The nurse is reviewing the arterial blood gas (ABG) result for a client currently on a 100% non-rebreather mask. The nurse is able to interpret which of the following results as hypoxemic respiratory failure?
 

Table 9.9 Normal Arterial Blood Gas Values

ABG Value.                                                             Normal Value

pH                                                                             7.35-7.45

PaCO2                                                                                                            35-45 mmHg

HCO3-                                                                         22-26mEq/L

Base excess                                                               -2 to +2

PaO2                                                                            80-95 mmHg

SaO2                                                                            >95%

A. Speak slow and loud so that the client can understand speech:

While speaking slowly and clearly may help with communication in some patients with ALS, this approach is less effective as the disease progresses. As ALS advances, speech muscles become affected, and the client may be unable to speak at all, making this method inappropriate for end-stage ALS. Simply speaking louder does not address the communication needs of a client who can no longer use their voice.

B. Encourage the client to write questions on a white erase board:

While writing on a whiteboard may be an effective communication strategy in the early stages of ALS when the client still has adequate hand function, this becomes increasingly difficult as muscle weakness progresses. By the end-stage, clients may lose the ability to hold a pen or write legibly, making this method less viable as the disease advances. It is not the best option for clients with significant motor impairment.

C. Use pre-arranged eye signals because eye muscles remain intact: In clients with end-stage amyotrophic lateral sclerosis (ALS), muscle weakness and loss of voluntary control progressively affect motor functions, including the ability to speak, write, and move. However, the eye muscles are typically preserved until the later stages of the disease, allowing patients to communicate through eye movements. Pre-arranged eye signals, such as blinking for "yes" or "no" or using a system of eye movements to select letters or words, are effective ways to facilitate communication with clients who can no longer speak or write. This method respects the client's remaining abilities and allows for more effective communication, especially as the disease progresses to its final stages.

D. Have the client squeeze the nurse's hand when intubated and on the ventilator:

When a client is intubated and on a ventilator, their ability to squeeze the nurse's hand may be limited due to the sedation and ventilator settings, and they may not have sufficient motor control to respond consistently. Additionally, when intubated, respiratory effort is controlled by the ventilator, so relying on hand squeezing would not be an effective or reliable method of communication. Furthermore, ALS patients in the later stages may not have enough muscle control for this method to be practical.

A. Suction the client as needed: Suctioning is an essential nursing intervention for clients on mechanical ventilation to maintain effective ventilation. Ventilated clients are at risk for accumulating secretions in the airway, which can obstruct the endotracheal tube or tracheostomy, impairing ventilation and oxygenation. Regular or as-needed suctioning helps to clear secretions, ensuring that the airway remains patent and effective ventilation is maintained. This intervention directly supports the goal of maintaining optimal respiratory function and preventing complications such as atelectasis, pneumonia, or hypoxia.

B. Administer pantoprazole sodium IV: Pantoprazole is a proton pump inhibitor used to decrease stomach acid, typically to prevent stress ulcers in critically ill patients. While this is an important aspect of care for preventing gastrointestinal complications in ventilated patients, it does not directly support ventilation. Therefore, administering pantoprazole is not as directly related to ensuring effective ventilation as suctioning or other respiratory interventions.

C. Apply sequential compression device (SCD): While applying an SCD is important for preventing deep vein thrombosis (DVT) and promoting circulation in immobile patients, it does not directly address the client's ventilation or respiratory function. This intervention is more relevant for preventing venous thromboembolism, not for managing ventilation or airway clearance.

D. Perform oral care with chlorhexidine: Oral care with chlorhexidine is an important practice to reduce the risk of ventilator-associated pneumonia (VAP) and promote overall oral hygiene. It helps decrease the colonization of bacteria in the mouth and reduces the risk of infection. However, while oral care is an essential component of care for a ventilated patient, suctioning directly addresses the goal of effective ventilation by maintaining airway patency, making it the most immediate and relevant intervention for supporting ventilation.