A patient with significant flail chest has arterial blood gases (ABGs) that reveal a PaO₂ of 68 and PaCO₂ of 51. Two hours ago the PaO₂ was 82 and PaCO₂ was 44. Based on these changes, which item should the nurse assure easy access to in order to help ensure patient safety?

Question

Question

This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

Attempt Online

Answer 1

Correct Answer: Intubation tray

Rationale:

A patient with significant flail chest is at risk of respiratory deterioration due to impaired gas exchange and potential fatigue of respiratory muscles. Flail chest, characterized by the paradoxical movement of a segment of the chest wall, compromises effective ventilation and oxygenation.
The arterial blood gases (ABGs) indicate a worsening condition, as evidenced by the dropping PaO2 (from 82 to 68) and rising PaCO2 (from 44 to 51). These changes suggest hypoxemia (low oxygen in the blood) and hypercapnia (elevated carbon dioxide levels), signaling that the patient is failing to maintain adequate ventilation.
In cases of worsening respiratory function, intubation may be required to secure the airway and provide mechanical ventilation to support the patient’s breathing. This is crucial to prevent respiratory failure and ensure patient safety.
Having an intubation tray readily available ensures that the nurse and healthcare team can act quickly if the patient requires intubation due to further respiratory compromise.

Explanation of Other Options:

Injectable lidocaine

Rationale: Lidocaine is commonly used as a local anesthetic or as an anti-arrhythmic agent. However, it is not directly relevant in this scenario. The patient’s primary issue is respiratory compromise due to flail chest, and lidocaine does not address this problem.

Chest tube insertion set

Rationale: While a chest tube insertion set is essential in cases of pneumothorax or hemothorax, there is no indication in the question that the patient has developed either of these complications. The primary concern here is respiratory failure, not the need for chest drainage.

Portable chest X-ray machine

Rationale: A portable chest X-ray can be useful for diagnosing complications such as pneumothorax or assessing the severity of flail chest, but it is not immediately life-saving in the context of worsening respiratory failure. The priority is securing the airway and ensuring adequate ventilation.

Conclusion:

The patient’s declining ABG values indicate a need for intervention to prevent respiratory failure. An intubation tray should be readily available to facilitate rapid intubation if necessary. The other options, while useful in specific scenarios, do not address the immediate risk to the patient’s airway and breathing.