A 58-year-old client is admitted with a severe acute asthma exacerbation. The client is diaphoretic, restless, and using accessory muscles to breathe. The nurse reviews two sets of arterial blood gas (ABG) results drawn two hours apart on room air:
Initial ABG: pH 7.51, PaCO2 28 mm Hg, PaO2 74 mm Hg
Current ABG: pH 7.37, PaCO2 44 mm Hg, PaO2 59 mm Hg
Based on these clinical findings and the ABG trend, which action should the nurse anticipate immediately to reduce the risk of a severe physiological complication?
- Preparing the client for immediate endotracheal intubation and mechanical ventilationCevap
- BInitiating a rapid intravenous fluid bolus to treat impending hypovolemic shock
- CDocumenting the values as clinical improvement and continuing current therapies
- DPositioning the client flat in a supine position to promote uniform gas exchange
Cevap
The correct action is to prepare the client for immediate endotracheal intubation and mechanical ventilation.
The initial ABG demonstrated respiratory alkalosis, which is an expected compensatory response to hypoxemia in early asthma attacks as the client hyperventilates. However, the subsequent ABG shows a rising PaCO2 (now 44 mm Hg) and a falling pH (7.37), despite continued severe clinical distress. This phenomenon, known as 'pseudonormalization', indicates that the client's respiratory muscles are severely fatigued and they are no longer able to maintain the excessive work of breathing. This is a critical warning sign of impending acute respiratory failure and respiratory arrest. The nurse must immediately prepare to secure the airway through intubation and mechanical ventilation to reduce the risk of a fatal outcome.
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Pseudonormalization of ABGs in Asthma