A client, age 82, with advanced emphysema and cor pulmonale is receiving treatment for hospital-acquired pneumonia. The client is currently prescribed continuous supplemental oxygen at 4 L/min via nasal cannula. During an assessment, the nurse finds the client somnolent, difficult to arouse, and taking 9 shallow breaths per minute. The most recent arterial blood gas analysis reveals a pH of 7.24, PaCO2 of 74 mm Hg, PaO2 of 56 mm Hg, and HCO3 of 32 mEq/L. Based on these clinical findings, which immediate intervention should the nurse implement?
- Activate the rapid response team and prepare to initiate manual positive-pressure ventilation.Cevap
- BIncrease the oxygen flow rate to 6 L/min to correct the hypoxemia.
- CPlace the client in a supine position to maximize pulmonary perfusion.
- DAdminister a prescribed intravenous loop diuretic to reduce right ventricular workload.
Cevap
The most appropriate action is to activate the rapid response team and prepare to initiate manual positive-pressure ventilation.
The client is exhibiting classic signs of CO2 narcosis (somnolence, bradypnea) and acute respiratory failure, as evidenced by the severe respiratory acidosis on the ABG analysis. In clients with advanced COPD, excessive supplemental oxygen (such as 4 L/min) can eliminate their hypoxic drive to breathe. The immediate priority is to secure the airway, assist ventilation to eliminate excess carbon dioxide, and summon emergency assistance.
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Anahtar Kavram
Hypercapnic Respiratory Failure and CO2 Narcosis in COPD