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

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    Hey everyone it's Sarah with RegisteredNurseRN.com and in this video I'm going to be going over
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    respiratory acidosis. I'm actually doing a series on acid and base imbalances so if you're studying
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    that right now be sure to check out those videos. Now in the previous video I went over respiratory
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    alkalosis and showed you the differences, how it affects the body, what to remember for the
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    NCLEX exam and your nursing lecture exam. So be sure to check out that video. So in this video
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    what I'm going to do is I'm going to simplify the pathophysiology with what's going on in
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    respiratory acidosis. I'm going to give you a mnemonic on how to remember the causes and we're
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    going to go over signs and symptoms, nursing interventions and then I'm going to take it a
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    step further and work an arterial blood gas problem with a patient that's in respiratory
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    acidosis and show you how to set the problem up using the tic-tac-toe method and how you can
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    determine if it's compensated or not compensated and things like that. Now after this video be sure
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    to go to my website registernursern.com and take the free quiz that will test your knowledge on
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    respiratory alkalosis and respiratory acidosis. A card should be popping up or a link in the
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    description below and you can access that free quiz. So let's get started with the pathophysiology
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    because in order to truly understand what's going on in the body during respiratory acidosis you
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    have to know what is being affected in the lungs. Then the causes will make sense. It'll literally
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    be like common sense and it'll click in your brain. So let's simplify this. Okay whenever you breathe
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    you take in oxygen through your either your nose or your mouth. So the oxygen enters in through
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    there the pharynx area then it goes down through the larynx which is your throat down through the
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    trachea which branches off into the bronchus which then branches off into the bronchioles
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    and then to the alveolar sacs. Now the alveolar sacs is where everything the gas exchanges are
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    happening and what happens is that oxygen enters in and carbon dioxide comes out because carbon
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    dioxide is that build-up of whatever your body has left over and you're going to breathe that out. So
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    the carbon dioxide will go backwards of how the oxygen entered and it will exit through your nose
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    or through your mouth. Now in those alveolar sacs what's happening is oxygen is going into those
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    sacs, carbon dioxide is coming out, oxygen is attaching to the red blood cells. The red blood
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    cells are transporting it throughout your body to your organs to your tissues and giving it fresh
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    supply of oxygen. But whenever you have something that's interrupting the breathing either you have
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    depressed respirations where maybe you gave them an opioid they have too much drugs involved or
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    something like that it causes depressed breathing they're not expelling the CO2. So anything that's
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    affecting the body's ability to breathe normally because in an adult normal respirations are 12 to
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    20 breaths per minute. So if it's less than 12 they're not breathing appropriately so they're not
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    expelling the CO2 and we'll go over the causes a lot more in depth. And your diaphragm which is
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    below your lungs plays a role in this as well. So if you have anything that affects the diaphragm
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    which in neuromuscular diseases which we'll go over here in a second that can affect because
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    whenever you breathe in diaphragm goes up helps squeeze that air out squeeze out carbon dioxide
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    out and then it relaxes. So if you have anything affecting that that can cause problems. So whenever
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    you have the buildup of the CO2 this causes your blood pH to become acidic and here are some key
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    concepts that you need to remember for this disease process that your teachers will probably ask you
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    on exams or on the NCLEX. So let's look at these key concepts. Okay overall respiratory acidosis
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    is the buildup of carbon dioxide in the blood and it's mainly due to bradypnea which brady means
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    slow penia deals with respirations. So you're having really slow respirations where you're not
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    getting rid of that carbon dioxide. And what happens carbon dioxide's in your body there's
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    too much of it and your body's like oh we do not like this. So your blood pH because of that carbon
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    dioxide causes the blood to become very acidic and it will become a pH of less than 7.35.
