Problem
L.B. is brought to the ER after a motor vehicle accident. He was going through an intersection when someone ran a red light and hit his car.
Initial assessment:
Subjective:
Patient is complaining of chest pain rated 6/10. The pain gets worse with deep breaths.
Patient complains of neck pain.
Objective:
Lacerations on his face and hands from broken glass
Bruising on chest where he hit the steering wheel
Vital Signs: Pulse 110, RR 25 and shallow, BP 110/60, Pulse ox 95%
Lab Values: hemoglobin 15, Hematocrit 45%, Troponin negative, Na 139, KCl 4
ECG: Normal sinus rhythm
X-ray: Factured ribs 3-5 on left side
ABG: pH 7.35, PaCO2 42, Bicarbonate 22, PaO2 90
What type of respiratory distress (ventilatory or oxygenation failure) are we concerned about?
What complications may occur?
L.B. is discharged from hospital with hydrocodone/APAP 5/325 for pain.
Two days later the wife brings L.B. back to ER
Subjective data:
Wife states patient has become sleepy with periods of confusion
Wife has been giving Hydrocodone Q 4 hours as instructed by ER personnel at discharge
Last dose of Hydrocodone was 1 hour ago
Patient arouses with difficulty and oriented to person only
Objective data:
RR 10 with shallow breathing
Vitals: pulse 120, RR 10, BP 95/50, pulse ox 88%
ABG: pH 7.30, PaCO2 50, Bicarbonate 22, PaO2 70
Lungs diminished bilaterally
Patient placed on mask 30% oxygen and transferred to the medical inpatient floor
Evaluate the ABG from the ER. What is happening?
As the nurse taking care of L.B. What are your three priority interventions with rationale?