Acid Base Imbalances in Respiratory Distress Patient Assignment PDF

Acid base imbalances in
respiratory distress patient

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Concept of acid base imbalance..................................................................................................1
Respiratory acidosis....................................................................................................................2
Respiratory alkalosis...................................................................................................................6
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11

INTRODUCTION
Acid base imbalance refers to a situation of occurring imbalance in acid and base
concentration which is responsible for causing plasma pH in order to deviate out of natural range
i.e. 7.35 to 7.45. However, the acid base balance can be considered as one of the fundamental
homoeostatic needs of overall organisation as the hydrogen ion effects the same. It include the
fact that modifications in [H+] impacts on the rate constants of various types of enzymes along
with cell cycle, cell proliferation and signal transduction (Crook, 2014). However, the fluid of
body i.e. blood have to conduct various functions for which it needs proper balance between
acidic and basic compounds in respect of functioning in correct way. The balance of acid base
concentration is very important in order to maintain homoeostasis with the help of several
physiological adaptations. This report will focus on pathophysiology of respiratory acidosis and
respiratory alkalosis which is actually responsible for causing respiratory related acid base
imbalances.
MAIN BODY
Concept of acid base imbalance
The blood can be described as an essential fluid in human body which is made up of
acids and base and their concentration in blood soundly be measured in pH scale. It is important
for maintaining balance among acid and base in blood because slight changes can create severe
health problems. Meanwhile, it has been analysed that blood should have slighter highly amount
of bases as compared to acids. However, abnormality in concentration of bicarbonate and carbon
dioxide refers to imbalance of acid and base in blood. The acid base imbalance include
decreased level of carbon dioxide and increased concentration of bicarbonate.
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Respiratory acidosis
The respiratory acidosis can be described as a situation that take place while lungs
become non-capable for removing desired amount of carbon dioxide (CO2) generated by the
human body. However, increasing of concentration in carbon dioxide can cause pH of blood and
other essential fluids of body get decreased which is responsible for making it too acidic
accordingly (Brent and et. al., 2017). In general, the human body is capable to maintain overall
balance of ions in respect of controlling acidity and balance can be measured on pH scale from 0
to 14. Moreover, acidosis occurs at the time when pH blood falls below 7.35 (normal blood pH is
between 7.35 to 7.45). In addition to this, it is determined that the respiratory acidosis is typically
caused by an underlying disease or condition which can be known as respiratory failure and
ventilatory failure. It has been analysed that lungs take oxygen and exhale carbon dioxide
normally where oxygen passes lungs to blood and CO2 passes from blood to lungs. Meanwhile,
sometimes lungs become unable to remove enough amount of carbon dioxide which caused due
to reduced respiratory rate or decrease in air movement due to an several health conditions such
as asthma, chronic obstructive pulmonary disease (COPD), pneumonia and sleep apnoea.
Respiratory acidosis can be divided into two categories such as acute respiratory acidoses
and chronic respiratory acidosis which has their own symptoms and impacts on human body.
Initially, an acute respiratory acidosis is a conditions that take place quickly which can be
considered as medical emergency (Lewis and et. al., 2014). However, if this condition remain
untreated then it may leads progressively worst symptoms and become life threatening for an
individual. Moreover, chronic respiratory is a condition that develops over time and does not
cause symptoms which is responsible for adaptation of human body in terms of boosting up
acidity. For example, kidney produce extra bicarbonate to help for maintaining balance.
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Meanwhile, it is necessary that chronic respiratory acidosis cause symptoms but development of
different health problems in body may responsible for causing chronic respiratory acidosis to
worsen and become acute respiratory acidosis.
Symptoms of respiratory acidosis
There are various symptoms of respiratory acidosis at initial level such as headache,
anxiety, blurred vision, restlessness and confusion which are required to be treated immediately
to make an individual healthy. If in case, the early remain untreated then few of other serious
signs can be observed including shortness of breathe, delirium or confusion, coma and
sleepiness or fatigue. However, the signs and evidences of chronic respiratory acidosis are not
usually observable but they are subtle and non specific which can consist personality changes,
memory loss and sleep disturbances. It is necessary to treat early symptoms to maintain acid
based balance in human body in order to make an individual healthy. Moreover, ignorance of
acid based imbalance in body is responsible for creating many severe health problems (Raphael
and et. al., 2016).
