58. A client with COPD is scheduled for abdominal surgery. Arterial blood gases before surgery were: pH 7.36, PCO2 54, PO2 70. After surgery the ABGs were pH 7.35, PCO2 60, PO2 65 on 2 L of O2. Which action should a nurse take?
58. A client with COPD is scheduled for abdominal surgery. Arterial blood gases before surgery were: pH 7.36, PCO2 54, PO2 70. After surgery the ABGs were pH 7.35, PCO2 60, PO2 65 on 2 L of O2. Which action should a nurse take?
. Suction the client.
. Have the client cough and deep breathe.
. Administer sodium bicarbonate, per order.
. Position the client in high Fowler's.
Test-Taking Tip
With general anesthesia and abdominal surgery, hypoventilation is likely. An independent nursing action is encouraging coughing and deep breathing.
Content Area: Adult Health, Respiratory; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
.
Answer 1 is incorrect because the ABGs support hypoventilation and atelectasis. Suctioning will not reexpand the alveoli as effectively as coughing and deep breathing. Answer 2 is correct because atelectasis is likely as a result of general anesthesia. The client also appears to be hypoventilating most likely because of abdominal pain. The client should be medicated for pain before coughing and deep breathing. Answer 3 is incorrect because the pH is within normal limits, indicating compensation. Answer 4 is incorrect because coughing and deep breathing, not just a position change, is needed. Any degree of head elevation will improve deep breathing.