A patient who is admitted with shortness of breath has a tracing with atrial fibrillation at 140 beats/minute of unknown duration. The nurse begins oxygen per nasal cannula and establishes a saline lock. Which should the nurse prepare to implement next?

• Myocardial infarction (MI): The client reports chest pain rated 8/10, radiating to the left arm, and has ST segment elevation on ECG. These findings are classic for ST-elevation myocardial infarction (STEMI), requiring immediate intervention.
• Draw laboratory cardiac markers: Troponin and other cardiac enzymes are critical for confirming myocardial injury. They help guide diagnosis, treatment, and monitoring of MI progression or resolution.
• Insert two peripheral IV (PIV) access devices: Dual IV access ensures reliable and rapid administration of emergency medications, fluids, or thrombolytics. This is vital for stabilizing the client during acute cardiac events.
• Pain level: Ongoing pain assessment is essential for monitoring myocardial ischemia, evaluating treatment response, and guiding further interventions to prevent cardiac tissue damage.
• 12-lead electrocardiogram (ECG): Continuous or repeated ECGs help detect changes in ST segments, arrhythmias, or infarct progression. It’s crucial in monitoring the effectiveness of interventions and early detection of complications.

• Reflux: While reflux may cause chest discomfort, it is not associated with ST elevation or arm radiation. These findings are cardiac in nature and point away from gastrointestinal causes.
• Costochondritis: This musculoskeletal condition causes localized chest pain but does not result in ECG changes or radiating pain. It is not supported by the client's data.
• Atrial fibrillation (A-fib): The client has a normal heart rate and regular rhythm. A-fib would show an irregular rhythm on ECG, not ST elevation, and is not the suspected diagnosis here.
• Insert nasogastric tube (NGT) for nutritional intake: An NGT is not a priority for a client with acute chest pain. The focus should be on stabilizing cardiac function rather than nutritional support.
• Consult nutritionist: Nutritional counseling may be relevant later, but it is not an acute intervention during a suspected myocardial infarction.
• Begin strict bedrest: While activity should be limited, “strict bedrest” is not always necessary and may lead to complications like DVT. The client’s mobility orders depend on cardiac stability.
• Intake and output: While important in general care, it is not as immediately critical in early MI management as pain and ECG monitoring.
• Nutritional intake: Nutritional monitoring is not an immediate priority during acute chest pain evaluation and cardiac stabilization.
• Peripheral edema: Edema may indicate chronic heart failure, but it is not a key indicator for acute myocardial infarction or urgent follow-up in this scenario.

A. Compensated respiratory acidosis with hypoxia: The pH is at the low end of normal (7.35), PaCO₂ is elevated (60 mm Hg), and HCO₃⁻ is also elevated (35 mEq/L), indicating the kidneys are compensating for chronic respiratory acidosis. The PaO₂ is low (60 mm Hg), confirming hypoxia.

B. Compensated respiratory alkalosis with normal oxygenation: Respiratory alkalosis would be indicated by a high pH and low PaCO₂, which are not present here. Also, the client is hypoxic, not normally oxygenated, as shown by the PaO₂ of 60 mm Hg.

C. Acute respiratory acidosis: In acute respiratory acidosis, the PaCO₂ would be high with a low pH and little to no elevation in HCO₃⁻. The elevated HCO₃⁻ here shows that compensation has occurred, indicating the condition is not acute.

D. Normal acid-base balance: Although the pH falls within normal limits, the PaCO₂ and HCO₃⁻ are significantly abnormal. The body has compensated for the respiratory acidosis, but the acid-base balance is not normal due to the underlying pathology and associated hypoxia.