Causes of respiratory acidosis
The regulations of pH in human body can be conducted with the helps of major organs
like lungs and kidneys as the lungs helps on removing acid by exhaling carbon dioxide whereas
kidneys plays an important role to excrete acids through urine. However, kidneys are responsible
for maintaining the concentration of bicarbonate in blood of human body. Moreover, I has been
analyse that respiratory acidosis can generally take place due to disease related to lungs which
can affect normal breathing or impairs capability of lungs in order to remove carbon dioxide.
There are several causes which facilitate occurrence of chronic respiratory acidosis such as
asthma, chronic obstructive pulmonary disease (COP), acute pulmonary oedema, severe obesity
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(that is able to interfere the expansion of lungs), scoliosis and neuromuscular disorders (like
multiple sclerosis or muscular dystrophy) (Ignatavicius and Workman, 2015).
At the other hand, there are different cause which leads to acute respiratory acidosis such
which are required to be observed and get treatment properly to remain well-being. Initially, it
consist several disorder related to lungs which create problem of respiratory acidosis which
include COPD, emphysema, asthma, pneumonia. Secondly, it involve medical conditions which
are responsible to create problem in rate of breathing, hence may leads to abnormal breathing.
Thirdly, weakness of muscles that impacts negatively on breathing and taking deep breathe also
cause creation of acute respiratory acidosis. However, the obstructed airways because of
different problems like choking, cardiac arrest and sedative overdose are some of reasons for
occurrence of an acute respiratory acidosis.
Diagnosis of respiratory acidosis
The diagnosis refers to different types of activities and procedures which are helpful to
determine actual health problem and their real cause of the same, it include the criteria to make
an appropriate decision to conduct proper treatment for specific disease in order to make an
individuals healthy. However, it is necessary to conduct appropriate diagnosing activity for
analysing actual health issue of an individual so that correct medication can be provided to make
a patient disease free in proper manner. In context of determining problem of respiratory
acidosis, there are several diagnosing processes that can be carried out in which few of them are
described here (Bersten and Handy, 2018).
Blood gas measurement – This can be described as a process to analyse the levels of a
compound i.e. carbon dioxide in order to evaluate the acidity of blood accordingly. However, the
blood gas can be considered as a series tests which is utilised for measuring concentration of CO2
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and oxygen in blood. Meanwhile, the pathologist take sample of blood from artery of body of
patient and determine levels of carbon dioxide in blood and high concentration indicates the
situation of acidosis.
Electrolytes – This include the process of testing electrolytes that is group test which
helps for measuring concentration K+ (Potassium), Cl- (Chloride), bicarbonate and Na+ (Sodium).
Meanwhile, concentration of above mentioned electrolytes is required for measuring which can
be increased or decreased and that will facilitate to determine the condition of acid based
disorders. Moreover, one of more of these electrolytes can have improve or declined level in
people which indicates the problem of respiratory acidosis (Erickson, Goff and Uemura, 2015).
Lung function tests – This include to analyse that lungs are conducting their functions
normally in proper manner because the problem of respiratory acidosis create problems in
functioning of this organs. However, improper functions of lungs also provide indication of
problem known as respiratory acidosis.
Chest X- ray – This include to help physicians to clearly observed internal injuries of
problem that is responsible for creating condition of respiratory acidosis. It include to conduct an
X- ray process which consist an electromagnetic wave of high energy and very short wavelength
that is capable to pass through many materials opaque to light. However, problem of respiratory
acidosis can be identified through examining internal injury by X rays.
Other test – There are several other diagnosing tests that can use by doctor in order to
diagnose the underlying condition which causes acidosis. However, it may consist metabolic
acidosis that may cause similar symptoms which are required to be analyse specifically.
Moreover, various tests should be conducted to determine cause of respiratory acidosis because
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amount of acid can be increased due to several other problem like kidney failure, diabetes and
many more including glucose, lactate as well as ketones.
Treatment of respiratory acidosis
The treatment of respiratory acidosis is based on its specific form such as acute and
chronic as their symptoms are quite different. It consist variety of treatments procedure and
mediation in which more suitable one can be selected for particular individual with this in order
to make them healthy (Park, 2014). However, selection of appropriate treatment is necessary
because people have different level of immunity in their body which accept specific medications.
