Respiratory Alkalosis Nursing Diagnosis and Nursing Care Plan

Last updated on April 30th, 2023 at 09:30 am

Respiratory Alkalosis Nursing Care Plans Diagnosis and Interventions

Respiratory Alkalosis NCLEX Review and Nursing Care Plans

Respiratory alkalosis is a condition that happens when the blood lacks sufficient carbon dioxide; this condition is also known as hypocapnia.

When one exhales, the body emits carbon dioxide. The faster a person breathes, the lower the carbon dioxide level in the blood, which can lead to respiratory alkalosis.

Hyperventilation also causes respiratory alkalosis, which occurs when a person breathes deeply or rapidly.

The following are some potential underlying causes of hyperventilation that can result in respiratory alkalosis:

Signs and Symptoms of Respiratory Alkalosis

Hyperventilation or heavy breathing indicates the presence of respiratory alkalosis. Low carbon dioxide levels in the blood, on the other hand, have a variety of physical effects, including:

  • respiratory distress.
  • loss of coordination
  • numbness or tingling sensations in the fingers, toes, or lips
  • psychomotor retardation
  • dizziness or lightheadedness
  • muscle twitching or muscle cramps.
  • lethargy
  • fainting (syncope)
  • chest pain
  • breathing difficulty
  • tremors
  • cognitive dissonance

Causes of Respiratory Alkalosis

Doctors usually classify the possible factors of respiratory alkalosis into three categories. All of these factors contribute to hyperventilation or rapid breathing.

These three categories are as follows:

  • Causes of respiratory alkalosis that relate to a medical condition:
    • atrioventricular flutter
    • panic attack
    • hepatic disease
    • Pneumothorax is caused by air in the pleural space, resulting in a punctured lung.
    • embolism of the lungs
    • salicylate medication overdose
    • Pregnancy is also one of the contributing factors to respiratory alkalosis. During pregnancy, women typically breathe faster during the third trimester because of the metabolic requirements of the developing fetus. That is how respiratory alkalosis happens in gestation.
  • Causes of respiratory alkalosis that are accidentally induced. A person receiving ventilator-assisted breathing may occasionally exhibit signs of respiratory alkalosis. Accidentally-induced causes of respiratory alkalosis happen when the ventilator is supplying too many or too substantial breaths, causing the patient to expel excess carbon dioxide. This situation causes respiratory alkalosis.
  • Causes of respiratory alkalosis, which may be intentionally induced for therapeutic purposes. If a patient experiences a medical condition that causes acidosis, their ventilator settings may be changed to help them breathe off excessive carbon dioxide. This technique can help restore a patient’s pH levels to normal. After a head injury, for example, a doctor might do this. If a patient’s body cannot keep a regular breathing pattern, respiratory alkalosis may benefit the brain.

Other possible causes include:

  • Tissue hypoxia (hypoxemia)
  • Pneumonia
  • foreign body, food, or vomitus aspiration
  • pulmonary embolism
  • bronchospasm or laryngospasm
  • drowning
  • anemia
  • high elevation
  • cardiac disease
  • hypotension or circulatory failure

Risk Factors to Respiratory Alkalosis

The following are common risk factors for the development of respiratory alkalosis:

Less common risk factors for respiratory alkalosis development include:

  • certain medications
  • poisoning or overdose

People who have intense repetitions of anxiety, stress, panic, or despair are more likely to develop respiratory alkalosis. These circumstances can result in rapid, unmanaged respiration (hyperventilation).

Patients who use respiratory support (breathing machines) are also at risk. When patients breathe rapidly, the machines deliver a fixed breath volume for each breath, which can cause hyperventilation. As a critically ill person’s medical needs change, he or she may require more or less breathing assistance. Continuous monitoring assists healthcare providers in determining when to change ventilator settings.

