An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home
The patient is responsive only to painful stimuli. She has a peripheral IV and a feeding tube in place. Physical examination reveals: pulse 98 beats/min; respiratory rate 24 breaths/min and shal-low; blood pressure 100/48 mm Hg; and temperature 39.2° C. Auscultation reveals decreased breath sounds with crackles in the bases. The patient has an occasional weak, nonproductive cough. Arterial blood gas on NC 4 L/min is pH 7.42, PaCO2 38 mm Hg, PaO2 40 mm Hg, SaO2 76%, HCO3? 24 mEq/L. A portable chest X-ray shows patchy basilar infiltrates in both lungs. The most appropriate action to take at this time is which of the following?
a. Intubate and initiate mechanical ventila-tion.
b. Administer a bronchodilator and muco-lytic.
c. Initiate noninvasive positive pressure ven-tilation.
d. Change the nasal cannula to a nonre-breather mask.
ANS: D
According to the arterial blood gas (ABG) this patient has a normal acid-base balance; therefore intubation and artificial ventilation are not necessary. The patient does not seem to have evidence of requiring a bronchodilator and mucolytic. The patient does not require noninvasive positive airway pressure ventilation (NPPV), because he is breathing. The patient does, however, have severe hypoxemia that warrants a high oxygen concentration.
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A) question bystanders about the patient's history. B) place the patient in the recovery position. C) provide positive pressure ventilation. D) suction the airway.
Which identifies one aspect of safe patient movement from the OR table to the stretcher?
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