disorder mechanism manifestation treatment goal

respiratory acidosis hypoventilation d/t
↓pH (< 7.35) drugs, head injury, lung
↑PaCO2 (> 45 mmHg) disease, airway
obstruction, respiratory
muscle dysfunction, chest
wall dysfunction
early symptons: HA, fatigue,
flushed skin, irritability
later: lethargy → confusion
→ somnolence
breath more (↑ RR and depth), ↓ CO2 levels
treat underlying cause, reverse provide adequate O2
narcs prn, improve respiratory normal pH
effort (use IS, ↑ mobility,
positioning, C/DB,
bronchodilators, correct vent
settings, continually reassess.

respiratory alkalosis hyperventilation d/t
↑pH (> 7.45) stimulated resp. system,
↓PaCO2 (< 35 mmHg) arterial hypoxemia, ↑
metabolism/hepatic failure,
mechanical ventilation
anxiety, ↑ stimulation of address underlying cause (give ↑ CO2 levels
CNS and peripheral NS pain and/or anxiety meds), ↓ RR provide adequate O2
by calming patient or changing normal pH
vent settings, ↓ volume on vent

metabolic acidosis loss of base or gain or acid CNS depression, HA, treat the underlying problem, normal pH
↓pH (< 7.35) d/t loss of bile, pancreatic weakness, Kussmaul’s, replace bicarb, monitor K+ normal Bicarb
↓HCO3 (< 22 mEq) juice, small intestine respiratory depression,
secretions containing confusion → delirium →
bicarb (fistulas, diarrhea); stupor
ketoacidosis, lactic
acidosis, drugs, poisons,
TPN, renal failure (↓
secretion of H+ ions)

metabolic alkalosis gain of base or loss of acid irritability of CNS and remove source (decrease normal pH
↑pH (> 7.45) d/t excessive antacid use, peripheral NS (tingling of antacids, decrease gastric sxn), normal Bicarb
↑ HCO3 (> 28 mEq) GI output via vomiting and fingers, toes, circumoral), monitor electrolytes (K+), treat
gastric suctioning cramps, tetany, dizziness, cause of vomiting
disorientation → lethargy
Black, Joyce M., and Jane Hokanson Hawks. Medical-Surgical Nursing: Clinical Management for Positive Outcomes - Single Volume (Medical
Surgical Nursing- 1 Vol (Black/Luckmann)). St. Louis: Saunders, 2009. Print.