Complications of Respiratory Alkalosis

  • Acute asthma. Hyperventilation can cause respiratory alkalosis in the early stages of acute asthma. This is because obstructed lung units (slow compartment) are less abundant than unobstructed lung units (fast compartment). Carbon dioxide can be removed from the fast compartment through hyperventilation.
  • Arrhythmia. Rapid breathing contributes significantly to hyperventilation and respiratory alkalosis, which are common in patients with arrhythmia. Hyperventilation not only causes arrhythmia, but it can also cause other frightening symptoms such as heart palpitations and dizziness.
  • Febrile Seizure. According to new research, febrile seizures in children may be linked to respiratory alkalosis, characterized by increased blood pH and reduced carbon dioxide levels caused by hyperventilation, regardless of the extent of the underlying illness.
  • Cystic Fibrosis. Because of the abnormal electrolyte transport system in cystic fibrosis, the cells in the respiratory system, particularly the lungs, absorb excessive sodium and water. This condition causes the usually thin lung secretions to thicken and become difficult to move. These thick secretions raise the likelihood of frequent respiratory illnesses.
  • Pneumonia and Pulmonary embolism. Respiratory alkalosis is common in asthma, pneumonia, or pulmonary embolism patients.
  • Coma and Death. Respiratory alkalosis could be fatal if it is not managed immediately.

Diagnosis of Respiratory Alkalosis

  • Laboratory Tests
    • Arterial Blood Gas Test. An arterial blood gas (ABG) test is a blood test that measures the levels of oxygen and carbon dioxide in the blood by obtaining a sample from an artery in the body. The test also examines the balance of acids and bases in the blood, known as the pH balance.
    • Serum chemistry. Acute respiratory alkalosis alters electrolyte balances slightly. Minor changes in intracellular sodium, potassium, and phosphate occur during respiratory alkalosis. Because of the increased protein-bound fraction, there is also a minor decrease in free calcium. Increased renal excretion of bicarbonate compensates for respiratory alkalosis.
    • Complete blood cell count. An increase in WBC count may indicate early sepsis as a potential cause of respiratory alkalosis. A low hematocrit level may imply iron deficiency anemia as a possible cause of respiratory alkalosis.
    • Test for liver function. If hepatic failure is the cause of respiratory alkalosis, there could be aberrant findings in the liver function test.
    • Blood, sputum, urine, and other site cultures. These laboratory tests should be considered based on the data gathered from the history and physical examination, as well as whether sepsis or bacteremia is suspected as the main reason for the respiratory alkalosis.
    • Thyroid examination. Testing the presence of thyroid-stimulating hormone and thyroxine levels is essential to rule out hyperthyroidism.
  • Imaging Studies
  • Chest radiography. Chest radiography is beneficial to rule out respiratory disorders as a cause of hypocapnia and respiratory alkalosis. Chest radiography findings may verify potential etiological factors such as pneumonia, pulmonary embolism, aspiration pneumonitis, pneumothorax, and interstitial lung diseases.
    • Computerized tomography (CT) scanning. If chest radiography findings are ambiguous or a pulmonary disorder is strongly considered a differential diagnosis, CT Scan could be beneficial. CT scanning is more sensitive for detecting disease, and the results may reveal irregularities not visible on a chest radiograph. If pulmonary embolism is suspected, consider spiral CT angiography of the chest. Consider a brain CT scan if a fundamental cause of hyperventilation and respiratory alkalosis is suspected. Based on brain CT scan findings, cerebrovascular accidents, central nervous system malignancies, trauma, or injuries are all possible etiologies.
    • Ventilation perfusion scanning. Suggest this scan in patients unable to have an intravenous contrast injection as part of the procedure of CT scan to screen for pulmonary embolism.
    • Magnetic resonance imaging (MRI) of the brain. The doctor may recommend a brain MRI if a significant cause of hyperventilation and respiratory alkalosis is suspected, and the preliminary brain CT scan findings are negative or unclear. MRIs detect abnormalities that CT scans cannot, notably brain stem lesions. Based on MRI findings, possible etiologies include cerebrovascular accident, central nervous system malignancies, and CNS injuries.

