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, RegisteredNurseRN.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 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 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 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 Guillain-Barré 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, 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. It 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 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 had

a patient one time—he was starting to go into this—and 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. 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 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 5.5—so you want to watch that.

Whenever you get hyperkalemia involved, you need to watch for any EKG changes that's

associated with hyperkalemia, which are tall T waves, 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 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've 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 PaCO₂ 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 or 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: it's 27. So we know a normal bicarb is 22 to 26, and it's abnormal—it's 27. According to that

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 (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 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 pH is not normal—it is still acidic.

So it's just partially compensated. So if it were 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

out my other teaching tutorials, and please consider subscribing to this YouTube channel.