Assessment of a patient postarthroplasty reveals tachypnea, air hunger, hypoxia, O2 sat of 86%, declining mental status, and petechiae. What is the nurse's priority action?
1. Apply oxygen at 3 to 4 liters /minute.
2. Call a code for potential cardiac arrest.
3. Prepare the patient for immediate intubation and mechanical ventilation with PEEP.
4. Raise the head of the bed (HOB) and encourage coughing every hour.
3
Rationale 1: Application of oxygen would improve the availability of oxygen within the lungs but would not improve the perfusion at the alveolar capillary membrane.
Rationale 2: Calling for a code related to cardiac arrest is not appropriate at this time because the heart is not the problem; the pulmonary status should be addressed first.
Rationale 3: The symptoms are related to severely compromised pulmonary status, probably acute respiratory distress syndrome (ARDS), which is related to a fat embolus blocking the pulmonary vessel and inactivating surfactant. Intubation and mechanical ventilation with PEEP (positive end-expiratory pressure) are needed to maximize air exchange and treat symptoms until the condition resolves.
Rationale 4: Raising the HOB will improve gas exchange slightly, but the problem is not expansion of the chest, so the condition will not improve.
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