Treatment of Respiratory Alkalosis

The following are the pharmacological and nonpharmacological treatments used in respiratory alkalosis:

  • Medications
    • Bronchodilators. Bronchodilators are medications that relax the lungs and keep the airways open.
    • Anxiolytics and opioid pain relievers. The doctor may prescribe an opioid pain reliever or anti-anxiety medication to relieve hyperventilation.
  • Medical Procedures or Therapy
  • Oxygen Therapy. It is beneficial to provide oxygen to patients to keep them from hyperventilating.
    • Cardioversion using direct current. Repairing any abnormal heart rhythms with medications or direct current cardioversion, which uses an electric shock, is beneficial to reset the heart’s rhythm.
  • Non-Pharmacological Treatments. The following techniques can be incorporated in the health care teaching plan of a patient with respiratory alkalosis.
  • Breathing into a brown paper bag.
    • Exhale into the paper bag to fill it with carbon dioxide.
    • Breathe the bag’s exhaled air back into the lungs.
    • Advise the patient to perform this technique several times during hyperventilation episodes. This nonpharmacological management of hyperventilation can provide the body with the necessary carbon dioxide and restore levels to normal.
  • Relaxation techniques. Relaxation or breathing techniques. Relaxation and breathing techniques are some of the most beneficial nonpharmacological management for hyperventilation or respiratory alkalosis. These techniques can help prevent stress and anxiety, which may induce hyperventilation. These methods are also beneficial in helping the patient to relax and prevent breathing difficulties.
  • Lifestyle modifications. Maintaining good health, eating a healthy diet, and staying hydrated can reduce the likelihood of developing respiratory alkalosis. Living a healthy lifestyle is beneficial in the management of any medical condition.

The treatment for respiratory alkalosis is determined by a medical professional and depends on the underlying cause. If the patient’s breathing is under control but has other alkalosis manifestations, the patient should seek medical attention immediately. If the patient suffers from panic or anxiety-related hyperventilation, the symptoms of respiratory alkalosis can be frightening. Anxiety-related hyperventilation frequently leads to faster breathing, exacerbating the situation. Uncontrolled breathing frequently necessitates immediate medical attention in a hospital.

Nursing Diagnosis for Respiratory Alkalosis

Nursing Care Plan for Respiratory Alkalosis 1

Impaired Gas Exchange

Nursing Diagnosis: Impaired Gas Exchange related to respiratory alkalosis secondary to Chronic Obstructive Pulmonary Disease (COPD) as evidenced by shortness of breath, irregular breathing, confusion, anxiousness, incapacity to move secretions, aberrant ABG values (lack of oxygen and hypercapnia), alteration in vital signs, and decreased tolerance for activity.

Desired Outcomes:

  • The patient’s ABGs will show improved air circulation, sufficient oxygenation of tissues within the patient’s normal range, and the patient will be free of respiratory distress manifestations.
  • The patient will participate in the treatment plan to the best of their ability or situation.
Respiratory Alkalosis Nursing InterventionsRationale
Evaluate and document the patient’s respiratory rate and depth.        Take note of the usage of accessory muscles, the pursed lips, and the inability to communicate or engage in conversation. This intervention determines the level of respiratory distress or the severity and duration of the disease process.
Educate the patient on the importance of sputum expectoration and suction as necessary.  Thick, tenacious, and profuse secretions constitute a significant cause of obstructed gas exchange in air passages. When coughing is ineffective for secretion expectoration, deep suctioning may be required.
Evaluate and routinely monitor the patient’s skin and mucous membrane color.  Cyanosis can be either peripheral (found in the nail beds) or central (noted around lips or earlobes). Duskiness and central cyanosis indicate developed hypoxemia.
Determine the patient’s activity tolerance. Maintain a calm and quiet environment for the patient. During the acute phase, limit the patient’s activity and encourage bed or chair rest. Allow the patient to resume activity and start increasing as tolerated progressively.  Because of hypoxemia and dyspnea, a patient in severe, acute, or refractory respiratory distress may be completely unable to perform basic self-care activities. Rest, interspersed with care activities, is still essential to the treatment plan. An exercise program can improve one’s well-being by enhancing strength and stamina without causing severe dyspnea.
As necessary, give the patient humidified oxygen.  Giving patients humidified oxygen inhibits the airways from drying out, reduces convective moisture losses, and enhances compliance.
As directed, provide the patient with noninvasive positive pressure ventilation (NIPPV).During the first 4 hours of treatment, noninvasive positive pressure ventilation can reduce PacO2, increase blood pH, and reduce symptoms of severe dyspnea.

