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Difficulty: EasyPhysiological Adaptation

A nurse is assessing the risk profiles of several clients on a medical-surgical unit. Which of the following clients are at greatest risk for developing respiratory acidosis? (Select all that apply.)

  1. A client who received a large dose of intravenous hydromorphone.Answer
  2. B
    A client experiencing a severe panic attack with rapid, deep breathing.
  3. C
    A client who has had severe watery diarrhea for the past three days.
  4. A client with a high cervical spinal cord injury affecting diaphragmatic function.Answer

Answer

The clients at greatest risk for respiratory acidosis are the one who received intravenous hydromorphone and the one with a high cervical spinal cord injury.
Respiratory acidosis develops when there is compromised alveolar ventilation (hypoventilation), leading to the accumulation and retention of carbon dioxide in the blood. Central nervous system depressants like hydromorphone reduce the respiratory drive. High cervical spinal cord injuries impair the neural control of the diaphragm, leading to inadequate lung expansion and poor gas exchange. Both of these mechanisms lead to elevated carbon dioxide levels and respiratory acidosis.

Step-by-Step Solution

1
Identify the physiological mechanism that causes respiratory acidosis.
Respiratory acidosis is caused by hypoventilation, which leads to the retention and accumulation of carbon dioxide in the bloodstream.
Understanding the underlying etiology is essential to identify which clinical conditions place clients at risk.
2
Evaluate each client's condition to determine if it causes hypoventilation.
Hydromorphone (an opioid) suppresses the respiratory center in the brain, and a high cervical spinal injury impairs the neural control of the diaphragm. Both conditions cause hypoventilation.
Conditions that impair the respiratory drive or mechanics of breathing directly lead to respiratory acidosis.
3
Identify conditions that cause alternative acid-base imbalances to eliminate them as options.
A panic attack causes hyperventilation (respiratory alkalosis), and severe diarrhea causes bicarbonate loss (metabolic acidosis).
Recognizing the causes of other imbalances ensures the correct options are selected.

Key Concept

Etiology of Respiratory Acidosis
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Topics

Physiological Adaptation

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