Respiratory Acidosis Acid Base Balance Made Easy NCLEX Review | ABGs Made Easy for Nurses

Hey everyone it's Sarah with RegisteredNurseRN.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

NCLEX exam and your nursing lecture exam. So be sure to check out that video. So in this video

what I'm going to do is I'm going to simplify the pathophysiology with what's going on in

respiratory acidosis. I'm going to give you a mnemonic 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 an 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 or not compensated and things like that. Now after this video be sure

to go to my website registernursern.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 causes will make sense. It'll literally

be like common sense and 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 pharynx area then it goes down through the larynx which is your throat down through the

trachea which branches off into the bronchus which then branches off into the bronchioles

and then to the alveolar sacs. Now the alveolar sacs 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 build-up 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 alveolar sacs what's happening is oxygen is going into those

sacs, carbon dioxide is coming out, oxygen is 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 whenever you have something that's interrupting the breathing either you have

depressed respirations where 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 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 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 out 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 NCLEX. 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 bradypnea which brady means

slow penia deals with respirations. 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 acidic 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 actually start to release bicarbonate

HCO3 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's

trying to do is trying to compensate with that. Now you want to memorize these lab 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 PaCO2 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 PaCO2 is 35 to 45 you see the

three and the five and the four and the five and then the HCO3 which is your bicarb 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 alkalotic and PaCO2 is the opposite so the high number anything greater

than 45 is acidotic and anything less than 35 is alkalotic and bicarb anything less than 22

is acidotic and anything greater than 26 is alkalotic. So just try to remember that because

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 mnemonic the word depressed depressed 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 depressed and each word will correlate with what's what the cause is. Okay first drugs any

drugs such as opiates which are morphine, fentanyl questions like to throw that out at you say the

patient overdosed on morphine or fentanyl or something like that or any sedatives such as

versed that's a lot of times given during moderate 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 gilliam bray 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 especially with congestive heart failure patients that fluid is hanging around

those sacs and remember in the alveolar sacs we talked about how there's a gas exchange between

oxygen and carbon dioxide and messes up those sacs those sacs 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 sacs

which is in your sacs 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 pons 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 emboli and this can block the pulmonary

artery or the branches of the lungs depending on where the emboli left the body this can be a fat

emboli air emboli and 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 alveolar 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 emboli the

gas exchange and what is going to happen is that 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 and this what is happening with this is that you have the

sac elasticity of the alveolar 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

emphysema and what happens is whenever this sac is damaged it's usually due to smoking so that's why

health care providers really encourage patients to quit smoking because they're taking the smoke

the smoke goes through the lungs and it damages those sacs and what happens is that the sac

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 they're co2 retainers because that sac

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 nod 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 and 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 because remember we

want them to expel that carbon dioxide that's built up so we want them to be taking normal

breaths at a rate of at least 12 to 20 breaths per minute and if the patient has been having asthma

attacks COPD or emphysema a respiratory treatment might be good so get respiratory therapy involved

to give them a treatment help with that bronchodilators because remember in asthma you

have bronchoconstriction and that'll help open them up and so they can breathe properly 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 narcotics will cause this morphine fentanyl even lortabs 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 hyperkalemia fluid and electrolyte series because this will cause

an increase of your potassium levels anything greater than 1.5 so you want to watch that

whenever you get hyperkalemia involved you start you need to watch for any ekg changes that's

associated with hyperkalemia which are tall t 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

antibiotics encourage incentive spirometer usage so they can breathe in pop those sacs open which

have the mucus and the pus in them so you can help gas exchange and if it's really really bad

if the co2 level whenever you draw your blood gas if it's greater than 50 the doctor may order the

patient to have endotracheal intubation so 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 NCLEX 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 link 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 paco2 level of 48 a ph of 7.25 a bicarb hco3 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

to whether it's an acid or base so let's take it one by one okay paco2 48 okay we're thinking back

to our table we know that 35 to 45 is a normal paco2 level and anything greater than 45 is

acidotic so we're going to put p a co2 here because 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-tac-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 bicarb and then 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

our bicarb is 27 so we know a normal bicarb 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 build-up of co2 in the lungs the kidneys are

going to try to fix this by releasing bicarb hco3 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 a thing

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 ph 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 check

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