Now we're ready to go over the most common causes
in nursing interventions for the Big 4 imbalances:
respiratory acidosis and alkalosis,
metabolic acidosis and alkalosis.
Let's start with respiratory acidosis.
Now this is the one you're gonna
see most often in your practice
and its cause is from an increase in CO2.
So you'll look for things like pulmonary
disease, the patient may have a history of COPD,
they might be asthmatic and having
an attack, they might have pneumonia,
because remember those alveoli
are filled with gunks so it's really hard
for the lungs to exchange
CO2 and O2 efficiently.
Possibly pulmonary edema, so instead of being filled
with infection, the lungs are filled with fluid
which also makes it difficult
for them to exchange CO2 for O2.
and just plain old respiratory failure.
Respiratory acidosis is a sign that the lungs are not
functioning at their normal level, so what do we do?
Well we got to get rid of the
CO2 and improve respiration.
So don't couple of options.
We can look at medications.
First of all bronchodilators, right? we use those for COPD
patients, asthma patients, all types of respiratory patients.
Bronchodilators are usually meds that are inhaled
either with a breathing treatment or an MDI,
they're taken into their lungs
and will open up those airways.
Also, we can use steroids that helps us deal with
some the inflammatory things that could be going on.
BiPAP is a type of
mask in forced ventilation.
So when we say BiPAP, first of all I'll refer it to like
a CPAP machine that you may have seen a patient with this.
A CPAP is a mask that usually goes over the nose
and it has a long hose that goes to a small machine.
It has a constant centimeter
of pressure going on.
So it's like, think about taking a hair dryer
and hooking it to the hose, it's constant pressure
forcing the airways to remain open.
Those people with obstructive sleep apnea,
their airways shut down when they're sleeping.
BiPAP is a little more technical because instead
of having just having just at constant pressure,
it has one pressure when the patient is inhaling but
it has a lower pressure when the patient is exhaling
so they don't have to
work as hard to breathe out.
Now we put patients on BiPAP who
are on pretty severe respiratory distress
but they're still able
to breathe on their own.
We try to avoid having to
put the patient on a ventilator.
So when you see a patient on a
bipap, they're in pretty serious trouble
but we're hoping to avoid having to intubate
them and put them on mechanical ventilator.
If we do have them on the ventilator, the physician will
work with what's gonna be the right amount of tidal volume,
the size of the breath and the rate
depending on what the patient's ABGs are.
So those are our options for treatment.
To get rid of CO2 and improve respiration we can try
meds, we can try special oxygen support like BiPAP
or with the last ditch is ventlator - we try to avoid
that if we can but some patients absolutely need it.
Now what does the body do the respond?
Well it's respiratory acidosis so we look at the
opposite system which is the metabolic system.
We're gonna need that system to increase
bicarb to bring that pH back up to a normal range.