Respiratory alkalosis is a loss of carbon dioxide (PCO2 < 35 mm Hg) with a resultant decrease of carbonic acid (H2CO3) due to a marked increase in the rate of respirations. The two primary mechanisms that trigger hyperventilation are (1) hypoxemia and (2) direct stimulation of the central respiratory center of the brain (such as occur with high fever, head trauma/CNS lesions, early salicylate intoxication).
Compensatory mechanisms include decreased respiratory rate (if the body is able to respond to the drop in PaCO2), increased renal excretion of bicarbonate, and retention of hydrogen. It is the most frequently occurring acid-base imbalance in hospitalized patients, with the elderly at increased risk because of high incidence of pulmonary disorders and alterations in neurological status.
CARE SETTING
This condition does not occur in isolation, but rather is a complication of a broader problem and usually requires inpatient care in a medical/surgical or subacute unit.
RELATED CONCERNS
Plans of care specific to predisposing factors, e.g.:
Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Cirrhosis of the liver
Craniocerebral trauma
Hyperthyroidism
Fluid and electrolyte imbalances
Heart failure: chronic
Pneumonia: microbial
Sepsis/septicemia
Ventilatory assistance (mechanical)
OTHER CONCERNS
Metabolic acidosis
Metabolic alkalosis
Patient Assessment Database
Dependent on underlying cause.
CIRCULATION
May report: History/presence of anemia
Palpitations
May exhibit: Hypotension
Tachycardia, irregular pulse/dysrhythmias
EGO INTEGRITY
May exhibit: Extreme anxiety (most common cause of hyperventilation)
FOOD/FLUID
May report: Dry mouth
Nausea/vomiting
May exhibit: Abdominal distension (elevating diaphragm as with ascites, pregnancy)
Vomiting
NEUROSENSORY
May report: Headache, tinnitus
Numbness/tingling of face, hands, and toes; circumoral and generalized paresthesia
Lightheadedness, syncope, vertigo, blurred vision
May exhibit: Confusion, restlessness, obtunded responses, coma
Hyperactive reflexes, positive Chvostek’s sign, tetany, seizures
Heightened sensitivity to environmental noise and activity
Muscle weakness, unsteady gait
PAIN/DISCOMFORT
May report: Muscle spasms/cramps, epigastric pain, precordial pain (tightness)
RESPIRATION
May report: Dyspnea
History of asthma, pulmonary fibrosis
Recent move/visit to location at high altitude
May exhibit: Tachypnea; rapid, shallow breathing; hyperventilation (often 40 or more respirations/minute)
Intermittent periods of apnea
SAFETY
May exhibit: Fever
TEACHING/LEARNING
May report: Use of salicylates/salicylate overdose, catecholamines, theophylline
Discharge plan
DRG projected mean length of inpatient stay: 5.4 days
May require change in treatment/therapy of underlying disease process/condition
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Arterial pH: Greater than 7.45 (may be near normal in chronic stage).
Bicarbonate (HCO3): Normal or decreased; less than 25 mEq/L (compensatory mechanism).
PaCO2: Decreased, less than 35 mm Hg (primary).
Serum potassium: Decreased.
Serum chloride: Increased.
Serum calcium: Decreased.
Urine pH: Increased, greater than 7.0.
Screening tests as indicated to determine underlying cause, e.g.:
CBC: May reveal severe anemia (decreasing oxygen-carrying capacity).
Blood cultures: May identify sepsis (usually Gram-negative).
Blood alcohol: Marked elevation (acute alcoholic intoxication).
Toxicology screen: May reveal early salicylate poisoning.
Chest x-ray/lung scan: May reveal multiple pulmonary emboli.
NURSING PRIORITIES
1. Achieve homeostatis.
2. Prevent/minimize complications.
3. Provide information about condition/prognosis and treatment needs as appropriate.
DISCHARGE GOALS
1. Physiological balance restored.
2. Free of complications.
3. Condition, prognosis, and treatment needs understood.
4. Plan in place to meet needs after discharge.
Compensatory mechanisms include decreased respiratory rate (if the body is able to respond to the drop in PaCO2), increased renal excretion of bicarbonate, and retention of hydrogen. It is the most frequently occurring acid-base imbalance in hospitalized patients, with the elderly at increased risk because of high incidence of pulmonary disorders and alterations in neurological status.
CARE SETTING
This condition does not occur in isolation, but rather is a complication of a broader problem and usually requires inpatient care in a medical/surgical or subacute unit.
RELATED CONCERNS
Plans of care specific to predisposing factors, e.g.:
Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Cirrhosis of the liver
Craniocerebral trauma
Hyperthyroidism
Fluid and electrolyte imbalances
Heart failure: chronic
Pneumonia: microbial
Sepsis/septicemia
Ventilatory assistance (mechanical)
OTHER CONCERNS
Metabolic acidosis
Metabolic alkalosis
Patient Assessment Database
Dependent on underlying cause.
CIRCULATION
May report: History/presence of anemia
Palpitations
May exhibit: Hypotension
Tachycardia, irregular pulse/dysrhythmias
EGO INTEGRITY
May exhibit: Extreme anxiety (most common cause of hyperventilation)
FOOD/FLUID
May report: Dry mouth
Nausea/vomiting
May exhibit: Abdominal distension (elevating diaphragm as with ascites, pregnancy)
Vomiting
NEUROSENSORY
May report: Headache, tinnitus
Numbness/tingling of face, hands, and toes; circumoral and generalized paresthesia
Lightheadedness, syncope, vertigo, blurred vision
May exhibit: Confusion, restlessness, obtunded responses, coma
Hyperactive reflexes, positive Chvostek’s sign, tetany, seizures
Heightened sensitivity to environmental noise and activity
Muscle weakness, unsteady gait
PAIN/DISCOMFORT
May report: Muscle spasms/cramps, epigastric pain, precordial pain (tightness)
RESPIRATION
May report: Dyspnea
History of asthma, pulmonary fibrosis
Recent move/visit to location at high altitude
May exhibit: Tachypnea; rapid, shallow breathing; hyperventilation (often 40 or more respirations/minute)
Intermittent periods of apnea
SAFETY
May exhibit: Fever
TEACHING/LEARNING
May report: Use of salicylates/salicylate overdose, catecholamines, theophylline
Discharge plan
DRG projected mean length of inpatient stay: 5.4 days
May require change in treatment/therapy of underlying disease process/condition
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Arterial pH: Greater than 7.45 (may be near normal in chronic stage).
Bicarbonate (HCO3): Normal or decreased; less than 25 mEq/L (compensatory mechanism).
PaCO2: Decreased, less than 35 mm Hg (primary).
Serum potassium: Decreased.
Serum chloride: Increased.
Serum calcium: Decreased.
Urine pH: Increased, greater than 7.0.
Screening tests as indicated to determine underlying cause, e.g.:
CBC: May reveal severe anemia (decreasing oxygen-carrying capacity).
Blood cultures: May identify sepsis (usually Gram-negative).
Blood alcohol: Marked elevation (acute alcoholic intoxication).
Toxicology screen: May reveal early salicylate poisoning.
Chest x-ray/lung scan: May reveal multiple pulmonary emboli.
NURSING PRIORITIES
1. Achieve homeostatis.
2. Prevent/minimize complications.
3. Provide information about condition/prognosis and treatment needs as appropriate.
DISCHARGE GOALS
1. Physiological balance restored.
2. Free of complications.
3. Condition, prognosis, and treatment needs understood.
4. Plan in place to meet needs after discharge.
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