Question

Your 76-year-old female patient is having trouble breathing. When you auscultate her lungs, you hear crackles (rales) and you are concerned that she may have pulmonary edema. Her oxygen saturation is 92%, so you place her on 100% oxygen via a nonrebreather mask. Her breathing gets a little easier with the oxygen. You decide to expedite transport since she is anxious about her condition. Later, as you are completing your reassessment, you see that her respirations have slowed to 8 times per minute and she is barely staying awake. What should you do next?

A. Shake her to keep her awake.
B. Begin ventilating her with a bag-valve mask.
C. Ask your partner to pull over and wait for ALS backup.
D. Assist her with using her metered-dose inhaler.

Answer 1

In the described medical scenario, the correct course of action is to begin ventilating the patient with a bag-valve mask to treat the respiratory depression evidenced by a slow respiratory rate and decreased alertness.

Step-by-step explanation:

The student has described a scenario where a 76-year-old female patient presents with signs of pulmonary edema, evidenced by crackles in the lung upon auscultation and a reduced oxygen saturation of 92%. After providing supplemental oxygen via a nonrebreather mask, there is an initial improvement in her breathing. However, during a reassessment, she demonstrates a dangerously slow respiratory rate of 8 breaths per minute and decreased alertness, which indicates respiratory depression. The priority action in this situation would be option B: Begin ventilating her with a bag-valve mask. This intervention is critical because the patient is unable to maintain adequate ventilation on her own. Manually assisting ventilation ensures that the patient receives enough oxygen and that carbon dioxide is adequately expelled from her body. The other options mentioned are not appropriate given the patient's current respiratory state and do not adequately address the immediate need for assisted ventilation.