The nurse is caring for a client with hypercapnic respiratory failure. The client is lethargic & slow to follow commands. Current vitals: BP 78/52. pulse 132. respirations 8, and pulse ox 84% on 35% Venturi mask. The nurse would anticipate which medical prescription?

Insertion of a tracheostomy to maintain the airway

Use of noninvasive positive pressure ventilation (BIPAP)

Endotracheal intubation with mechanical ventilation

Administration of 50% Venturi mask

Answer and Explanation

The Correct Answer is B

A. Insertion of a tracheostomy to maintain the airway: This is not the first step in the management of hypercapnic respiratory failure. A tracheostomy is usually considered in cases where prolonged mechanical ventilation is required or for patients who need long-term airway support. It would not be immediately prescribed in this situation.

B. Use of noninvasive positive pressure ventilation (BIPAP): The client is showing signs of hypercapnic respiratory failure, indicated by lethargy, slow response to commands, and low oxygen saturation (pulse ox 84%) despite receiving oxygen via a Venturi mask. BIPAP (Bilevel Positive Airway Pressure) is a form of noninvasive ventilation that can help improve both oxygenation and ventilation by providing positive pressure to help the client breathe more effectively. It is often used in cases of hypercapnic respiratory failure, especially when the patient is alert enough to tolerate the mask.

C. Endotracheal intubation with mechanical ventilation: While this may be necessary if noninvasive ventilation (like BIPAP) is not effective, endotracheal intubation is typically considered when the patient is unable to tolerate noninvasive ventilation or if their respiratory failure worsens significantly. Given that the patient is still responsive (though lethargic), BIPAP would likely be tried first.

D. Administration of 50% Venturi mask: Increasing the oxygen concentration is unlikely to resolve the underlying issue of hypercapnia (elevated CO2 levels) in this patient. Hypercapnic respiratory failure is primarily due to inadequate ventilation, not just oxygen deficiency. Therefore, a higher concentration of oxygen may not be sufficient and would not address the need for improved ventilation.

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Correct Answer is A

Explanation

A. Muscle rigidity, flat affect, and bradykinesia: The hallmark symptoms of PD include:

Muscle rigidity: Stiffness or inflexibility in the muscles, often felt as resistance when the patient’s limbs are moved.

Flat affect: A reduced facial expression or lack of emotional expression, which is common in PD due to the difficulty in controlling facial muscles.

Bradykinesia: Slowness of movement, which makes initiating and completing voluntary movements more difficult. This is a major characteristic of PD.

B. Generalized weakness and fatigue: While weakness and fatigue can occur in PD, they are not considered the primary hallmark symptoms. The primary issues in PD are related to movement abnormalities, including tremor, rigidity, and bradykinesia. Fatigue can be secondary to the motor difficulties.

C. Ascending weakness starting in the legs: This is more characteristic of conditions like Guillain-Barré syndrome or other neurological disorders that cause progressive weakness, rather than PD. In PD, motor symptoms are typically bilateral and affect both sides of the body more symmetrically over time, not starting in the legs.

D. Increasing dementia and involuntary movements: While dementia can occur later in the course of PD, it is not a primary early symptom. Involuntary movements, such as tremors, can be a feature of PD but are not typically described as the same type of "involuntary movements" seen in conditions like Huntington's disease.

A. Insert an oral airway to prevent the client from biting the endotracheal tube B. Suction the patient and reset the ventilator alarm C. Disconnect the client from the ventilator and use a manual bag-valve mask D. Notify the respiratory therapist and health care provider

Correct Answer is C

Explanation

A. Inserting an oral airway may be appropriate if the client is biting the endotracheal tube, but in this scenario, the cause of the low-pressure alarm is unknown and could be due to disconnection or a leak — a more urgent issue requiring immediate action.
B. Suctioning and resetting the alarm could delay appropriate ventilation if the issue is a disconnection or leak; it’s not the priority intervention in an unclear emergency.
C. When the source of a low-pressure alarm (which often indicates a leak or disconnection) cannot be identified and the client’s ventilation status is in question, the nurse should immediately disconnect the client from the ventilator and manually ventilate with a bag-valve mask to ensure oxygenation until the issue is resolved.
D. Notifying the respiratory therapist and provider is appropriate after immediate interventions are performed to maintain the patient’s airway and oxygenation.

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The nurse is caring for a client with hypercapnic respiratory failure. The client is lethargic & slow to follow commands. Current vitals: BP 78/52. pulse 132. respirations 8, and pulse ox 84% on 35% Venturi mask. The nurse would anticipate which medical prescription?

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