Nursing Care Plan Respiratory Alkalosis (Primary Carbonic Acid Deficit)

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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.


  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)


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


May report: 
  1. History/presence of anemia
  2. Palpitations

May exhibit: 
  1. Hypotension
  2. Tachycardia, irregular pulse/dysrhythmias


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


May report: 
  1. Dry mouth
  2. Nausea/vomiting

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


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


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


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


May exhibit: 


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.


  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.


  1. Achieve homeostatis.
  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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