Nursing Care Plan Respiratory Acidosis (Primary Carbonic Acid Excess)

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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.


  1. Plans of care specific to predisposing factors/disease or medical condition, e.g.:
  2. Cerebrovascular accident (CVA)/stroke
  3. Chronic obstructive pulmonary disease (COPD) and asthma
  4. Craniocerebral trauma (acute rehabilitative phase)
  5. Eating disorders: obesity
  6. Alcohol: acute withdrawal
  7. Spinal cord injury (acute rehabilitative phase)
  8. Surgical intervention
  9. Ventilatory assistance (mechanical)


  1. Fluid and electrolyte imbalances
  2. Metabolic acidosis
  3. Metabolic alkalosis
  4. Patient Assessment Database
  5. Dependent on underlying cause. Findings vary widely.


May report: 
Fatigue, mild to profound

May exhibit: 
Generalized weakness, ataxia/staggering, loss of coordination (chronic), to stupor


May exhibit: 
  1. Low BP/hypotension with bounding pulses, pinkish color, warm skin (reflects vasodilation of severe acidosis)
  2. Tachycardia, irregular pulse (other/various dysrhythmias)
  3. Diaphoresis, pallor, and cyanosis (late stage)


May report: 


May report: 
  1. Feeling of fullness in head (acute—associated with vasodilation)
  2. Headache, dizziness, visual disturbances

May exhibit: 
  1. Confusion, apprehension, agitation, restlessness, somnolence; coma (acute)
  2. Tremors, decreased reflexes (severe)


May report: 
Shortness of breath; dyspnea with exertion

May exhibit: 
  1. Respiratory rate dependent on underlying cause, i.e., decreased in respiratory center depression/ muscle paralysis; otherwise rate is rapid/shallow
  2. Increased respiratory effort with nasal flaring/yawning, use of neck and upper body muscles
  3. Decreased respiratory rate/hypoventilation (associated with decreased function of respiratory center as in head trauma, oversedation, general anesthesia, metabolic alkalosis)
  4. Adventitious breath sounds (crackles, wheezes); stridor, crowing


  1. Refer to specific plans of care reflecting individual predisposing/contributing factors.
  2. Discharge plan
  3. DRG projected mean length of inpatient stay: 4.9 days
  4. May require assistance with changes in therapies for underlying disease process/condition
  5. Refer to section at end of plan for postdischarge considerations.


  1. ABGs: PaO2: Normal or may be low. Oxygen saturation (SaO2) decreased.
  2. PaCO2: Increased, greater than 45 mm Hg (primary acidosis).
  3. Bicarbonate (HCO3): Normal or increased, greater than 26 mEq/L (compensated/chronic stage).
  4. Arterial pH: Decreased, less than 7.35.
  5. Electrolytes: Serum potassium: Typically increased.
  6. Serum chloride: Decreased.
  7. Serum calcium: Increased.
  8. Lactic acid: May be elevated.
  9. Urinalysis: Urine pH decreased.
  10. Other screening tests: As indicated by underlying illness/condition to determine underlying cause.


  1. Achieve homeostasis.
  2. Prevent/minimize complications.
  3. Provide information about condition/prognosis and treatment needs as appropriate.


  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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