Which of the following items should the nurse include in teaching Sara about asthma? (Select all that apply)

Choice A reason: Oxygen saturation of 92% is low-normal (95-100%), not specific to worsening heart failure acutely. It may reflect chronic lung issues or mild hypoxia, but alone, it’s not a definitive sign of decompensation.

Choice B reason: Bilateral pulmonary congestion on x-ray shows fluid in alveoli from left heart failure, impairing gas exchange. It’s a classic sign of worsening, as rising pressure backs fluid into lungs, causing dyspnea.

Choice C reason: A 5-lb weight gain over days indicates fluid retention, a hallmark of worsening heart failure. It reflects sodium and water buildup from reduced cardiac output, directly correlating with symptom exacerbation.

Choice D reason: BUN of 28 mg/dL (normal 7-20 mg/dL) suggests mild renal stress, possibly from diuretics. It’s not specific to worsening heart failure without symptoms like dyspnea, as it may reflect dehydration instead.

Choice E reason: Potassium of 4.9 mEq/L is normal (3.5-5.0 mEq/L), not indicating worsening heart failure. It may rise with ACE inhibitors, but this value alone doesn’t signal acute decompensation or symptom progression.

Choice A reason: Metabolic alkalosis shows pH >7.45 with HCO3- >26 mEq/L from base excess. Here, pH is 7.48, but HCO3- is normal at 24 mEq/L, ruling out metabolic cause. PaO2 of 55 mmHg indicates hypoxemia, but the primary issue isn’t metabolic.

Choice B reason: Respiratory alkalosis occurs with pH >7.45 and PaCO2 <35 mmHg from hyperventilation. Here, pH is 7.48, PaCO2 is 28 mmHg, and HCO3- is normal, confirming respiratory etiology. PaO2 of 55 mmHg shows hypoxemia, matching this acute ventilatory pattern.

Choice C reason: Metabolic acidosis has pH <7.35 and HCO3- <22 mEq/L from acid gain. Here, pH is 7.48 and HCO3- is 24 mEq/L, contradicting acidosis. PaO2 of 55 mmHg indicates hypoxemia, but the acid-base status is alkalotic, not acidic.

Choice D reason: Respiratory acidosis features pH <7.35 and PaCO2 >45 mmHg from CO2 retention. Here, pH is 7.48 and PaCO2 is 28 mmHg, showing CO2 loss, not retention. Hypoxemia (PaO2 55 mmHg) is present, but the pattern is alkalotic.