Which of the following dysrhythmias are the only ones that Dr. Reid says should be defibrillated?

A. Obtain a medical order for the administration of sodium bicarbonate: Sodium bicarbonate is used to treat metabolic acidosis, not respiratory acidosis. In this case, the elevated PaCO₂ indicates hypoventilation and respiratory acidosis, so bicarbonate would not address the underlying problem and could worsen acid-base imbalance.

B. Prepare for intubation: Intubation may be necessary if the client cannot maintain adequate ventilation or oxygenation. However, this client is showing mild respiratory acidosis with only slightly decreased oxygenation, and less invasive interventions like deep breathing and coughing should be attempted first.

C. Encourage the client to cough productively and take deep breaths: Postoperative clients often have shallow respirations due to pain, leading to hypoventilation and CO₂ retention. Encouraging deep breathing and effective coughing helps expand the lungs, improve alveolar ventilation, and reduce PaCO₂, addressing the underlying cause of the respiratory acidosis.

D. Have the client breathe into a rebreather bag at a slow rate: Rebreathing into a bag increases CO₂ levels and would worsen respiratory acidosis. This intervention is inappropriate for a client already retaining CO₂ and could further compromise acid-base balance and oxygenation.

A. Inverted P wave: An inverted P wave may indicate an ectopic atrial rhythm, but it is usually not an immediate life-threatening finding and does not require urgent intervention in the context of chest pain.

B. Sinus tachycardia: Sinus tachycardia can be a response to pain, anxiety, or hypovolemia. While it should be monitored, it is less specific for myocardial ischemia or infarction and is not the priority finding to report immediately.

C. ST segment elevation: ST segment elevation is a hallmark sign of acute myocardial injury or infarction. Immediate reporting to the healthcare provider is critical, as timely intervention can prevent myocardial damage and reduce morbidity and mortality.

D. Frequent premature atrial contractions (PACs): PACs are common and often benign. They may require monitoring, but they are not as urgent as ST segment changes in a client presenting with chest pain.