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Difficulty: MediumPhysiological Adaptation

An adult client is treated in the emergency department for a severe asthma attack. Following one hour of continuous bronchodilator therapy, the client becomes markedly lethargic. Assessment reveals a "silent chest" with absent wheezing on auscultation and a respiratory rate that has decreased to 1010 breaths/minute. Laboratory analysis shows an arterial pHpH of 7.287.28, PaCO2PaCO_2 of 60 mm Hg60 \text{ mm Hg}, PaO2PaO_2 of 62 mm Hg62 \text{ mm Hg}, and HCO3−HCO_3^- of 24 mEq/L24 \text{ mEq/L}. Based on these clinical findings, which action is the priority?

  1. A
    Increase the supplemental oxygen flow rate to improve arterial oxygenation.
  2. B
    Administer an intravenous dose of sodium bicarbonate to correct the acidosis.
  3. C
    Prompt the client to forcefully cough and use an incentive spirometer.
  4. Gather equipment for rapid sequence intubation and mechanical ventilation.Answer

Answer

The priority action is to gather equipment for rapid sequence intubation and mechanical ventilation.
The client is exhibiting classic signs of impending respiratory failure. In the context of a severe asthma attack, a transition from wheezing and tachypnea to a "silent chest," lethargy, and a dropping respiratory rate indicates that the client is exhausted and no longer moving enough air. The arterial blood gas values confirm acute uncompensated respiratory acidosis. The absolute priority is to secure the airway and initiate mechanical ventilation to restore gas exchange.

Step-by-Step Solution

1
Analyze the client's physical assessment findings.
The client exhibits lethargy, a slowing respiratory rate (1010 breaths/minute), and absent wheezing ("silent chest").
These are ominous signs of respiratory muscle fatigue and impending respiratory failure, indicating that airflow is severely restricted.
2
Interpret the arterial blood gas (ABG) results.
The results show a low pHpH (7.287.28), elevated PaCO2PaCO_2 (60 mm Hg60 \text{ mm Hg}), and normal HCO3−HCO_3^- (24 mEq/L24 \text{ mEq/L}).
This confirms acute uncompensated respiratory acidosis caused by severe hypoventilation and carbon dioxide retention.
3
Determine the priority nursing intervention based on physiological needs.
The client requires immediate artificial airway placement and mechanical ventilation.
According to the ABCs (Airway, Breathing, Circulation), securing the airway and restoring adequate alveolar ventilation is the life-saving priority for a client in acute respiratory failure.

Key Concept

Acute Respiratory Failure and ABG Interpretation in Asthma
Estimated Time:1m 30s
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Topics

Physiological Adaptation

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