The nurse is reviewing the arterial blood gas (ABG) result for a client currently on a 100% non-rebreather mask. The nurse is able to interpret which of the following results as hypoxemic respiratory failure?
 

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%

A. Use pyridostigmine as needed to relieve symptoms of muscle weakness and fatigue: Pyridostigmine should not be used on an "as-needed" basis, as it is a long-acting medication that works by maintaining a steady level of acetylcholine at the neuromuscular junction. The client needs to take the medication regularly at prescribed intervals, not sporadically, to maintain consistent symptom control. This statement reflects a misunderstanding of the medication's use.

B. Be able to crush the sustained release tablet because of difficulty swallowing: Sustained-release (or extended-release) tablets should not be crushed because doing so can cause the medication to be released too quickly, leading to potential side effects or overdose. If the client has difficulty swallowing, an alternative form of the medication, such as a liquid or split tablet, should be considered. This statement reflects a lack of understanding regarding the proper administration of the medication.

C. Skip a dose if I have symptoms of fatigue to minimize side effects of the medications: Skipping doses of pyridostigmine is not appropriate. The medication should be taken as prescribed, even if the client feels fatigued. Fatigue is a symptom of myasthenia gravis, not necessarily a side effect of the medication. Consistent dosing is important for controlling the disease and preventing worsening of symptoms. Skipping doses can lead to inadequate symptom control and potential exacerbation of weakness.

D. Take pyridostigmine 30-60 minutes before meals to improve muscle function: This statement indicates that the client understands the appropriate use of pyridostigmine for managing myasthenia gravis (MG). Pyridostigmine is an acetylcholinesterase inhibitor that helps improve neuromuscular transmission, and it is typically taken 30-60 minutes before meals. This timing helps optimize muscle strength during the period when the client is eating, as muscle weakness can make swallowing more difficult. By taking the medication before meals, the client is more likely to experience improved muscle function when needed most.

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