A nurse is evaluating a client admitted with a severe exacerbation of chronic obstructive pulmonary disease (COPD). The client's most recent arterial blood gas (ABG) analysis on room air reveals the following results: of , of mm Hg, of mEq/L, and of mm Hg. Based on these physiological values, which clinical manifestations should the nurse anticipate during the physical assessment? Select all that apply.
- Progressive somnolence and decreasing level of consciousnessAnswer
- Bounding peripheral pulsesAnswer
- Diaphoresis accompanied by tachycardiaAnswer
- DCool, pale, and clammy extremities
- EDeep, rapid, and unlabored respiratory pattern
- FPositive Chvostek's sign with carpopedal spasms
Answer
The nurse should anticipate progressive somnolence and decreasing level of consciousness, bounding peripheral pulses, and diaphoresis accompanied by tachycardia.
The correct answers identify the classic physiological manifestations of acute hypercapnic respiratory failure with hypoxemia. Severe hypercapnia ( of mm Hg) causes significant cerebral vasodilation, which increases intracranial pressure and depresses the central nervous system, leading to progressive somnolence. It also causes peripheral vasodilation, resulting in bounding peripheral pulses. Concurrently, the profound hypoxemia ( of mm Hg) and acidemia trigger a compensatory sympathetic nervous system response, manifesting as tachycardia and diaphoresis.
Step-by-Step Solution
Key Concept
In acute uncompensated respiratory acidosis, severe hypercapnia induces both cerebral and peripheral vasodilation (causing somnolence and bounding pulses), while concurrent hypoxemia triggers sympathetic nervous system activation (causing tachycardia and diaphoresis).