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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