hey everyone it's Sarah with register nurse rn.com and in this video I'm going to be going over respiratory acidosis I'm actually doing a series on acid and base imbalances so if you're studying that right now be sure to check out those videos now in the previous video I went over respiratory alkalosis and showed you the differences how it affects the body what to remember for the inlex exam in your nursing lecture exam so be sure to check out that video so in this video what I'm going to do is I am going to simp simplify the pathophysiology with what's going on in respiratory acidosis I'm going to give you a pneumonic on how to remember the causes and we're going to go over signs and symptoms nursing interventions and then I'm going to take it a step further and work a arterial blood gas problem with a patient that's in respiratory acidosis and show you how to set the problem up using the Tic Tac Toe method and how you can determine if it's compensated not compensated and things like that now after this video be sure to go to my website register nurse ran.com and take the free quiz that will test your knowledge on respiratory alkalosis and respiratory acidosis a card should be popping up or a link in the description below and you can access that free quiz so let's get started with the pathophysiology because in order to truly understand what's going on in the body during respiratory acidosis you have to know what is being affected in the lungs then the cause is will make sense it'll literally be like Common Sense it'll click in your brain so let's simplify this okay whenever you breathe you take in oxygen through your either your nose or your mouth so the oxygen enters in through there the ferx area then it goes down through the Linx which is your throat down through the trachea which branches off into the bronchus which then branches off into the bronchials and then to the avolar Sachs now the avolar sax is where everything the gas exchanges are happening and what happens is that oxygen enters in and carbon dioxide comes out because carbon dioxide is that buildup of whatever your body has left over and you're going to breathe that out so the carbon dioxide will go backwards of how the oxygen entered and it will exit through your nose or through your mouth now in those avolar sacs what's happening is oxygen is going into those sacks carbon dioxide's coming out Oxygen's attaching to the red blood cells the red blood cells are transporting it throughout your body to your organs to your tissues and giving it fresh supply of oxygen but when youever you have something that's interrupting the breathing either you have depressed respirations where um maybe you gave them an opioid they have too much drugs involved or something like that it causes depressed breathing they're not expelling the CO2 so anything that's affecting the the body's ability to breathe normally because in an adult normal respirations are 12 to 20 breaths per minute so if it's less than 12 they're not breathing appropriately so they're not expelling the CO2 and we'll go over the causes a lot more in depth and your diaphragm which is below your lungs plays a role in this as well so if you have anything that affects the diaphragm which in neuromuscular dis diseases which we'll go over here in a second that can affect because whenever you breathe in diaphragm goes up helps squeeze that air out squeeze that carbon dioxide out and then it relaxes so if you have anything affecting that that can cause problems so whenever you have the buildup of the CO2 this causes your blood pH to become acidic and here are some key Concepts that you need to remember for this disease process that your teachers will probably ask you on exams or on the inlex so let's look at these key Concepts okay overall respiratory acidosis is the buildup of carbon dioxide in the blood and it's mainly due to Brady penia which Brady means slow penia deals with respiration so you're having really slow respirations where you're not getting rid of that carbon dioxide and what happens carbon dioxide's in your body there's too much of it and your body's like oh we do not like this so your blood pH because of that carbon dioxide causes the blood to become very acid it and it will become a pH of less than 7.35 and you remember you have a lot of Co carbon dioxide CO2 hanging around so the levels are going to increase so anything greater than 45 now whenever this happens in the body remember your body loves homeostasis it loves to keep everything nice and equal so it'll use other systems of the body to try to regulate this out so the kidneys will act actually start to release bicarbonate hc3 and you will start to see these levels rise and the reason that they're trying to rise is to help decrease that pH help to increase that pH level to make it normal because right now it's decreased and they want to increase it so by releasing the bicarb it will help hopefully increase it and any levels greater than 26 if you see that in a blood gas that's what your body trying to do is trying to compensate with that now you want to memorize these live values you seriously just want to commit these to memory so you can understand what's going on because whenever you're solving blood gas levels or anything like that you're going to have to refer back into your memory hey what's normal what's acidotic what's not so let's go over it real fast a normal pH level is 7.35 to 7.45 a normal P2 level your carbon dioxide level is 35 to 45 how I remember these two remember the fives at the end 7.35 to 7.45 and then again P2 is 35 to 45 you see the three and the five and the four and the five and then the hc3 which is your B carb the normal is 22 to 26 and then I just have this little chart this helps me remember it if it's if it's an acid or not an