A postoperative patient complaining of dyspnea is found to have tachypnea and tachycardia, and is somewhat confused. Breath sounds reveal end inspiratory crackles in both lung bases
An arterial blood gas (ABG) is drawn and reveals the following: pH 7.49; PaCO2 33 mm Hg; PaO2 51 mm Hg; SaO2 87%; HCO3? 25 mEq/L while on a 30% air entrainment mask. The most appropriate respiratory therapy intervention includes which of the following?
a. Initiate noninvasive positive pressure ven-tilation (NPPV).
b. Initiate continuous positive airway pres-sure (CPAP) by mask.
c. Administer bronchodilator therapy.
d. Intubate and mechanically ventilate.
ANS: B
This patient is showing signs and symptoms of hypoxemic respiratory failure due to postoperative atelectasis. This patient's PaO2/FIO2 is below the critical value. Since the patient is still able to move air, intubation and mechanical ventilation, as well as noninvasive positive pressure ventila-tion (NPPV), are not appropriate at this time. This patient is not showing signs of increased work of breathing due to bronchospasm. Therefore, administering bronchodilator therapy is not appro-priate. Initiating continuous positive airway pressure (CPAP) by mask will help to reverse the at-electasis and improve the patient's oxygenation status.
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