Sally was admitted to the pulmonary floor for increased whee…

Sally was admitted to the pulmonary floor for increased wheezing and poor oxygenation. The following ABGs were obtained:  pH = 7.30 (7.35-7.45)   pCO2 = 50 mmHg (35-45 mmHg)      HCO3 = 30 mEq/L (20-29 mEq/L) Which of the following disorders does Sally have?

For each body system, select the potential nursing actions t…

For each body system, select the potential nursing actions that would be appropriate for this client. More than 1 action may be selected for each body system.  Explain your selection and how you will use these interventions to manage the patients care: Body System Potential Nursing Actions Cardiovascular [answer1] Apply continuous cardiac monitoringTake vital signs every 15 minutesInitiate lactated Ringer’s infusion at 250 mL/hr Pulmonary [answer2] Draw blood sample for arterial blood gases (ABGs)Teach client breathing techniques to slow RRIncrease supplemental oxygen to 6 L/min via NC Neurologic [answer3] Encourage client to ambulate in the hallwaysPlace seizure pads on the bed and floorInitiate fall precautions and bed alarm