Final answer:
When a palpable pulse is detected during CPR but breath sounds are absent over the left lung, the nurse should assess for a pneumothorax or incorrect endotracheal tube placement, adjust or replace the tube, and pause chest compressions for assessment if the pulse is adequate.
Step-by-step explanation:
During cardiopulmonary resuscitation (CPR) of an intubated client, if a nurse detects a palpable pulse but absent breath sounds over the left lung, the nurse should first assess for the possibility of a pneumothorax or incorrect tube placement, which may be indicated by the absence of breath sounds on one side. The nurse should then validate the tube placement and, if necessary, adjust or replace the endotracheal tube to ensure proper ventilation. Immediate reassessment of breath sounds after any intervention is critical to confirm correct tube positioning and effective ventilation.
Moreover, the nurse should ensure that chest compressions are paused to allow for this assessment and subsequent interventions, as the presence of a palpable pulse might indicate that chest compressions are no longer required unless the pulse is deemed insufficient. However, in the case of compromised ventilation where a tension pneumothorax is suspected, an urgent needle thoracostomy may be indicated.
Appropriate and timely action is essential in this situation, as indicated by Figure 19.3, which describes the importance of proper CPR technique. As stated, if the heart should stop, CPR can maintain the flow of blood until the heart resumes beating, with proper hand placement between T4 and T9 being crucial for effective compressions. The nurse's actions in this scenario are critical for the patient's survival and highlight the importance of proper CPR training emphasized by the relevant medical guidelines.