The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS). The client's ABG reveals: pH 7.59, PaCO2 29 mmHg, Pa02 55 mmHg, HCO3 22 mEq/L, and 02 saturation 72%. What would be the expected assessment finding?

Table 9.9 Normal Arterial Blood Gas Values

ABG Value.                                                             Normal Value

pH                                                                             7.35-7.45

PaCO2                                                                                                            35-45 mmHg

HCO3-                                                                         22-26mEq/L

Base excess                                                               -2 to +2

PaO2                                                                            80-95 mmHg

SaO2                                                                            >95%

respiratory rate of 10 breaths per minute.

respiratory rate of 32 breaths per minute.

blood pressure 86/42 mmHg.

heart rate of 45 beats per minute.

Answer and Explanation

The Correct Answer is B

Explanation of each option:

A. Respiratory rate of 10 breaths per minute:
A respiratory rate of 10 breaths per minute would be too slow in a patient with ARDS and hypoxemia. In response to hypoxemia, the body typically increases the respiratory rate to improve oxygenation. A respiratory rate of 10 breaths per minute would not be expected in this situation.

B. Respiratory rate of 32 breaths per minute: The arterial blood gas (ABG) results indicate respiratory alkalosis with hypoxemia, which is a common finding in patients with acute respiratory distress syndrome (ARDS). pH 7.59: This is alkalotic, meaning the body is experiencing respiratory alkalosis.

PaCO2 29 mmHg: The PaCO2 is low, indicating hyperventilation, which is a compensatory response to the alkalosis in an attempt to reduce carbon dioxide levels.

PaO2 55 mmHg: This is severely low, indicating hypoxemia (low oxygen levels in the blood), a hallmark of ARDS. HCO3 22 mEq/L: The bicarbonate is normal, suggesting that the metabolic component has not yet compensated for the respiratory alkalosis, or that it is in the early stages of compensation. Given these ABG results, the body is attempting to compensate for hypoxemia by increasing respiratory rate (tachypnea), which leads to hyperventilation and further reduction in PaCO2. Therefore, an expected assessment finding in this scenario would be a high respiratory rate (such as 32 breaths per minute), which is a compensatory response to hypoxemia.

C. Blood pressure 86/42 mmHg:
While hypotension can occur in severe cases of ARDS due to impaired oxygenation and circulation, it is not directly reflected by the ABG results provided. Hypoxemia and alkalosis would more likely lead to tachypnea and compensatory mechanisms like tachycardia, rather than significant hypotension unless there is another contributing factor, such as shock or sepsis. Therefore, hypotension is not the most expected finding based on these ABGs.

D. Heart rate of 45 beats per minute:
A heart rate of 45 beats per minute is bradycardic, which would be unusual in a patient with hypoxemia and respiratory alkalosis. Tachycardia is a more common compensatory response to hypoxia, as the heart works harder to improve oxygen delivery to tissues. A heart rate of 45 beats per minute would be more suggestive of a different underlying condition, such as vagal stimulation or cardiac conduction issues, but it is not the expected response in this case.

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Correct Answer is A

Explanation

A. pH 7.44; PaO2 44 mmHg; PaCO2 35 mmHg; HCO3 25 mEq/L; O2 Sat 76%: This set of arterial blood gas (ABG) values is consistent with hypoxemic respiratory failure. Hypoxemic respiratory failure is characterized by a PaO2 less than 60 mmHg, and this client has a PaO2 of 44 mmHg, which is significantly below the normal range of 80-95 mmHg. Despite the fact that the client is on a 100% non-rebreather mask (which should ideally deliver high levels of oxygen), the low PaO2 suggests that oxygenation is not being effectively improved. Additionally, the low O2 saturation of 76% further supports the diagnosis of hypoxemic respiratory failure.

B. pH 7.30; PaO2 80 mmHg; PaCO2 62 mmHg; HCO3 25 mEq/L; O2 Sat 94%: This ABG indicates respiratory acidosis (pH is low, PaCO2 is elevated), but the PaO2 of 80 mmHg is within the normal range, and the O2 saturation of 94% is also normal. Respiratory acidosis with a normal PaO2 would indicate an issue with ventilation (hypoventilation), not hypoxemic respiratory failure. The patient is retaining CO2 but is still oxygenating well, so this result does not indicate hypoxemic respiratory failure.

C. pH 7.35; PaO2 65 mmHg; PaCO2 40 mmHg; HCO3 26 mEq/L; O2 Sat 90%: This result shows a PaO2 of 65 mmHg, which is mildly low but not sufficiently low to meet the criteria for hypoxemic respiratory failure (PaO2 should be below 60 mmHg for this diagnosis). The O2 saturation of 90% is also slightly low but not critically low. This client may have mild hypoxia but is not in respiratory failure based on these values.

D. pH 7.48; PaO2 75 mmHg; PaCO2 41 mmHg; HCO3 28 mEq/L; O2 Sat 93%: In this case, the PaO2 of 75 mmHg is slightly low but still within an acceptable range, and the O2 saturation of 93% is adequate. The elevated pH and normal PaCO2 suggest the presence of respiratory alkalosis (likely caused by hyperventilation). These ABG results are not consistent with hypoxemic respiratory failure, as the oxygen levels are still within a safe range.

A. Encourage the daily use of the incentive spirometer B. Assisting the client with ambulation in the hallway C. Increasing the chest tube suction to 44 mmHg D. Assessing for adequate pain relief

Correct Answer is D

Explanation

A. Encourage the daily use of the incentive spirometer: While the use of an incentive spirometer is important for improving lung expansion and preventing atelectasis, it may not be effective unless the client’s pain is well-managed. If pain is not addressed first, the client may be unable or unwilling to use the incentive spirometer properly, thus delaying recovery and increasing the risk of respiratory complications.

B. Assisting the client with ambulation in the hallway: Ambulation is an important post-operative activity for improving circulation and preventing complications such as deep vein thrombosis (DVT) or pneumonia. However, the priority at this time should be addressing the client's pain and ensuring adequate breathing before attempting more strenuous activities like ambulation. If the client is in pain and not breathing effectively, ambulation could exacerbate respiratory difficulties..

C. Increasing the chest tube suction to 44 mmHg: Increasing chest tube suction is not indicated unless there is evidence of inadequate drainage or a specific complication, such as a pneumothorax or pleural effusion. In this case, the priority is to address the client’s respiratory function, which is more likely to improve with pain relief, deep breathing, and appropriate positioning. Suctioning should only be adjusted if there is a clinical reason such as signs of a pneumothorax or inadequate drainage, which is not indicated by the information provided.

D. Assessing for adequate pain relief: The most urgent intervention in this scenario is ensuring that the client has adequate pain relief. The client’s shallow respirations and guarding of the operative site suggest that pain is inhibiting effective breathing and deep inspiration, which is crucial for preventing atelectasis and improving ventilation. Pain control is essential in promoting optimal respiratory function, as uncontrolled pain can lead to shallow breathing, reduced lung expansion, and compromised gas exchange, all of which can increase the risk of acute respiratory failure. Once pain is managed, the client will be better able to engage in other respiratory interventions

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Correct Answer is D

Explanation

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