acid and for pH anything acid right here anything less than 7.35 is an acid anything greater than 7 .45 is a base alkalic um pco2 is the opposite so the high number anything greater than 45 is acidotic and anything less than 3 35 is um alkalotic and bicarb anything less than 22 is acidotic and anything greater than 26 is alkalotic so just try to remember that cuz that's going to help us whenever we try to solve our blood gases and I'm going to show you how to do that using the Tic Tac Toe method okay so let's go over the causes of respiratory acidosis okay remember this pneumonic the word depressed depress breathing because that is one of the big reasons why your body is becoming acidotic why you're having that buildup of CO2 so remember the word depress and each word will correlate with what's what the cause is okay first drugs any drugs such as opiates which are morphine fitel questions like to throw that out at you say the patient overdosed on morphine or Fenty or something like that or any sedative such as versed that's a lot of times given during moderate SED sedation will cause respiratory depression and remember when the patient is breathing less than 12 breaths per minute they're just barely breathing and they're not expelling that CO2 that CO2 is building up so that can cause respiratory acidosis so you want to watch patients with that also the other D diseases of the neuromuscular system I talked about this at the beginning this is the myasthenia gravis or gillium bra syndrome and this is weakness of the voluntary muscles like the diaphragm which helps to squeeze that carbon dioxide out and in these syndromes they're not working properly so they can't expel that carbon dioxide it's hanging around in there okay e edema anytime you get extra fluid in these lungs like in pulmonary edema um especially with congestive heart failure patients that fluid is hanging around those sacks and remember in the avolar Sachs we talked about how there's a gas exchange between oxygen and carbon dioxide it messes up those Sachs those Sachs can't open and close properly so it just starts to retain the CO2 so that can cause it next pneumonia almost the same concept as the fluid with pneumonia you have that excessive mucus production around those sacks which is and your sacks are filled with pus and fluid and they're not able to even properly inflate and deflate so you have that buildup of that carbon dioxide that your body is trying to get rid of so pneumonia can cause it and the rest next one the r respiratory center of the brain is damaged okay in your brain you have the medulla and the ponds area that is responsible for your respiratory center now if you have any traumatic brain injury or you have a stroke that affect that affects that area that can affect the way that the patient breathes how they take breaths so they can develop respiratory acidosis okay e for imali and this can block the pulmonary artery or the branches of the lungs depending on where the imali left the body this can be a fat emili air emilii um it can go into the branches and block off so if you have something blocking off that Branch whenever you're trying to get that oxygen into that AV AR Sac it can't go so if it can't go carbon dioxide can't go and carbon dioxide is just going to stay and hang out in the blood so that can cause problems so anything blocking in the lungs can cause those issues and the other s spasms of the bronchial tubes this is asthma whenever a patient has an asthma attack these bronchial tubes start spasming which is blocking again just like the Emi the gas exchange the and what is going to happen is at that patient whenever they're having that they're not taking those nice deep breaths and they're building up that CO2 okay and the last s this is another this is another important s um this what is happening with this is that you have the sac elasticity of the avolar sac is damaged and what's happened is that this Sac is damaged either because of a disease process called chronic obstructive pulmonary disease COPD or empyema and what happens is whenever this sack is damaged it's usually due to smoking so that's why healthc care providers really encourage patients to quit smoking because they take in the smoke the smoke goes through the lungs and it damages those sacks and what happens is that the sack becomes damaged and it doesn't properly deflate so whenever it doesn't properly deflate it retains CO2 that's why you'll hear patients who are COPD patients their CO2 retain because that sack is not deflating properly and it's keeping all that carbon dioxide now let's look at the signs and symptoms the nursing interventions and work an arterial blood gas problem and show you what a patient with respiratory acidosis would look like okay how does your patient present and look whenever they're in respiratory acidosis normally this is going to start to happen gradually and you'll start to see a neuro decline neuro changes all of a sudden they'll become confused maybe not answer your questions appropriately and they'll just KN off and fall asleep I remember I um had a patient one time he was starting to go into this and he we would be talking and all of a sudden he would literally fall asleep right in front of my face and we checked his ABG levels and sure enough he was in respiratory acidosis so really watch your neuro part um also the patient may say I just have a headache and then they're confused and they're drowsy that should send a red flag too and of course respiratory depression they're going to have a really slow respiratory rate less than 12 breaths per minute so make sure as a nurse you're counting those respirations appropriately and monitoring those and have low blood pressure as well okay so what do you typically do for a patient who is in respiratory