To improve the oxygenation of a client with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation, the nurse should place the client in which position?

Supine

Prone

Lateral side

Semi-Fowler's

Answer and Explanation

The Correct Answer is B

Choice A reason: The supine position is when a patient lies flat on their back. Although it is commonly used for many procedures and treatments, it is not the best position for improving oxygenation in clients with ARDS. Lying flat on the back can cause the lungs to become compressed, reducing the efficiency of gas exchange and potentially leading to further respiratory complications.

Choice B reason: The prone position, where the patient is lying face down, is the recommended position to improve oxygenation in clients with ARDS. Prone positioning helps to recruit more alveoli, improves ventilation-perfusion matching, and reduces the shunting of blood through non-ventilated areas of the lung. Studies have shown that placing patients in the prone position can significantly improve oxygenation and decrease mortality in ARDS patients.

Choice C reason: The lateral side position, where the patient lies on their side, can be used for patients with certain conditions or during recovery from some surgical procedures. However, it does not provide the same benefits for improving oxygenation in ARDS as the prone position does. Lateral positioning might help with comfort and prevent pressure sores, but it does not enhance lung function and gas exchange in the same way.

Choice D reason: The Semi-Fowler's position, where the patient's head and torso are elevated to a 30-45 degree angle, is useful for promoting respiratory comfort and reducing the risk of aspiration. While it can help improve ventilation and is beneficial for patients with respiratory distress, it does not offer the same degree of improvement in oxygenation for ARDS patients as the prone position.

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Correct Answer is A

Explanation

Choice A reason: Decerebrate posturing is characterized by the extension of the arms and legs, pronation of the arms, and plantar flexion. This type of posturing indicates severe brain damage, typically involving the brainstem. It is a sign of a more serious injury than decorticate posturing and suggests that the damage has progressed to affect the brainstem.

Choice B reason: Flexion withdrawal is a response to a painful stimulus where the patient pulls away from the pain. It is a reflex that indicates some level of preserved spinal cord or brainstem function. However, it does not involve the specific pattern of extension and pronation seen in decerebrate posturing.

Choice C reason: Decorticate posturing involves flexion of the arms, clenched fists, and extension of the legs. The arms are bent inward toward the body with the wrists and fingers flexed on the chest. This posturing indicates damage to the brain's cortical areas or the corticospinal tract. It is less severe than decerebrate posturing.

Choice D reason: Localization of pain is a response where the patient moves a hand towards the site of the painful stimulus, indicating a higher level of brain function. This response suggests that the brain can still process and respond to the location of the pain, which is not consistent with the described posturing.

A. pH 7.50, pO2 85, pCO2 35, HCO3 30 mEq/L B. pH 7.30, pO2 90, pCO2 35, HCO3 20 mEq/L C. pH 7.50, pO2 95, pCO2 25, HCO3 22 mEq/L D. pH 7.30, pO2 80, pCO2 55, HCO3 22 mEq/L

Correct Answer is D

Explanation

Choice A reason: The values pH 7.50, pO2 85, pCO2 35, HCO3 30 mEq/L indicate alkalosis with a high bicarbonate level, which is not consistent with the patient’s slow respiratory rate that would typically lead to respiratory acidosis.

Choice B reason: The values pH 7.30, pO2 90, pCO2 35, HCO3 20 mEq/L indicate metabolic acidosis with normal pCO2, which does not align with the respiratory issue described (hypoventilation).

Choice C reason: The values pH 7.50, pO2 95, pCO2 25, HCO3 22 mEq/L indicate respiratory alkalosis, which is characterized by a low pCO2. This is not consistent with the patient’s hypoventilation, which would lead to elevated pCO2 levels.

Choice D reason: The values pH 7.30, pO2 80, pCO2 55, HCO3 22 mEq/L indicate respiratory acidosis, which aligns with the patient’s hypoventilation due to anesthesia effects and incisional pain. The elevated pCO2 and decreased pH are consistent with reduced respiratory rate and shallow breathing.

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