A male client with a massive pulmonary embolus is tachycardic, hypotensive, and has audible bilateral pulmonary crackles. His arterial blood gas (ABG) results are: pH 7.0: PaCO, 66 mm Fig; HCO3- 24 mEq/L (24 mmol/L); PaO, 60 mm Hg. Based on these findings, this client is at greatest risk for which pathophysiological condition?

Reference Ranges:

pH [7.35 to 7.45] PaCO, [35 to 45 mm Hg]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

PaO, [80 to 100 mm Hg]

Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically involving the stapes bone. This abnormal bone growth interferes with the transmission of sound vibrations from the middle ear to the inner ear, resulting in conductive hearing loss. Here's a breakdown of each option:

A) Presbycusis:

Presbycusis refers to age-related hearing loss, typically involving sensorineural components such as the degeneration of hair cells in the inner ear or changes in the auditory nerve. While presbycusis is a common cause of hearing loss in older adults, it is not directly related to otosclerosis or previous ear surgeries.

B) Conductive:

Correct. Otosclerosis primarily affects the middle ear by causing abnormal bone growth around the stapes bone, which can immobilize it and interfere with sound transmission to the inner ear. As a result, individuals with otosclerosis often experience conductive hearing loss, where sound is not effectively conducted from the outer or middle ear to the inner ear.

C) Endolymphatic:

Endolymphatic hydrops, also known as Ménière's disease, involves abnormal fluid accumulation in the inner ear, leading to symptoms such as vertigo, tinnitus, and fluctuating sensorineural hearing loss. While inner ear disorders like endolymphatic hydrops can cause sensorineural hearing loss, otosclerosis primarily affects the conductive components of hearing.

D) Sensorineural:

Sensorineural hearing loss occurs due to dysfunction or damage to the inner ear (cochlea) or auditory nerve pathways leading to the brain. This type of hearing loss is typically permanent and can result from various factors, including age-related changes, noise exposure, and certain medical conditions. While sensorineural hearing loss can coexist with conductive hearing loss in some cases, otosclerosis primarily causes conductive hearing loss rather than sensorineural hearing loss.

Disseminated intravascular coagulation (DIC) is a serious condition characterized by widespread activation of coagulation throughout the body, leading to both thrombosis and hemorrhage. Here's why option C is the correct choice:

A) Glucosuria and lethargy:

Glucosuria (presence of glucose in the urine) and lethargy are not typical findings associated with DIC. Glucosuria may indicate diabetes mellitus or renal dysfunction, while lethargy can result from various causes but is not specific to DIC.

B) Frothy urine and anorexia:

Frothy urine may indicate proteinuria, which can occur in conditions such as nephrotic syndrome, but it is not a characteristic finding of DIC. Anorexia (loss of appetite) is a nonspecific symptom that can occur in many conditions but is not directly related to DIC.

C) Hematuria and hemoptysis:

Correct. Hematuria (blood in the urine) and hemoptysis (coughing up blood) are common manifestations of DIC. In DIC, widespread activation of the coagulation cascade can lead to microthrombi formation in small blood vessels, resulting in tissue ischemia and bleeding. Hematuria and hemoptysis can occur due to bleeding from the urinary tract or respiratory system, respectively, as a result of DIC-induced coagulopathy.

D) Polyuria and productive cough:

Polyuria (excessive urination) and productive cough (cough with production of sputum) are not specific findings of DIC. Polyuria may occur in conditions such as diabetes mellitus or diuretic use, while productive cough can be seen in respiratory infections or chronic lung diseases but is not directly related to DIC.