A patient is admitted to the trauma center with obvious chest injuries following a fall from a roof. The patient has shallow respirations at 8 breaths per minute. Which ABG would the nurse anticipate for this patient?

Reference ranges:

pH: 7.35-7.45 PaCO2: 35-45 mmHg

Pa02: 80-100 mmHg

HCO: 22-26 mEq/L Sa02: 95-100%

pH 7.37, PaCO2 36, HCO3- 20, SaO2 92%

pH 7.53, PaCO2 35, HCO3-28, SaO2 90%

pH 7.28, PaCO2 53, HCO3- 22, SaO2 89%

pH 7.44, PaCO2 52, HCO3- 34. SaO2 94%

Answer and Explanation

The Correct Answer is C

A. pH 7.37, PaCO2 36, HCO3- 20, SaO2 92%: This ABG shows normal pH and CO2 levels with slightly low bicarbonate and oxygen saturation. These values do not reflect the hypoventilation present in a patient with shallow respirations at 8 breaths per minute, as CO2 would be expected to rise and pH to fall.

B. pH 7.53, PaCO2 35, HCO3- 28, SaO2 90%: This ABG indicates alkalosis with normal CO2 and slightly elevated bicarbonate, consistent with metabolic alkalosis rather than respiratory compromise. A patient with severe hypoventilation would not present with alkalemia or low-normal PaCO2.

C. pH 7.28, PaCO2 53, HCO3- 22, SaO2 89%: This ABG demonstrates respiratory acidosis with hypoxemia, which is consistent with hypoventilation from shallow respirations. The elevated PaCO2 indicates CO2 retention, the low pH shows acidemia, and the reduced SaO2 reflects impaired oxygenation, all expected in chest trauma with inadequate ventilation.

D. pH 7.44, PaCO2 52, HCO3- 34, SaO2 94%: This ABG shows compensated respiratory acidosis with elevated bicarbonate and a near-normal pH. Compensation would not occur immediately in acute trauma; therefore, this pattern does not match the patient’s acute presentation of shallow respirations and impending respiratory failure.

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Correct Answer is C

Explanation

A. Gemfibrozil: Gemfibrozil is a lipid-lowering medication used to treat hypertriglyceridemia. It has no role in reversing anticoagulation or controlling acute bleeding and would not be appropriate.

B. Vitamin K: Vitamin K is the antidote for warfarin (Coumadin) toxicity but does not reverse the effects of heparin. Administering vitamin K would not stop heparin-induced bleeding and could delay proper treatment.

C. Protamine sulfate: Protamine sulfate is the specific antidote for heparin. It binds to heparin, neutralizing its anticoagulant effect, and is indicated in cases of serious bleeding, such as frank hematuria, as seen in this patient. Prompt administration can prevent further hemorrhagic complications.

D. Thromboplastin: Thromboplastin is used in laboratory testing to assess coagulation (PT/INR or aPTT) but is not a therapeutic agent for reversing anticoagulation. It cannot be administered to stop heparin-induced bleeding and is not appropriate in this clinical situation.

A. Remove the in-line suction system and use a sterile tracheostomy suctioning catheter B. Place the in-line suction catheter into the ET tube and suction for 10 seconds C. Disconnect the patient from the ventilator and oxygenate with the bag valve mask D. Assess the patient’s respiratory status and oxygen saturation before suctioning

Correct Answer is D

Explanation

A. Remove the in-line suction system and use a sterile tracheostomy suctioning catheter: Removing the closed in-line suction system is unnecessary and breaks sterility. The closed system is designed to allow suctioning without disconnecting the ventilator, minimizing infection risk and oxygen desaturation.

B. Place the in-line suction catheter into the ET tube and suction for 10 seconds: Suctioning before assessing the patient could cause unnecessary hypoxia, trauma, or arrhythmias. The nurse must first determine the need for suctioning based on clinical assessment and oxygenation status.

C. Disconnect the patient from the ventilator and oxygenate with the bag valve mask: Disconnecting the ventilator is not indicated when using a closed in-line suction system. The closed system allows suctioning without loss of positive pressure or oxygenation, which prevents hypoxemia.

D. Assess the patient’s respiratory status and oxygen saturation before suctioning: The first step is to evaluate the patient’s respiratory condition, including auscultation, respiratory rate, work of breathing, and SpO₂. This assessment ensures suctioning is indicated, identifies any potential complications, and allows for safe and effective removal of secretions.

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