The arterial blood gas (ABG) report of a patient with a spinal cord injury indicates hypoxia. Select two interventions the nurse would perform to improve the patient's respiratory status.

Choice A reason: Metabolic acidosis is characterized by a decrease in blood pH (less than 7.35) due to a primary decrease in bicarbonate (HCO₃). The arterial blood gas results in this scenario do not indicate metabolic acidosis, as the pH is elevated and HCO₃ is within the normal range.

Choice B reason: Metabolic alkalosis is characterized by an increase in blood pH (greater than 7.45) due to a primary increase in bicarbonate (HCO₃). In this case, the pH is indeed elevated, but the bicarbonate level is normal, making this condition unlikely.

Choice C reason: Respiratory acidosis is characterized by a decrease in blood pH (less than 7.35) due to a primary increase in PaCO₂. The arterial blood gas results show an elevated pH and a decreased PaCO₂, which are not consistent with respiratory acidosis.

Choice D reason: Respiratory alkalosis is characterized by an increase in blood pH (greater than 7.45) due to a primary decrease in PaCO₂. In this scenario, the pH is elevated at 7.48, and the PaCO₂ is decreased at 32 mm Hg, indicating respiratory alkalosis. The bicarbonate level is within the normal range, further supporting this interpretation.

Choice A reason: Type 2 diabetes mellitus, while a serious chronic condition, does not directly predispose patients to delirium. Diabetes primarily impacts the body's ability to regulate blood glucose levels, leading to complications such as cardiovascular disease, neuropathy, and nephropathy. However, it is not directly linked to the acute cognitive disturbances seen in delirium unless it leads to severe metabolic derangements, which is less common.

Choice B reason: Alcohol abuse is a significant risk factor for the development of delirium, especially in ICU patients. Chronic alcohol use can lead to a condition known as delirium tremens (DTs) during withdrawal, characterized by severe agitation, confusion, hallucinations, and autonomic hyperactivity. Patients with a history of alcohol abuse may have altered brain chemistry and neurotransmitter imbalances that predispose them to delirium when stressed by illness or surgery. Moreover, alcohol abuse can lead to liver dysfunction, nutritional deficiencies (particularly thiamine), and other systemic issues that further exacerbate the risk.

Choice C reason: Anxiety can exacerbate stress and discomfort in a patient but is not a primary causative factor for delirium. Anxiety may contribute to an increased sense of fear or confusion, especially in an ICU setting. However, it does not cause the profound disruption in cognitive function, attention, and awareness that characterizes delirium.

Choice D reason: Impaired communication might be a consequence or symptom seen in patients with delirium, but it is not a root cause. Patients with pre-existing communication difficulties might struggle more to express symptoms or needs, which could complicate care, but it does not inherently lead to the onset of delirium. Effective communication strategies and aids can help manage these challenges but do not address the underlying neurological changes seen in delirium.