15 Oct John is a 59-year-old man admitted to the emergenc
John is a 59-year-old man admitted to the emergency department with complaints of severe shortness of breath and a cough producing frothy, blood-tinged mucous. His history reveals a myocardial infarction 2 years ago. Since then, he has been on a low-salt diet, digoxin, and furosemide for control of congestive heart failure. The client is admitted to the hospital for treatment of acute pulmonary edema secondary to congestive heart failure. On his fourth hospital day, the client complains of tingling and numbness of his fingers, muscle weakness, and palpitations. His electrocardiogram shows frequent premature ventricular contractions (PVCs). Four hours later, he is confused and restless. The client’s diagnostic findings are as follows: Arterial Blood Gases: pH 7.55, PaCO2 25 mm Hg, HCO3 18 mEq/L, PaO2 65 mm Hg, SaO2 91% Hematology: K = 2.5 mEq/L Questions: What conclusions can you draw about the client’s clinical manifestations, PaO2, and SaO2 levels? Analyze clinical manifestations, noting those that are reflective of oxygenation. Review normal findings for PaO2 and SaO2 and compare them with the client’s levels. Discuss the concepts of hypoxia and hypoxemia. List possible problems related to the client’s present state of oxygenation. Consider hypoxia, acid-base balance imbalance, and so on 2. What are the most likely causes of the acid-base imbalance? Review the concepts of acid-base balance and imbalance, respiratory compensation, and metabolic compensation. On the basis of the data provided, interpret the client’s blood gases. Investigate common factors that contribute to the development of acid-base imbalance and compare those factors with the client’s data. Identify the most likely cause of the client’s acid-base imbalance. 3. What is the relationship between the client’s arterial blood gas values and his serum potassium level? Review factors that negatively alter serum potassium levels. Review the effects of acid-base imbalance on serum potassium levels. Discuss the significance of a serum potassium of 2.5 mEq/L. Identify possible consequences to the client if his hypokalemia is not addressed. 4. What are the priority nursing diagnoses for the client? Group objective and subjective data into problem categories. Prioritize problems into those that need to be addressed immediately versus those that can wait. Use Maslow’s hierarchy of needs, life preservation, or other criteria to establish priorities. 5. What nursing actions can be implemented to address the client’s priority nursing diagnoses? Discuss the client’s anxiety, hypokalemia, and associated PVCs, acid-base imbalance, hypoxia, and so forth. Consider interventions to control or reduce his anxiety; prevent, monitor, or report abnormal electrolytes or acid-base imbalances; reduce or eliminate hypoxia, and so forth
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