Nursing Care Plan for Respiratory Alkalosis 2

Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to respiratory alkalosis secondary to bronchial asthma as evidenced by unusual breathing rate, bradypnea, shortness of breath, rhinorrhea, difficulty breathing, pursed-lip respiration, and the utilization of accessory muscles to gasp for air.

Desired Outcomes:

  • The patient’s breathing pattern will be effective, as evidenced by comfortable breathing at average depth and rate, and they will exhibit no dyspnea.
  • The patient’s respiratory rate will remain within the established range.
  • The patient’s ABG levels will return to and remain within acceptable limits.
Respiratory Alkalosis Nursing InterventionsRationale
Position the patient with proper body alignment for the best breathing pattern.Sitting enables maximum chest expansion and lung excursion.  
Encourage the patient to take long, deep breaths. Among the techniques are the following: demonstrating slow breathing, holding end inspiration for a few seconds, and passive respiration;making use of an incentive spirometer andforcing the patient to yawn    Deep inspiration is encouraged by these techniques, which tend to increase oxygenation and preclude respiratory distress. Proper breathing techniques may also help tachypneic patients with slow respirations. Sustained expiration prevents air from being trapped.  
Assess the effectiveness of respiratory muscles training.      This training enhances breathing muscle control and respiratory muscle strength.  
Encourage the patients with bronchial asthma to perform diaphragmatic breathing techniques.  This method relaxes muscles while increasing oxygen levels in the patient.  
As directed by the doctor, administer respiratory medications and oxygen to the patient.    Beta-adrenergic agonist medications relax the bronchial smooth muscle and cause bronchodilation, which opens the airways.

Nursing Care Plan for Respiratory Alkalosis 3

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Breathing Pattern related to respiratory alkalosis secondary to bronchial asthma as evidenced by unusual breathing rate, bradypnea, shortness of breath, rhinorrhea, difficulty breathing, pursed-lip respiration, and the utilization of accessory muscles to gasp for air.

Desired Outcomes:

  • The patient’s breathing pattern will be effective, as evidenced by comfortable breathing at average depth and rate, and they will exhibit no dyspnea.
  • The patient’s respiratory rate will remain within the established range.
  • The patient’s ABG levels will return to and remain within acceptable limits.
Respiratory Alkalosis Nursing InterventionsRationale
Examine the patient’s respiratory rate and evaluate if the patient experiences respiration difficulties.Respiratory distress can occur due to cardiac pump failure or ischemic pain. Nonetheless, sudden or persistent dyspnea may indicate thromboembolic pulmonary complications.  
Look for symptoms of decreased tissue perfusion in the patient.  Specific clusters of signs and symptoms occur for a variety of reasons. The evaluation of the defining characteristics of ineffective tissue perfusion serves as a foundation for future comparison.  
Examine possible contributing factors to momentarily ineffective tissue perfusion.Early detection of the cause of ineffective tissue perfusion allows for prompt and efficient management.
As directed, submit the patient to diagnostic testing.  Depending on the cause of the impaired tissue perfusion, the doctor may recommend various tests for the patient.  
Describe to the patient all treatments and procedures for ineffective tissue perfusion.Understanding anticipated events and sensations can help reduce the patient’s anxiety caused by the unknown.

