 and pH under Acid, HCO3- under Base.
  3. Identify respiratory issue (Tic Tac Toe in Acid column).
  4. Determine compensation: Partially compensated (HCO3- elevated but pH not normal).

Conclusion

• Take the quiz on registerednursern.com to test knowledge on respiratory alkalosis and acidosis.
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