Acute respiratory acidosis – For treating the problem of acute acidosis, it is essential to
first address the underlying cause of this problem. However, medication or treatment is required
to be carrying out according to specific reason for acute acidosis. For example, if cause is
improper airways then it is necessary to make the same clear with the help of conducting
Artificial ventilation.
Chronic respiratory acidosis – This include to conduct treatment procedure in respect of
managing fundamental situations and it consist the target of improving functioning of airway by
several strategies which are suitable for particular patient accordingly. However, antibiotics can
be given for treating an issue of infection, utilise bronchodilators in terms of expanding airways
and carrying out process of diuretics in respect of decreasing extra fluids effects lungs & heart
accordingly. In addition to this, doctors can provide corticosteroids to patient for decreasing
inflammation and mechanical ventilation to people in critical conditions.
Respiratory alkalosis
The respiratory alkalosis is condition which take place at the time when concentration of
oxygen and carbon dioxide are not balanced in blood. It include the situation when levels of
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alkaline are observe as very high because of increase in level of bicarbonate and reduced
concentration of carbon dioxide. Meanwhile, the respiratory alkalosis is likely to be occurring
when a person take breathe excessively deep and fast then it will facilitate amount of carbon
dioxide drop too low. However, this will facilitate to cause increase in level of pH in blood
which is responsible for making it very much alkaline and that will create problem of respiratory
alkalosis. In addition to this, hyperventilation can be considered as typically underlying cause of
respiratory alkalosis which is known as over breathing as the hyperventilation breathes occur
very deeply or rapidly. Moreover, this conditions has most common causes like panic attacks and
anxiety but there are other problems also which may cause hyperventilation. Meanwhile, it
consist heart attack, pain, drug use, asthma, fever, chronic obstructive pulmonary disease,
infection, pulmonary embolism and pregnancy (Murray and et. al., 2014).
Symptoms of respiratory alkalosis
The sign of over breathing is responsible for indicating that respiratory alkalosis is likely
to develop and low concentration of carbon dioxide in blood have several physical effects on
human body. It include various symptoms such as bloating, feeling light headedness, numbness
or muscle spasms in hands & feet, dizziness, dry mouth, confusion, discomfort in chest area
feeling shortness in breathing and tingling in arms heart palpitations.
Causes and types of alkalosis
The problem of respiratory alkalosis include reduced amount of carbon dioxide which
can caused due to several kinds of elements such as high altitude, lung disease, fever, lack of
oxygen, liver disease and salicylate poisoning. However, low levels of carbon dioxide facilitate
body to release more amount of bicarbonate in order to maintain pH level of blood to normal
which can be considered as compensated alkalosis. In addition to this, kidneys are releasing more
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amount of bicarbonate in respect of compensating for lower levels of carbon dioxide for making
pH level normal in blood of human body. Moreover, the situation of occurring more
concentration of bicarbonate in blood then it is known as metabolic alkalosis which is caused due
to prolonged vomiting. The metabolic alkalosis attributed to extra vomiting cause electrolyte
loss, large loss of sodium or potassium in short period of time, adrenal disease, antacids, overuse
of diuretics, laxatives, alcohol abuse and accidental ingestion of bicarbonate. Meanwhile, the
condition of prolonged vomiting is also create position of losing much more chloride that can be
called as hypochloremic alkalosis. Sometimes, it has been evaluated that intake of diuretics
medicines can cause a patient to loose too much potassium hence, this condition is known as
hypokalaemic alkalosis. Furthermore, deficiency of potassium may create severe problems as
this element is essential for correct functioning of muscles, nervous systems, heart, kidney, and
digestive systems respectively.
Diagnosis of respiratory alkalosis
The diagnosis of respiratory alkalosis is very essential in order to determine actual cause
of the problem in order to make appropriate decision making for providing correct medication. It
include to identify the type of respiratory alkalosis so that correct treatment can be conducted for
making an individual healthy (Manuel, Hart and Stradling, 2015). However, it consist physical
exam, diagnostic testing including metabolic panel blood gas analysis, urinalysis and urine pH.
