A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:
A. Begin mechanical ventilation.
B. Place the client on oxygen.
C. Give the client sodium bicarbonate.
D. Monitor for pulmonary embolism.
Correct Answer: B. Place the client on oxygen
The pH (7.50) reflects alkalosis, and the low PaCO2 indicates the lungs are involved. The client should immediately be placed on oxygen via mask so that the SaO2 is brought up to 95%. Encourage slow, regular breathing to decrease the amount of CO2 she is losing.
Option A: Mechanical ventilation may be ordered for acute respiratory acidosis. In patients who are not significantly encephalopathic and have no excessive secretions, noninvasive ventilation with CPAP or BIPAP can be a useful modality to support ventilation and avoid the need for anesthesia and sedation, as well as the risk of nosocomial infection with endotracheal intubation.
Option C: Sodium bicarbonate would be given to reverse acidosis. Sodium bicarbonate infusion reduces plasma ionized calcium concentration in critically ill patients with metabolic acidosis. In vitro, bicarbonate concentration has a major effect reducing ionized calcium level in serum
Option D: This client may have pulmonary embolism, so she should be monitored for this condition, but it is not the first intervention. A timely diagnosis of a pulmonary embolism (PE) is crucial because of the high associated mortality and morbidity, which may be prevented with early treatment. It is important to note that 30% of untreated patients with pulmonary embolism die, while only 8% die after timely therapy.
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