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.
- 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)
- Fluid and electrolyte imbalances
- Metabolic acidosis
- Metabolic alkalosis
- Patient Assessment Database
- Dependent on underlying cause. Findings vary widely.
Fatigue, mild to profound
Generalized weakness, ataxia/staggering, loss of coordination (chronic), to stupor
- Low BP/hypotension with bounding pulses, pinkish color, warm skin (reflects vasodilation of severe acidosis)
- Tachycardia, irregular pulse (other/various dysrhythmias)
- Diaphoresis, pallor, and cyanosis (late stage)
- Feeling of fullness in head (acute—associated with vasodilation)
- Headache, dizziness, visual disturbances
- Confusion, apprehension, agitation, restlessness, somnolence; coma (acute)
- Tremors, decreased reflexes (severe)
Shortness of breath; dyspnea with exertion
- Respiratory rate dependent on underlying cause, i.e., decreased in respiratory center depression/ muscle paralysis; otherwise rate is rapid/shallow
- Increased respiratory effort with nasal flaring/yawning, use of neck and upper body muscles
- Decreased respiratory rate/hypoventilation (associated with decreased function of respiratory center as in head trauma, oversedation, general anesthesia, metabolic alkalosis)
- Adventitious breath sounds (crackles, wheezes); stridor, crowing
- Refer to specific plans of care reflecting individual predisposing/contributing factors.
- Discharge plan
- DRG projected mean length of inpatient stay: 4.9 days
- May require assistance with changes in therapies for underlying disease process/condition
- Refer to section at end of plan for postdischarge considerations.
- ABGs: PaO2: Normal or may be low. Oxygen saturation (SaO2) decreased.
- PaCO2: Increased, greater than 45 mm Hg (primary acidosis).
- Bicarbonate (HCO3): Normal or increased, greater than 26 mEq/L (compensated/chronic stage).
- Arterial pH: Decreased, less than 7.35.
- Electrolytes: Serum potassium: Typically increased.
- Serum chloride: Decreased.
- Serum calcium: Increased.
- Lactic acid: May be elevated.
- Urinalysis: Urine pH decreased.
- Other screening tests: As indicated by underlying illness/condition to determine underlying cause.
- Achieve homeostasis.
- Prevent/minimize complications.
- Provide information about condition/prognosis and treatment needs as appropriate.
- Physiological balance restored.
- Free of complications.
- Condition, prognosis, and treatment needs understood.
- Plan in place to meet needs after discharge.