In addition to this, it is necessary to conduct desired pathological procedures including basic
metabolic panel, arterial blood gas analysis, urine pH level test and urinalysis. Moreover, overall
these activities are helpful to determine concentration of carbon dioxide along with evaluating
actual cause of the respiratory alkalosis. It will provide support to prefer correct treatment
process in respect of solving the given problem of an individual for their appropriate health.
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Additionally, abnormality can be compared to normal concentrations in respect of providing
correct dose of medicines and other treating process. Furthermore, the normal blood pH levels
are between 7.35 to 7.45 as the blood pH above 7.45 indicate the situation of respiratory
alkalosis accordingly.
Treatment of respiratory alkalosis
The process of treatment or medication is depends upon underlying cause of respiratory
alkalosis in proper manner. Initially, Panic & anxiety related causes requires treating condition in
order to raise concentration of carbon dioxide in blood which can be done by several strategies
that are explained further.
Breathe into paper bag – This process consist few of steps which are required to be
conducted in correct sequence for increase level of CO2. Firstly, it include to fill the paper bag
with carbon dioxide by exhaling air into it. Secondly, it is necessary to breathe the exhaled air
from the bag back into the lungs and repeat this several times. However, it will provide support
to increase levels of carbon dioxide in blood. Moreover, doing this process for several times give
sufficient amount of CO2 as per requirements that brings levels back up to where it should be.
Get reassurance – This include the fact that symptoms of respiratory alkalosis can be
frightening as it often causes faster and deeper breathing that making things worse. However,
such conditions can be overcome by having a calm loved one to provide assurance which is
helpful to get breathing under control in accurate way.
Restrict oxygen intake into the lungs – In order to restrict intake into lungs, try breathing
at the time of pursing lips or breathing through single nostril. Meanwhile, while doing the
mentioned process, the mouth and other nostril is required to be covered for gaining better
outcomes.
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CONCLUSION
As per the above report it has been summarised that it is required factor to balance of acid
base concentration which is a crucial aspect in order to maintain homoeostasis with the help of
several physiological adaptations. In this regard treatment procedure for managing underlying
conditions and the goal is to amend function of airway by several strategies which are
appropriate for patient accordingly their need. Moreover, consideration for the respiratory
alkalosis is a condition that occurs when denseness of carbon dioxide and oxygen in blood are
not balanced. In addition to this, the major consideration of this project is on pathophysiology of
respiratory acidosis and respiratory alkalosis. At the other hand, is include that treatment of
respiratory acidosis and alkalosis is based in actual cause of the same in human body.
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REFERENCES
Books and journals
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management. Nutrition. 30(11-12). 1448-1455.
Brent, J. and et. al., (2017). Critical care toxicology: diagnosis and management of the critically
poisoned patient. Springer.
Lewis, L. M. and et. al., (2014). Albuterol administration is commonly associated with increases
in serum lactate in patients with asthma treated for acute exacerbation of
asthma. Chest. 145(1). 53-59.
Raphael, K. L. and et. al., (2016). Bicarbonate concentration, acid-base status, and mortality in
the health, aging, and body composition study. Clinical Journal of the American Society
of Nephrology. 11(2). 308-316.
Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book: Patient-
Centered Collaborative Care, Single Volume. Elsevier health sciences.
Bersten, A. D., & Handy, J. (2018). Oh's intensive care manual. Elsevier Health Sciences.
Erickson, H. H., Goff, J. P., & Uemura, E. E. (2015). Dukes' physiology of domestic animals.
John Wiley & Sons.
Park, H. (2014). Identifying core NANDA‐I nursing diagnoses, NIC interventions, NOC
outcomes, and NNN linkages for heart failure. International journal of nursing
knowledge. 25(1). 30-38.
Murray, R. K. and et. al., (2014). Harper’s illustrated biochemistry. McGraw-Hill.
Manuel, A. R., Hart, N., & Stradling, J. R. (2015). Is a raised bicarbonate, without hypercapnia,
part of the physiologic spectrum of obesity-related hypoventilation?. Chest. 147(2). 362-
368.
Online
Physiology, Respiratory Alkalosis. 2019. [Online]. Available
through:<https://www.ncbi.nlm.nih.gov/books/NBK482117/>
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