 Hi, welcome to Nursing School Explained and this video on respiratory acidosis. If you haven't already done so, I highly recommend that you watch my video called ABG interpretation, where I go a little bit more into the physiology of how the body regulates homeostasis, but I've also prepared a little review of this topic here just for a quick refresher. In general, we have H2CO3, which is carbonic acid, and in order to maintain pH balance and homeostasis, the respiratory system and the renal system work together. And so this carbonic acid can be broken down either into H2O and CO2, so water and carbon dioxide by the respiratory system or into HCO3 minus and H plus, which is bicarbonate and hydrogen ion. And the way that the respiratory system regulates the CO2, the acid, is either to increase or decrease the respiratory rate to retain or blow off more of that CO2. Where on the renal side, the kidneys work by either reabsorbing or excreting more of the bicarbonate or the hydrogen ion. So they really work well together to keep this pH balance. And if we look here, normal values for pH are 7.35 through 7.45. And then for carbon dioxide, 35 through 45. So basically leave out the sevens. It's the same thing. And then for bicarbonate is 22 through 26. And then I've also written down here this acronym called ROM, or OME, which is respiratory opposite metabolic equal. So in respiratory acidosis, respiratory opposite means that the respiratory system represented by the CO2 goes are in the opposite direction of the pH. So in respiratory acidosis, we're acidic. So the pH is low. And because the respiratory is always opposite, the CO2 will go high. So keep that in mind as you go through your ABG interpretation. And so for respiratory acidosis in specific, if we look at the causes, always it's related to hypoventilation, which is a decreased respiratory rate, which leads to CO2 retention. And then that CO2 builds up that acid builds up in the patient's bloodstream. And although this is hypoventilation, there are many different causes that can cause this. So COPD, for example, a patient with underlying lung issues, where their respiratory drive is not normal, they can hypoventilate. Therefore, that CO2 builds up in their system. Anything that causes CNS depression. So think about overdoses or too much ingestion of alcohol, for example, benzodiazepines, narcotics or any kind of sedative medication that can halt or alter the respiratory drive and the central nervous system, where it would decrease the respiratory rate. Further, any chest wall abnormalities, think about patients with chest trauma, maybe a broken ribs or flail chest, any of those things. When the chest wall cannot expand and contract appropriately, it might lead to hypoventilation and then respiratory acidosis. Certainly severe pulmonary infections, where the patient has, for example, a severe pneumonia or bad COVID infection or ARDS even, that can lead to hypoventilation, as well as atelectasis. So that includes all of your post-op patients, all of the patients that come from anesthesia and anybody with any kind of injury to the chest, because they're more likely to not breathe deeply because it hurts or because there is sedated or bed bound in the post-op period, therefore causing hypoventilation and CO2 retention. And then certain respiratory disorders that cause respiratory muscle weaknesses, such as multiple sclerosis, as well as myasthenia gravis can cause that. And then it's also a late sign of pulmonary edema. Initially in pulmonary edema, the respiratory rate will go up with this air hunger, but later on as the fluid or the edema takes over the lungs, it can cause to hypoventilation and then lead to respiratory acidosis. And then certainly if the ventilator is not adjusted appropriately for the patient, when there is mechanical hypoventilation and the patient's respiratory rate is not set at the appropriate rate, we might hypoventilate them and therefore they are prone to go into respiratory acidosis. Now signs and symptoms, initially the patient will feel short of breath, they will be restless and maybe become lethargic as that CO2 builds up in their system. They might have altered level of consciousness and complain of dizziness. Also their heart rate will go up and they might have dysrhythmias because of an increased potassium level. Further respiratory acidosis can lead to seizures, which would basically be more of an advanced altered level of consciousness and then into coma. And here is a quick review of why the patient is prone to hyperkalemia. So when the acid builds up in the bloodstream in this acidotic state, the body tries to not only adjust the respiratory rate but also to shift that hydrogen ion somewhere out of the bloodstream to achieve homeostasis. And the easiest way to do that is to shift that hydrogen ion into the cell. And in the cell we have an abundance of potassium which is typically an intracellular electrolyte. So if something goes in, something has to come out of the cell. So in exchange for getting rid of the acid out of the bloodstream into the cell, the potassium leaves the cell coming into the bloodstream and then we have elevated levels of potassium in the bloodstream that can be measured and then we have hyperkalemia. So acidosis leads to serum hyperkalemia and we always with potassium level abnormalities have to be careful about this rithmias. So what do we do? Treatment and nursing care for patients in respiratory acidosis treats the underlying cause. So whatever is causing this will have to treat it to reverse this hypoventilation. Let's look at this. In a patient with COPD, maybe they need a nebulizer treatment, maybe they need a biopap machine, maybe they need to be put on a ventilator to regulate their respiratory drive. CNS depression, if there's an overdose of whatever offending agent that might be, there might be a reversal agent we can use. Chest wall abnormalities, so if this is due to trauma the patient might need to be intubated and maybe a chest tube or any kind of other surgery to resolve the injury to the chest wall. Severe pulmonary infections, you can imagine antibiotics are certainly indicated but again we have to think about their respiratory drive and to make sure that they can then regulate their acidity so again they might have to be put on a ventilator. Atelectasis, so all those good things that we teach our patients in the post op period coughing and deep breathing, make sure they ambulate as soon as they are allowed to do so to prevent this atelectasis. Respiratory muscle weakness for these specific diseases that are medications that the patients can take to make sure that the muscle weakness does not lead to this hypoventilation. Pulmonary edema, again maybe the patient needs to go on a bipap machine or on mechanical ventilation and then if we have mechanical hypoventilation we need to adjust the ventilator, increase their respiratory rate so we can get rid and help them blow off that CO2 that's been building up in their system. And then for nursing care always remember your A, Bs and Cs so airway we have to protect their airway and intubate them as needed of course the physician will do that. For breathing so they might need oxygen, they might need an nebulizer treatment such as in COPD or maybe these pulmonary infections and all again they might need to be intubated. For a circulatory system we want to make sure we have a good IV access on these patients because they can be critically ill. We want to be able to administer any medications that they might need and keep them on a cardiac monitor because we know that we have this risk for increased potassium levels. And then we always want to keep a close eye on the vital signs especially their respiratory rate and depth. Think about CNS depression because we know that they are hypoventilating so if there's a concern in the post-op period for example this is something that you need to keep a close eye on and literally sit there and count their respirations for that full minute to make sure you get an accurate rate. And then ABG certainly we have to keep an eye on those to see if the things that we do and intervene help the patient get better get back into homeostasis. We certainly want to monitor electrolytes especially that potassium that we talked about here before. And then last caveat but very important always caution when administering CNS depressants because we know they can lead to hypoventilation and the patient might end up in respiratory acidosis. Thanks so much for watching this video in the float in the electrolyte playlist. Please also check out my other videos about the other acid-based imbalances so you get a better understanding. Thanks for watching Nursing School Explains. See you soon.