Nursing Care Plan for Respiratory Alkalosis 4

Acute Confusion

Nursing Diagnosis: Acute Confusion related to respiratory alkalosis secondary to idiopathic pulmonary fibrosis as evidenced by brain fog (forgetfulness or inability to think clearly), cognitive impairment, and worst quality of life.

Desired Outcomes:

  • The patient’s delirium episodes will subside.
  • The patient’s reality orientation and level of consciousness will return to normal.
  • The patient will verbalize understanding of the potential causes.
  • The patient will initiate lifestyle or behavioral modifications to prevent or reduce the recurrence of the situation.
  • The patient will engage in activities of daily living (ADLs).
Respiratory Alkalosis Nursing InterventionsRationale
Orient the patient to his or her surroundings, staff, and any necessary tasks. Present the facts succinctly and briefly. Prevent challenging illogical thinking because it may lead to defensive reactions.Increased orientation provides the patient with a higher level of safety.  
Adjust sensory exposure of the patient. Create a calm environment for the patient by eliminating unnecessary noise and stimuli.The confused patient may misinterpret elevated levels of auditory and visual stimulation.  
Encourage family members or significant others to participate in reorientation and to provide ongoing feedback.The confused patient may not fully comprehend what is going on. The presence of family and significant others may make the patient feel more at ease.  
Assist the family and other significant persons in improving coping strategies.  The family must allow the patient to do everything possible to maximize the patient’s quality of life and level of functioning.  
Teach the patient’s family to acknowledge early confusion symptoms and seek medical attention.Early detection helps to avoid long-term complications.
Assess the patient’s degree of impairment in orientation, ability to focus and follow instructions, receive or send communication, and response appropriateness.This intervention aims to ascertain the extent of confusion.  

Nursing Care Plan for Respiratory Alkalosis 5

Risk for Injury

Nursing Diagnosis: Risk for Injury related to respiratory alkalosis secondary to interstitial lung disease.

As a Nursing Diagnosis, the Risk for Injury is not supported by any signs and symptoms because the problem has not yet occurred, and nursing interventions are aimed at prevention.

Desired Outcome: The patient will show no signs of injury, with complications substantially reduced or managed.

Respiratory Alkalosis Nursing InterventionsRationale
Bring the patient’s attention to their surroundings. Install a call light and teach the patient how to use it.To avoid accidents, the patient should be familiar with the structure of the environment. Objects that are too far away from the patient may pose a risk.
Increase safety by utilizing medical alarm systems. Recognize and avoid alarm fatigue.    Medical alert systems are activated to notify emergency personnel that a patient is suffering from physiological changes that necessitate immediate treatment. Alarm fatigue, a common safety concern in health care facilities, occurs when an overwhelming amount of monitor alarm systems overtakes the health care provider, causing critical clinical alarms to be missed.
To reduce the patient’s chances of falling or pulling out tubes, ask family or significant others to accompany them.This intervention aims to keep the patient from injuring himself, falling, or pulling out tubes. Family members and significant others of hospitalized patients are essential in ensuring patient safety and protecting their loved ones from possible medication errors.
Examine the patient for changes in his or her medical status and cognitive awareness.A patient’s general health change may increase their risk of injury. For example, a patient suffering from a chronic illness may experience intense confusion, restlessness, and memory problems, putting them at risk of falling or injury. Certain medicines may also impair a patient’s judgment.
Label all medications for lung diseases, drug containers (medicine cups, bottles, syringes, basins), or other solutions on or off the sterile area.  To be considered safe, any medicines or solutions removed from their original container and transmitted to another canister must be labeled correctly. Throw away any unlabeled medications or solutions. Label medications or solutions that will not be administered urgently. The following information should be included on the label: drug name or solution, concentration, the quantity of medication, diluent name, and volume.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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