Respiratory Acidosis: Causes and Nursing Interventions

00:00 Hi.

00:01 Now we're ready to go over the most common causes in nursing interventions for the Big 4 imbalances: respiratory acidosis and alkalosis, metabolic acidosis and alkalosis.

00:15 Let's start with respiratory acidosis.

00:17 Now this is the one you're gonna see most often in your practice and its cause is from an increase in CO2.

00:23 So you'll look for things like pulmonary disease, the patient may have a history of COPD, they might be asthmatic and having an attack, they might have pneumonia, because remember those alveoli are filled with gunks so it's really hard for the lungs to exchange CO2 and O2 efficiently.

00:39 Possibly pulmonary edema, so instead of being filled with infection, the lungs are filled with fluid which also makes it difficult for them to exchange CO2 for O2.

00:48 and just plain old respiratory failure.

00:51 Respiratory acidosis is a sign that the lungs are not functioning at their normal level, so what do we do? Well we got to get rid of the CO2 and improve respiration.

01:03 So we've got a couple of options.

01:05 We can look at medications.

01:07 First of all bronchodilators, right? we use those for COPD patients, asthma patients, all types of respiratory patients.

01:14 Bronchodilators are usually meds that are inhaled either with a breathing treatment or an MDI, they're taken into their lungs and will open up those airways.

01:23 Also, we can use steroids that helps us deal with some the inflammatory things that could be going on.

01:29 BiPAP is a type of mask in forced ventilation.

01:34 So when we say BiPAP, first of all I'll refer it to like a CPAP machine that you may have seen a patient with this.

01:40 A CPAP is a mask that usually goes over the nose and it has a long hose that goes to a small machine.

01:47 It has a constant centimeter of pressure going on.

01:50 So it's like, think about taking a hair dryer and hooking it to the hose, it's constant pressure forcing the airways to remain open.

01:59 Those people with obstructive sleep apnea, their airways shut down when they're sleeping.

02:04 BiPAP is a little more technical because instead of having just having just at constant pressure, it has one pressure when the patient is inhaling but it has a lower pressure when the patient is exhaling so they don't have to work as hard to breathe out.

02:19 Now we put patients on BiPAP who are on pretty severe respiratory distress but they're still able to breathe on their own.

02:25 We try to avoid having to put the patient on a ventilator.

02:29 So when you see a patient on a bipap, they're in pretty serious trouble but we're hoping to avoid having to intubate them and put them on mechanical ventilator.

02:38 If we do have them on the ventilator, the physician will work with what's gonna be the right amount of tidal volume, the size of the breath and the rate depending on what the patient's ABGs are.

02:48 So those are our options for treatment.

02:50 To get rid of CO2 and improve respiration we can try meds, we can try special oxygen support like BiPAP or with the last ditch is ventlator - we try to avoid that if we can but some patients absolutely need it.

03:04 Now what does the body do the respond? Well it's respiratory acidosis so we look at the opposite system which is the metabolic system.

03:12 We're gonna need that system to increase bicarb to bring that pH back up to a normal range.