A nurse is reviewing the arterial blood gas (ABG) results of a patient. The patient's ABGs are: pH 7.5

CO2 40 mm Hg HCO3 32 mEq/L

Which of the following acid-base conditions should the nurse identify the patient is experiencing?

The correct answer is Choice A

Choice A rationale: Placing the patient in a supine position with knees flexed reduces tension on the abdominal wall and minimizes strain on the surgical site. This position promotes relaxation of the rectus muscles and decreases intra-abdominal pressure, which helps prevent further wound separation and evisceration. It also facilitates optimal circulation and allows for rapid assessment and intervention. Scientifically, this positioning is a first-line response to wound dehiscence and aligns with evidence-based emergency protocols.

Choice B rationale: Covering the wound with a clean towel does not meet sterile technique standards required for exposed internal tissues. In cases of dehiscence, especially with evisceration, sterile saline-soaked gauze is necessary to maintain tissue moisture and prevent infection. A clean towel may introduce contaminants and lacks the moisture-retaining properties needed to protect exposed organs. This action fails to meet scientific wound care principles and may compromise patient safety and healing.

Choice C rationale: Applying an abdominal binder to a dehisced wound can exert pressure on the compromised tissue and exacerbate separation. Binders are used prophylactically or postoperatively for support, not in acute dehiscence. Compression over an open or unstable wound risks ischemia, tissue damage, and impaired healing. Scientifically, this intervention is contraindicated during active wound separation and does not align with emergency wound management protocols.

Choice D rationale: Offering a drink of water is inappropriate during an acute surgical complication like wound dehiscence. Oral intake may be contraindicated due to potential need for surgical intervention or anesthesia. Additionally, hydration does not address the immediate risk of infection, tissue exposure, or hemorrhage. Scientifically, this action lacks relevance to the pathophysiology of dehiscence and may delay critical care. Priority should be stabilization and surgical evaluation, not fluid intake.

Choice A reason: The patient's son may be present for support, but he does not have the authority to sign the consent form unless he is a designated health care proxy and the patient is not competent.

Choice B reason: Since the patient is alert and competent, she has the right and responsibility to provide consent for her own medical procedures.

Choice C reason: A health care proxy is authorized to make decisions on behalf of the patient only if the patient is unable to do so.

Choice D reason: The consent form should be signed by the patient alone if she is competent, regardless of who accompanies her to the facility.