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    And you remember you have a lot of CO carbon dioxide CO2 hanging around so the levels are
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    going to increase so anything greater than 45. Now whenever this happens in the body remember your
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    body loves homeostasis it loves to keep everything nice and equal so it'll use other systems of the
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    body to try to regulate this out. So the kidneys will actually start to release bicarbonate
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    HCO3 and you will start to see these levels rise and the reason that they're trying to rise
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    is to help decrease that pH help to increase that pH level to make it normal because right now it's
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    decreased and they want to increase it so by releasing the bicarb it will help hopefully
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    increase it. And any levels greater than 26 if you see that in a blood gas that's what your body's
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    trying to do is trying to compensate with that. Now you want to memorize these lab values you
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    seriously just want to commit these to memory so you can understand what's going on because whenever
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    you're solving blood gas levels or anything like that you're going to have to refer back into your
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    memory hey what's normal what's acidotic what's not. So let's go over it real fast a normal pH
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    level is 7.35 to 7.45 a normal PaCO2 level your carbon dioxide level is 35 to 45. How I remember
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    these two remember the fives at the end 7.35 to 7.45 and then again PaCO2 is 35 to 45 you see the
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    three and the five and the four and the five and then the HCO3 which is your bicarb the normal is
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    22 to 26. And then I just have this little chart this helps me remember it if it's if it's an acid
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    or not an acid and for pH anything acid right here anything less than 7.35 is an acid anything
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    greater than 7.45 is a base alkalotic and PaCO2 is the opposite so the high number anything greater
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    than 45 is acidotic and anything less than 35 is alkalotic and bicarb anything less than 22
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    is acidotic and anything greater than 26 is alkalotic. So just try to remember that because
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    that's going to help us whenever we try to solve our blood gases and I'm going to show you how to
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    do that using the tic-tac-toe method. Okay so let's go over the causes of respiratory acidosis. Okay
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    remember this mnemonic the word depressed depressed breathing because that is one of the
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    big reasons why your body is becoming acidotic why you're having that buildup of CO2 so remember the
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    word depressed and each word will correlate with what's what the cause is. Okay first drugs any
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    drugs such as opiates which are morphine, fentanyl questions like to throw that out at you say the
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    patient overdosed on morphine or fentanyl or something like that or any sedatives such as
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    versed that's a lot of times given during moderate sedation will cause respiratory depression and
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    remember when the patient is breathing less than 12 breaths per minute they're just barely breathing
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    and they're not expelling that CO2 that CO2 is building up so that can cause respiratory acidosis
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    so you want to watch patients with that also the other d diseases of the neuromuscular system I
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    talked about this at the beginning this is the myasthenia gravis or gilliam bray syndrome and
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    this is weakness of the voluntary muscles like the diaphragm which helps to squeeze that carbon
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    dioxide out and in these syndromes they're not working properly so they can't expel that carbon
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    dioxide it's hanging around in there okay e edema anytime you get extra fluid in these lungs like in
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    pulmonary edema especially with congestive heart failure patients that fluid is hanging around
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    those sacs and remember in the alveolar sacs we talked about how there's a gas exchange between
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    oxygen and carbon dioxide and messes up those sacs those sacs can't open and close properly
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    so it just starts to retain the CO2 so that can cause it next pneumonia almost the same concept
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    as the fluid with pneumonia you have that excessive mucus production around those sacs
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    which is in your sacs are filled with pus and fluid and they're not able to even properly
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    inflate and deflate so you have that buildup of that carbon dioxide that your body is trying to
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    get rid of so pneumonia can cause it and the rest next one the r respiratory center of the
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    brain is damaged okay in your brain you have the medulla and the pons area that is responsible for
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    your respiratory center now if you have any traumatic brain injury or you have a stroke
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    that affect that affects that area that can affect the way that the patient breathes how they take
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    breaths so they can develop respiratory acidosis okay e for emboli and this can block the pulmonary
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    artery or the branches of the lungs depending on where the emboli left the body this can be a fat
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    emboli air emboli and it can go into the branches and block off so if you have something blocking
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    off that branch whenever you're trying to get that oxygen into that alveolar sac it can't go
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    so if it can't go carbon dioxide can't go and carbon dioxide is just going to stay and hang
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    out in the blood so that can cause problems so anything blocking in the lungs can cause those
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    issues and the other s spasms of the bronchial tubes this is asthma whenever a patient has an
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    asthma attack these bronchial tubes start spasming which is blocking again just like the emboli the
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    gas exchange and what is going to happen is that that patient whenever they're having that they're
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    not taking those nice deep breaths and they're building up that co2 okay and the last s this
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    is another this is another important s and this what is happening with this is that you have the
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    sac elasticity of the alveolar sac is damaged and what's happened is that this sac is damaged
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    either because of a disease process called chronic obstructive pulmonary disease COPD or
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    emphysema and what happens is whenever this sac is damaged it's usually due to smoking so that's why
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    health care providers really encourage patients to quit smoking because they're taking the smoke
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    the smoke goes through the lungs and it damages those sacs and what happens is that the sac
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    becomes damaged and it doesn't properly deflate so whenever it doesn't properly deflate it retains
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    co2 that's why you'll hear patients who are COPD patients they're co2 retainers because that sac
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    is not deflating properly and it's keeping all that carbon dioxide now let's look at the signs
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    and symptoms the nursing interventions and work an arterial blood gas problem and show you what
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    a patient with respiratory acidosis would look like okay how does your patient present and look
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    whenever they're in respiratory acidosis normally this is going to start to happen gradually and
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    you'll start to see a neuro decline neuro changes all of a sudden they'll become confused maybe not
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    answer your questions appropriately and they'll just nod off and fall asleep i remember i um had
