A client is admitted to the hospital with an acid base imbalance. Arterial blood gas (ABG) results are: Ph 7.33 (7.35-7.45), PaCO2 49mmHg (35-45mmHg), HCO3 26mEq/L (22-26mEq/L). How should the nurse interpret these results?

a. Monitor blood glucose: Monitoring blood glucose levels may not be directly related to the procedure itself unless the client has a pre-existing condition such as diabetes mellitus. However, it is important to monitor for any changes in blood glucose levels post-procedure, especially if the client received medications such as intravenous dextrose during the procedure.

b. Neurovascular check of lower extremities: Assessing neurovascular status of the lower extremities is crucial after percutaneous coronary revascularization via the left groin site. This procedure involves accessing the femoral artery, which carries the risk of compromising blood flow to the lower extremity. Assessing for pulses, capillary refill, sensation, and motor function helps identify any potential complications such as bleeding, hematoma, or vascular compromise.

c. Check coagulation studies: Checking coagulation studies, such as activated partial thromboplastin time (aPTT) or prothrombin time (PT/INR), may be necessary after percutaneous coronary revascularization, especially if anticoagulant medications such as heparin were used during the procedure. Monitoring coagulation studies helps assess the client's risk of bleeding or thrombosis post-procedure.

d. Continuous ECG monitoring: Continuous electrocardiogram (ECG) monitoring is essential after percutaneous coronary revascularization to monitor for any changes in cardiac rhythm, ST-segment elevation or depression, and ischemic events. This helps identify any potential complications such as arrhythmias, myocardial infarction, or ischemia.

e. Verify contrast dye allergies: Verifying contrast dye allergies is important before performing any procedure involving the use of contrast media, such as percutaneous coronary revascularization. Allergic reactions to contrast dye can range from mild itching or rash to severe anaphylaxis. Identifying any allergies beforehand allows the healthcare team to take appropriate precautions and choose alternative imaging techniques if necessary.

Brain natriuretic peptide (BNP): BNP is a hormone released by the heart in response to increased ventricular pressure and volume overload. It is typically elevated in conditions such as heart failure. While monitoring BNP levels may provide information about cardiac function and volume status, it is not specifically ordered for managing a mechanical valve.

b. Cardiac enzymes: Cardiac enzymes, such as troponin and creatine kinase (CK), are markers of myocardial damage and are typically elevated in conditions such as myocardial infarction. They are not specifically ordered for managing a mechanical valve unless there are signs or symptoms suggestive of myocardial ischemia or infarction.

c. Blood urea nitrogen and creatinine:- Monitoring blood urea nitrogen (BUN) and creatinine levels is important for assessing renal function, especially in individuals at risk of renal impairment due to factors such as medications or underlying conditions. While renal function is important in overall cardiac management, these tests are not specifically ordered for managing a mechanical valve unless there are concerns about renal function due to medications such as anticoagulants.

d. PT/INR (Prothrombin Time/International Normalized Ratio): PT/INR monitoring is crucial for managing patients with mechanical heart valves, as these valves are thrombogenic and increase the risk of thromboembolic events such as stroke or valve thrombosis. Warfarin, an oral anticoagulant, is commonly prescribed to maintain therapeutic anticoagulation. PT/INR monitoring helps ensure that the patient is within the target therapeutic range to prevent both thrombotic and bleeding complications associated with the mechanical valve.