A client is recovering in the surgical step-down unit hours after a right-sided pneumonectomy for lung cancer. The client is receiving oxygen at L/min via nasal cannula. The client reports incisional pain of on a - scale and is taking shallow breaths. The nurse evaluates the most recent arterial blood gas (ABG) results:
| Parameter | Client Result | Reference Range |
|---|---|---|
| pH | - | |
| PaCO | mm Hg | - mm Hg |
| HCO | mEq/L | - mEq/L |
| PaO | mm Hg | - mm Hg |
Based on these clinical findings, which action should the nurse take first to reduce the client's risk of respiratory compromise?
- AAssist the client into a left lateral decubitus position to maximize perfusion to the remaining lung.
- BIncrease the supplemental oxygen flow rate to L/min to rapidly treat the hypoxemia.
- Administer the prescribed analgesic and encourage the use of an incentive spirometer.Answer
- DAdminister the prescribed intravenous sodium bicarbonate to correct the acid-base disturbance.
Answer
The priority action is to administer the prescribed analgesic and encourage the use of an incentive spirometer to improve ventilation.
The arterial blood gas results demonstrate uncompensated respiratory acidosis (low pH, elevated PaCO2, normal HCO3-), indicating that the client is hypoventilating. Postoperative incisional pain frequently causes clients to take shallow breaths (splinting), which leads to carbon dioxide retention. The priority action is to treat the pain with analgesics so the client can effectively participate in deep breathing exercises and incentive spirometry. This will increase alveolar ventilation, blow off the excess carbon dioxide, and correct the acidosis.
Step-by-Step Solution
Key Concept
Postoperative respiratory acidosis and post-pneumonectomy safety precautions