Nursing Care Plan Respiratory Alkalosis (Primary Carbonic Acid Deficit)

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

1. Plans of care specific to predisposing factors, e.g.:
2. Anemias (iron deficiency, pernicious, aplastic, hemolytic)
3. Cirrhosis of the liver
4. Craniocerebral trauma
5. Hyperthyroidism
6. Fluid and electrolyte imbalances
7. Heart failure: chronic
8. Pneumonia: microbial
9. Sepsis/septicemia
10. Ventilatory assistance (mechanical)

OTHER CONCERNS

1. Metabolic acidosis
2. Metabolic alkalosis
3. Patient Assessment Database
4. Dependent on underlying cause.

CIRCULATION

May report: 

1. History/presence of anemia
2. Palpitations

May exhibit: 

1. Hypotension
2. Tachycardia, irregular pulse/dysrhythmias

EGO INTEGRITY

May exhibit: 
Extreme anxiety (most common cause of hyperventilation)

FOOD/FLUID

May report: 

1. Dry mouth
2. Nausea/vomiting

May exhibit: 

1. Abdominal distension (elevating diaphragm as with ascites, pregnancy)
2. Vomiting

NEUROSENSORY

May report: 

1. Headache, tinnitus
2. Numbness/tingling of face, hands, and toes; circumoral and generalized paresthesia
3. Lightheadedness, syncope, vertigo, blurred vision

May exhibit: 

1. Confusion, restlessness, obtunded responses, coma
2. Hyperactive reflexes, positive Chvostek’s sign, tetany, seizures
3. Heightened sensitivity to environmental noise and activity
4. Muscle weakness, unsteady gait

PAIN/DISCOMFORT

May report: 
Muscle spasms/cramps, epigastric pain, precordial pain (tightness)

RESPIRATION

May report: 

1. Dyspnea
2. History of asthma, pulmonary fibrosis
3. Recent move/visit to location at high altitude

May exhibit: 

1. Tachypnea; rapid, shallow breathing; hyperventilation (often 40 or more respirations/minute)
2. Intermittent periods of apnea

SAFETY

May exhibit: 
Fever

TEACHING/LEARNING

May report: 

1. Use of salicylates/salicylate overdose, catecholamines, theophylline
2. Discharge plan
3. DRG projected mean length of inpatient stay: 5.4 days
4. May require change in treatment/therapy of underlying disease process/condition
5. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Arterial pH: Greater than 7.45 (may be near normal in chronic stage).
2. Bicarbonate (HCO3): Normal or decreased; less than 25 mEq/L (compensatory mechanism).
3. PaCO2: Decreased, less than 35 mm Hg (primary).
4. Serum potassium: Decreased.
5. Serum chloride: Increased.
6. Serum calcium: Decreased.
7. Urine pH: Increased, greater than 7.0.
8. Screening tests as indicated to determine underlying cause, e.g.:
9. CBC: May reveal severe anemia (decreasing oxygen-carrying capacity).
10. Blood cultures: May identify sepsis (usually Gram-negative).
11. Blood alcohol: Marked elevation (acute alcoholic intoxication).
12. Toxicology screen: May reveal early salicylate poisoning.
13. 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.