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RESPIRATORY ACID-BASE IMBALANCES The body has the remarkable ability to maintain plasma pH within a narrow range of 7.35–7.45. It does so by means of chemical buffering mechanisms involving the lungs and kidneys. Although simple acid-base imbalances (e.g., respiratory acidosis) do occur, mixed acid-base imbalances are more common (e.g., the respiratory acidosis/metabolic acidosis that occurs with cardiac arrest). RESPIRATORY ACIDOSIS (PRIMARY CARBONIC ACID EXCESS) Respiratory acidosis (elevated Pa CO 2 level) is caused by hypoventilation with resultant excess carbonic acid (H 2 CO 3 ). Acidosis can be due to/associated with primary defects in lung function or changes in normal respiratory pattern. The disorder may be acute or chronic. Compensatory mechanisms include (1) an increased respiratory rate; (2) hemoglobin (Hb) buffering, forming bicarbonate ions and deoxygenated Hb; and (3) increased renal ammonia acid excretions with reabsorption of bicarbonate. Acute respiratory acidosis: Associated with acute pulmonary edema, aspiration of foreign body, overdose of sedatives/ barbiturate poisoning, smoke inhalation, acute laryngospasm, hemothorax/pneumothorax, atelectasis, adult respiratory distress syndrome (ARDS), anesthesia/surgery, mechanical ventilators, excessive CO 2 intake (e.g., use of rebreathing mask, cerebral vascular accident [CVA] therapy), Pickwickian syndrome. Chronic respiratory acidosis: Associated with emphysema, asthma, bronchiectasis; neuromuscular disorders (such as Guillain-Barré syndrome and myasthenia gravis); botulism; spinal cord injuries. CARE SETTING This condition does not occur in isolation, but rather is a complication of a broader health problem/disease or condition for which the severely compromised patient requires admission to a medical-surgical or subacute unit. RELATED CONCERNS Plans of care specific to predisposing factors/disease or medical condition, e.g.: Cerebrovascular accident (CVA)/stroke Chronic obstructive pulmonary disease (COPD) and asthma Craniocerebral trauma (acute rehabilitative phase) Eating disorders: obesity Alcohol: acute withdrawal Spinal cord injury (acute rehabilitative phase) Surgical intervention Ventilatory assistance (mechanical) OTHER CONCERNS Fluid and electrolyte imbalances Metabolic acidosis Metabolic alkalosis Patient Assessment Database Dependent on underlying cause. Findings vary widely. ACTIVITY/REST
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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