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Zorluk: Çok zorReduction of Risk Potential

A preceptor is evaluating a newly licensed nurse who is caring for a 64-year-old client. The client is mechanically ventilated for severe acute respiratory distress syndrome (ARDS) and is in the early stages of septic shock. Which actions by the newly licensed nurse require the preceptor to intervene immediately to reduce the client's risk of life-threatening complications? (Select all that apply)

  1. Interpreting an arterial blood gas result of pHpH 7.507.50, PaCO2PaCO_2 29 mm Hg29\text{ mm Hg}, and HCO3−HCO_3^- 22 mEq/L22\text{ mEq/L} as metabolic alkalosis and independently decreasing the intravenous fluid rateCevap
  2. Documenting a blood pressure trend from 118/76 mm Hg118/76\text{ mm Hg} to 102/82 mm Hg102/82\text{ mm Hg} over one hour as a sign of hemodynamic stabilization and deferring provider notificationCevap
  3. Placing the client in a strict supine position at a 0∘0^\circ angle for 45 minutes45\text{ minutes} to facilitate a comprehensive physical assessment and complete linen changeCevap
  4. D
    Delaying the administration of a newly prescribed intravenous broad-spectrum antibiotic by 15 minutes15\text{ minutes} to first obtain ordered peripheral blood cultures
  5. E
    Pausing the continuous enteral nutritional infusion before temporarily lowering the head of the bed to reposition the client
  6. F
    Performing in-line endotracheal suctioning only when coarse crackles are auscultated over the trachea, rather than on a fixed hourly schedule

Cevap

The preceptor must intervene when the newly licensed nurse misinterprets the ABG as metabolic alkalosis, documents a narrowing pulse pressure as hemodynamic stabilization, and places the mechanically ventilated client in a strict supine position.
The correct selections represent dangerous clinical errors that require immediate preceptor intervention. First, the ABG reveals uncompensated respiratory alkalosis (elevated pHpH, decreased PaCO2PaCO_2), not metabolic alkalosis. Decreasing intravenous fluids in a septic client based on this error could precipitate profound hypovolemia. Second, a blood pressure trend from 118/76 mm Hg118/76\text{ mm Hg} to 102/82 mm Hg102/82\text{ mm Hg} represents a narrowing pulse pressure (from 4242 to 2020). This is a subtle, early sign of compensatory shock, not hemodynamic stabilization. Finally, placing a mechanically ventilated client with ARDS flat (0∘0^\circ) for an extended period severely increases the risk of ventilator-associated pneumonia and immediate hypoxemia.

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1
Analyze the ABG results (pHpH 7.507.50, PaCO2PaCO_2 2929, HCO3−HCO_3^- 2222).
The high pHpH indicates alkalosis, and the low PaCO2PaCO_2 identifies it as respiratory, not metabolic.
Accurate ABG interpretation is critical; decreasing fluids in sepsis based on a misinterpretation can precipitate profound hypovolemia.
2
Calculate the pulse pressure for the blood pressure trend (118/76118/76 vs 102/82102/82).
The pulse pressure narrowed from 42 mm Hg42\text{ mm Hg} to 20 mm Hg20\text{ mm Hg}.
A narrowing pulse pressure is a subtle but critical early indicator of compensatory shock, signaling a decreasing stroke volume.
3
Evaluate the safety of placing a mechanically ventilated client at a 0∘0^\circ angle.
Strict supine positioning is contraindicated.
It significantly increases the risk of aspiration and ventilator-associated pneumonia (VAP), especially in clients with ARDS.
4
Review the remaining actions (cultures before antibiotics, pausing tube feeds before repositioning, and PRN suctioning).
These are all evidence-based, correct nursing actions.
The preceptor does not need to intervene when safe and appropriate care is provided.

Anahtar Kavram

Identifying subtle indicators of physiological decompensation and correcting unsafe clinical actions to prevent life-threatening complications.
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Konular

Reduction of Risk Potential

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