Question

A nurse is assessing a client who is using a PCA following a thoracotomy. The client is short of breath, appears restless, and has a respiratory rate of 28/min. The client's ABG results are pH 7.52, PaO₂ 89 mmHg, PaCO₂28 mmHg, HCO₃ 24 mEq/L. Which of the following actions should the nurse take?

1) instruct the client to cough forcefully
2) assist the client with ambulation
3) provide calming interventions
4) discontinue the PCA

Answer 1

The client's symptoms and ABG results indicate respiratory alkalosis, so the nurse should provide calming interventions to regulate the client's breathing rate.

Step-by-step explanation:

Assessing Acid-Base Imbalance in PCA Use After A Thoracotomy

The client experiencing shortness of breath, restlessness, and a high respiratory rate after a thoracotomy and is currently using a Patient-Controlled Analgesia (PCA) pump. This patient has arterial blood gas (ABG) results with a pH of 7.52, indicating a state of alkalosis. The PaO2 is within a normal range, but both the PaCO2 at 28 mmHg and the respiratory rate are low, suggesting a primary respiratory alkalosis. Considering these symptoms and ABG results, the proper nursing action would be to provide calming interventions to the patient.

Respiratory alkalosis often occurs when a person hyperventilates, causing too much CO2 to be expelled and therefore increasing blood pH. The target is to address the underlying cause of the hyperventilation and to calm the patient to control their breathing rate. Forceful coughing or ambulation might exacerbate the hyperventilation, and discontinuing the PCA could increase pain, leading to more restlessness and potentially worsening the respiratory alkalosis.

It is important to monitor the patient closely and ensure they are comfortable, reassured, and that their breathing is being regulated to promote a return to normal acid-base balance.