acidosis um of course you'll contact the doctor they'll give you a lot of orders on what to do but typically this is what's going to happen you're going to administer oxygen and if the patient is alert enough you're going to encourage coughing and deep breathing helping them take those full deep breaths in and out cuz remember we want them to expel that carbon dioxide that's buil up so we want them to be taking normal breaths at a rate of at least 12 to 20 breasts per minute and if the patient has been having asthma attacks COPD or empyema a respiratory treatment might be good so get respiratory therapy involved to give them a treatment help with that Bronco dilators because remember in asthma you have Bronco constriction and that'll help open them up and so they can breathe proper properly and have that gas exchange go so they can expel that carbon dioxide and also if your patient is in this a lot of times um narcotics will cause this morphine fentel even lur tabs things like that anything that's an opiate or a sedative like Valium things like that can cause respiratory depression so you'll want to hold those medications don't want to give those because it will make it worse now remember this this is very very very important watch potassium levels with respiratory acidosis we talked about this in the hyperemia fluid and electrolyte series um because this will cause an increase of your pottassium levels anything greater than 1.5 so you want to watch that whenever you get hyperemia involved you start you need to watch for any EKG changes that's associated with hyperemia which are tall p waves the flat p waves or a prolonged QRS and PR interval so watch for any of that now if the patient has pneumonia you'll be giving um antibiotics encourage incentive spirometer usage so they can Brea in pop those sacks open which have the mucus and the PFF in them so you can help gas exchange and um if it's really really bad um if it the CO2 level whenever you draw your blood gas if it's greater than 50 the doctor May order the patient to have endot tracheal intubation so um prepare the patient for this or if they're in respiratory distress so that is the nursing interventions for that now let's work a problem that will show you how to do a blood gas problem on a nursing exam or the inlex because this is what nursing professors love to ask you whenever they're going over acid base imbalances they're going to throw some ABG values out out at you and they're going to give you some options and you have to decide what it is so I like to do the ABG I mean the Tic Tac Toe method whenever I'm solving ABG problems I have several two videos on where I go in depth on how to use the Tic Tac Toe method setting up your problem and solving that a card should pop up a links should be in the description as well so you can watch that video on how to do that okay so here's what the problem says patient has the following abgs a p CO2 level of 48 a pH of 7. 25 a by carb H3 level of 27 what condition is presenting so we've got to go back to our chart that you have hopefully memorized and you got to remember what's acidotic what's alkalotic and you're going to set up your Tic Tac Toe remember as a child we would play tic tac toe so just set it up with your lines name one column base one normal and I mean one acid one normal and one base now we are going to plug these values in um to whether it's an acid or a base so let's take it one by one okay p248 okay we're thinking back to our table we know that 35 to 45 is a normal P2 level and anything greater than 45 is acidotic so we're going to put P A2 here cuz it's an acid and then we're going to look at our pH okay we know that a normal pH is 7.35 to 7.45 anything less than 7.35 is an acid so we're going to put pH under acid okay we got a tic TCT toe right here is our Tic-Tac toe three in a row so we know that we are dealing with a respiratory problem that right there tells us in our tic-tac-toe another reason tic tac toe is great is because you're trying to figure out if you're dealing with a respiratory metabolic problem that's the whole issue with these abgs for a lot of students okay now we're going to look at our by carb and the the last part whenever after you get your tic tac toe the one that's in the other column you're going to be looking at that and you're going to be saying to yourself okay is this the body based on this value is this compensating fully is it partially compensating or is it not compensating at all so let's look at it our buy carb is 27 so we know a normal by carb is 22 to 26 and it's abnormal it's 27 according to that our chart it is basic so we're going to put it over here so remember at the beginning of this lecture we talked about how whenever there's a buildup of CO2 in the lungs the kidneys are going to try to fix this by releasing bicarb hc3 so the levels are going to increase abnormally why because it wants to bring that PH down and this is what we're seeing so the body is trying to compensate so we got some compensation going on here so we know we have respiratory acidosis and it's compensated but is it fully or partially compensated so this is where you've got to think okay it's 27 now what's the purpose of bicarb trying to increase the purpose is because it wants to bring that pH back to a normal level right now our is not normal it is still acidic so it's just partially compensated so if it would fully compensated the pH would be back to normal so this is respiratory acidosis partially compensated okay so that is about respiratory acidosis now be sure to take that quiz to test your knowledge on the difference between respiratory alkalosis and acidosis and thank you so much for watching and be sure to to check out my other teaching tutorials and please consider subscribing to this YouTube channel