Nursing Care Plan Respiratory Acidosis (Primary Carbonic Acid Excess)

CARE SETTING

This condition does not occur in isolation, but rather is a complication of a broader health problem/disease or condition for which the severely compromised patient requires admission to a medical-surgical or subacute unit.

RELATED CONCERNS

1. Plans of care specific to predisposing factors/disease or medical condition, e.g.:


2. Cerebrovascular accident (CVA)/stroke


3. Chronic obstructive pulmonary disease (COPD) and asthma


4. Craniocerebral trauma (acute rehabilitative phase)


5. Eating disorders: obesity


6. Alcohol: acute withdrawal


7. Spinal cord injury (acute rehabilitative phase)


8. Surgical intervention


9. Ventilatory assistance (mechanical)

OTHER CONCERNS

1. Fluid and electrolyte imbalances


2. Metabolic acidosis


3. Metabolic alkalosis


4. Patient Assessment Database


5. Dependent on underlying cause. Findings vary widely.

ACTIVITY/REST

May report: 
Fatigue, mild to profound

May exhibit: 
Generalized weakness, ataxia/staggering, loss of coordination (chronic), to stupor

CIRCULATION

May exhibit: 

1. Low BP/hypotension with bounding pulses, pinkish color, warm skin (reflects vasodilation of severe acidosis)


2. Tachycardia, irregular pulse (other/various dysrhythmias)


3. Diaphoresis, pallor, and cyanosis (late stage)

FOOD/FLUID

May report: 
Nausea/vomiting

NEUROSENSORY

May report: 

1. Feeling of fullness in head (acute—associated with vasodilation)


2. Headache, dizziness, visual disturbances

May exhibit: 

1. Confusion, apprehension, agitation, restlessness, somnolence; coma (acute)


2. Tremors, decreased reflexes (severe)

RESPIRATION

May report: 
Shortness of breath; dyspnea with exertion


May exhibit: 

1. Respiratory rate dependent on underlying cause, i.e., decreased in respiratory center depression/ muscle paralysis; otherwise rate is rapid/shallow


2. Increased respiratory effort with nasal flaring/yawning, use of neck and upper body muscles


3. Decreased respiratory rate/hypoventilation (associated with decreased function of respiratory center as in head trauma, oversedation, general anesthesia, metabolic alkalosis)


4. Adventitious breath sounds (crackles, wheezes); stridor, crowing

TEACHING/LEARNING

1. Refer to specific plans of care reflecting individual predisposing/contributing factors.


2. Discharge plan


3. DRG projected mean length of inpatient stay: 4.9 days


4. May require assistance with changes in therapies for underlying disease process/condition


5. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. 
   ABGs: PaO2: Normal or may be low. Oxygen saturation (SaO2) decreased.


2. PaCO2: Increased, greater than 45 mm Hg (primary acidosis).


3. Bicarbonate (HCO3): Normal or increased, greater than 26 mEq/L (compensated/chronic stage).


4. Arterial pH: Decreased, less than 7.35.


5. 
   Electrolytes: Serum potassium: Typically increased.


6. Serum chloride: Decreased.


7. Serum calcium: Increased.


8. Lactic acid: May be elevated.


9. 
   Urinalysis: Urine pH decreased.


10. Other screening tests: As indicated by underlying illness/condition to determine underlying cause.

NURSING PRIORITIES

1. Achieve homeostasis.


2. Prevent/minimize complications.


3. Provide information about condition/prognosis and treatment needs as appropriate.

DISCHARGE GOALS

1. Physiological balance restored.


2. Free of complications.


3. Condition, prognosis, and treatment needs understood.


4. Plan in place to meet needs after discharge.