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    a patient one time he was starting to go into this and he we would be talking and all of a sudden he
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    would literally fall asleep right in front of my face and we checked his abg levels and sure enough
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    he was in respiratory acidosis so really watch your neuro part um also the patient may say i just
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    have a headache and then they're confused and they're drowsy that should send a red flag too
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    and of course respiratory depression they're going to have a really slow respiratory rate
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    less than 12 breaths per minute so make sure as a nurse you're counting those respirations
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    appropriately and monitoring those and have low blood pressure as well okay so what do you
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    typically do for a patient who is in respiratory acidosis and of course you'll contact the doctor
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    they'll give you a lot of orders on what to do but typically this is what's going to happen
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    you're going to administer oxygen and if the patient is alert enough you're going to encourage
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    coughing and deep breathing helping them take those full deep breaths in and out because remember we
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    want them to expel that carbon dioxide that's built up so we want them to be taking normal
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    breaths at a rate of at least 12 to 20 breaths per minute and if the patient has been having asthma
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    attacks COPD or emphysema a respiratory treatment might be good so get respiratory therapy involved
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    to give them a treatment help with that bronchodilators because remember in asthma you
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    have bronchoconstriction and that'll help open them up and so they can breathe properly properly and
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    have that gas exchange go so they can expel that carbon dioxide and also if your patient is in this
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    a lot of times narcotics will cause this morphine fentanyl even lortabs things like that anything
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    that's an opiate or a sedative like valium things like that can cause respiratory depression so
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    you'll want to hold those medications don't want to give those because it will make it worse now
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    remember this this is very very very important watch potassium levels with respiratory acidosis
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    we talked about this in the hyperkalemia fluid and electrolyte series because this will cause
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    an increase of your potassium levels anything greater than 1.5 so you want to watch that
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    whenever you get hyperkalemia involved you start you need to watch for any ekg changes that's
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    associated with hyperkalemia which are tall t waves the flat p waves or a prolonged qrs and pr
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    interval so watch for any of that now if the patient has pneumonia you'll be giving
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    antibiotics encourage incentive spirometer usage so they can breathe in pop those sacs open which
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    have the mucus and the pus in them so you can help gas exchange and if it's really really bad
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    if the co2 level whenever you draw your blood gas if it's greater than 50 the doctor may order the
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    patient to have endotracheal intubation so prepare the patient for this or if they're
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    in respiratory distress so that is the nursing interventions for that now let's work a problem
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    that will show you how to do a blood gas problem on a nursing exam or the NCLEX because this is what
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    nursing professors love to ask you whenever they're going over acid base imbalances they're
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    going to throw some abg values out out at you and they're going to give you some options and you
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    have to decide what it is so i like to do the abg i mean the tic-tac-toe method whenever i'm solving
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    abg problems i have several two videos on where i go in depth on how to use the tic-tac-toe method
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    setting up your problem and solving that a card should pop up a link should be in the description
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    as well so you can watch that video on how to do that okay so here's what the problem says
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    patient has the following abgs a paco2 level of 48 a ph of 7.25 a bicarb hco3 level of 27
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    what condition is presenting so we've got to go back to our chart that you have hopefully memorized
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    and you got to remember what's acidotic what's alkalotic and you're going to set up your tic-tac-toe
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    remember as a child we would play tic-tac-toe so just set it up with your lines name one column
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    base one normal and i mean one acid one normal and one base now we are going to plug these values in
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    to whether it's an acid or base so let's take it one by one okay paco2 48 okay we're thinking back
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    to our table we know that 35 to 45 is a normal paco2 level and anything greater than 45 is
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    acidotic so we're going to put p a co2 here because it's an acid and then we're going to
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    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
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    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
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    a row so we know that we are dealing with a respiratory problem that right there tells us
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    in our tic-tac-toe another reason tic-tac-toe is great is because you're trying to figure out if
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    you're dealing with a respiratory metabolic problem that's the whole issue with these abgs
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    for a lot of students okay now we're going to look at our bicarb and then the last part whenever
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    after you get your tic-tac-toe the one that's in the other column you're going to be looking at
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    that and you're going to be saying to yourself okay is this the body based on this value is this
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    compensating fully is it partially compensating or is it not compensating at all so let's look at
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    our bicarb is 27 so we know a normal bicarb is 22 to 26 and it's abnormal it's 27 according to that
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    our chart it is basic so we're going to put it over here so remember at the beginning of this
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    lecture we talked about how whenever there's a build-up of co2 in the lungs the kidneys are
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    going to try to fix this by releasing bicarb hco3 so the levels are going to increase abnormally
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    why because it wants to bring that ph down and this is what we're seeing so the body is trying
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    to compensate so we got some compensation going on here so we know we have respiratory acidosis
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    and it's compensated but is it fully or partially compensated so this is where you've got a thing
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    okay it's 27 now what's the purpose of bicarb trying to increase the purpose is because it
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    wants to bring that ph back to a normal level right now our ph is not normal it is still acidic
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    so it's just partially compensated so if it would fully compensated the ph would be back to normal
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    so this is respiratory acidosis partially compensated okay so that is about respiratory
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    acidosis now be sure to take that quiz to test your knowledge on the difference between
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    respiratory alkalosis and acidosis and thank you so much for watching and be sure to check
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    out my other teaching tutorials and please consider subscribing to this youtube channel
Title:
Respiratory Acidosis Acid Base Balance Made Easy NCLEX Review | ABGs Made Easy for Nurses
Description:

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Video Language:
English
Duration:
19:34

Hawai'i Creole English subtitles

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