Nursing 211

N211: Health Differences Across the Lifespan I

Chapter Two: Respiratory Disease 2.1 Acid Base Imbalance Acid Base Imbalance is a pH less than 7.15 or greater than 7.45 that can depress the respiratory center. The medulla oblongata is the inspiratory and expiratory center of the brain that controls the rate and depth of respiration. The apneustic center of the lower pons may also contribute to inspiration and the pneumotaxic center may assist in expiration. Carbon dioxide acts as an acid in the body. It is also the indicator of how the respiratory system is functioning. Bicarbonate acts as a base in the body. It is also the indicator of how the metabolic system is functioning. 2.2 Respiratory Acidosis Respiratory Acidosis ( ↓<7.35, CO2↑ >45) is anything which prevents the body from getting rid of excess carbon dioxide (CO2), increases acid which decreases the pH level. This occurs in response to hypoventilation, which occurs with respiratory depression, inadequate chest expansion, airway obstruction, or interference with the alveolar capillary exchange. Diagnostics • pH decreased below 7.35 • PaCO2 elevated above 45 mm Hg • Hyperkalemia Compensation • Increased rate and depth of respirations to blow off CO2 • Kidneys eliminate hydrogen ions and retain bicarbonate • Urine pH less than 6 • Bicarbonate levels rise when body is compensating for acidosis Nursing Interventions Include correct the underlying cause and improve ventilation; provide adequate fluid intake to liquefy secretions, low flow oxygen, take apical pulse and check for tachycardia, note color of skin, nail beds and mucous membranes. Monitor level of consciousness, monitor arterial blood gases, and monitor EKG for dysrthymias. Administer bronchodilators to decrease bronchospasm, antibiotics to treat respiratory infections, Mucomyst to decrease viscosity of pulmonary secretions, anticoagulants and thrombolytics to prevent pulmonary emboli. Keep side rails up, bed at lowest level and call bell within easy reach. Provide good oral hygiene and maintain a calm, quiet environment. 2.3 Respiratory Alkalosis


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