A nurse is reviewing the laboratory results of a client who is postoperative and has a respiratory rate of 7/min. The arterial blood gas (ABG) values include: pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Oxygen saturation 80% Bicarbonate 28 mEq/L. Which of the following interpretations of the ABG values should the nurse make?

A. Lower oxygen saturations of 93% to 94%

In an older adult client with a pneumothorax, the nurse could expect to observe lower oxygen saturations of 93% to 94%. A pneumothorax involves the accumulation of air in the pleural space, which can compress the lung and impair gas exchange, leading to hypoxemia (low blood oxygen levels). Decreased oxygen saturations would be a common finding in this condition.

B. Higher oxygen saturations of 98% to 99%

Higher oxygen saturations would be less likely in a client with a pneumothorax due to impaired gas exchange resulting from lung compression. Oxygen saturations are more likely to be lower in this condition, as indicated in option A.

C. Lower energy expenditure

While a pneumothorax may cause discomfort and dyspnea, which could potentially decrease energy expenditure due to reduced activity levels, it is not a direct physiological effect of the condition. Energy expenditure would depend on various factors, including the severity of symptoms and the individual's overall health status.

D. Increased lung capacity

A pneumothorax typically results in a decrease in lung capacity rather than an increase. The accumulation of air in the pleural space causes partial or complete collapse of the affected lung, reducing its ability to expand and decreasing overall lung capacity. Therefore, increased lung capacity would not be expected in a client with a pneumothorax.

A. Position the client on the nonoperative side.

Positioning the client on the nonoperative side after a pneumonectomy may not be the best choice. The positioning of the client post-pneumonectomy should be based on factors such as the individual's comfort, respiratory status, and any specific instructions from the healthcare provider. Placing the client on the nonoperative side may inadvertently put pressure on the surgical site, leading to discomfort or potential complications.

B. Monitor respiratory status every 8 hr.

Monitoring respiratory status every 8 hours is not sufficient for a client post-pneumonectomy. After such a major surgical procedure, respiratory status should be closely monitored and assessed more frequently, especially in the immediate postoperative period. This frequency allows for the early detection of any signs of respiratory distress, such as decreased oxygen saturation, dyspnea, or abnormal breath sounds, as well as complications like pneumothorax or atelectasis.

C. Elevate the head of the bed to a 15° angle.

Elevating the head of the bed to a 15° angle is a general recommendation for clients postoperative to promote respiratory function and reduce the risk of aspiration. However, after a pneumonectomy, the positioning of the client may vary based on their individual condition and surgical approach. It's important to follow the healthcare provider's specific instructions regarding positioning for optimal recovery. The angle of elevation may need to be adjusted based on the client's comfort and respiratory status.

D. Encourage the client to splint the incision when coughing.

After a pneumonectomy, it's crucial to encourage the client to splint the incision when coughing. Splinting the incision with a pillow or hands helps to reduce pain and prevent strain on the surgical site, promoting healing and minimizing the risk of complications such as wound dehiscence (opening of the surgical incision).