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. Dopamine: Dopamine is a medication that primarily acts as a vasopressor and inotropic agent. While it can increase cardiac contractility and improve cardiac output, it does not directly decrease afterload. In fact, dopamine may increase systemic vascular resistance (afterload) at higher doses.

b. Warfarin: Warfarin is an anticoagulant medication used to prevent blood clot formation, particularly in individuals with certain cardiac conditions such as atrial fibrillation or mechanical heart valves. While warfarin is important for preventing thromboembolic events in individuals with mitral valve regurgitation, it does not directly affect afterload.

c. Digoxin: Digoxin is a medication that primarily acts as a positive inotropic agent by increasing myocardial contractility. While it can improve cardiac function, particularly in individuals with heart failure, it does not directly decrease afterload.

d. Lisinopril: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor medication that reduces blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By reducing angiotensin II levels, lisinopril dilates blood vessels and decreases systemic vascular resistance (afterload), thus reducing the workload on the heart. Therefore, lisinopril is the medication that would help decrease afterload for a client with mitral valve regurgitation.

a. Urinary output 275ml over the last 8 hours: While urinary output is an important parameter to monitor, especially in post-operative patients, a urinary output of 275ml over 8 hours is within an acceptable range. It is important to ensure adequate renal perfusion and urine output, but this finding does not raise immediate concerns.

b. Hemoglobin 14g/dl (12-16 g/dl): A hemoglobin level of 14g/dl is within the normal range and does not indicate any immediate issues with oxygen-carrying capacity or blood loss. While it is important to monitor hemoglobin levels post-operatively, this finding does not require immediate action.

c. Heart rate 110 and irregular: A heart rate of 110 beats per minute (bpm) and irregular rhythm is concerning, especially in a post-operative patient who recently underwent valve replacement surgery. An irregular heart rate could indicate cardiac dysrhythmias, which may be related to the surgery or underlying cardiac issues. This finding warrants further evaluation and may require intervention, making it a priority for the nurse to report to the healthcare provider.

d. Oral temperature 99.2°F: An oral temperature of 99.2°F is slightly elevated but is not significantly outside the normal range. While fever can indicate infection, post-operative patients can have mild elevations in temperature due to the inflammatory response to surgery. Unless accompanied by other signs of infection or instability, this finding may not be a priority for immediate reporting.