Retaining Ray — Respiratory Acidosis
COPD, CO₂ narcosis, pH ↓ · PaCO₂ ↑
Ray has carried a barrel chest and a pack-a-day habit for forty years. When bronchitis hits, the air goes in but refuses to come out, and the CO₂ that builds up puts him quietly to sleep.
Ray cannot get carbon dioxide out. Barrel chest, pursed-lip breathing and a slow slide into somnolence as CO₂ climbs. Labs: pH < 7.35 with PaCO₂ > 45 and a compensating bicarbonate. Support ventilation — sedatives and high-flow oxygen without monitoring make him worse.
Read Retaining Ray's full story →The story arc
The setup
Forty years of smoking leave Ray with air trapped behind narrowed, floppy airways. He breathes through pursed lips to keep them open.
The turn
A chest infection thickens his secretions; he stops finishing sentences and his headache starts in the morning.
The crisis
Someone turns his oxygen to 6 L/min. An hour later he is drowsy, flushed and flapping his hands.
The save
Oxygen is dialed back, BiPAP goes on, secretions are cleared, and the nurse holds the ordered sedative.
NCLEX study section — Respiratory Acidosis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.