A 6-foot, 6-inch tall, 38-year-old man is being mechanically ventilated at a tidal volume of 500 mL and a respiratory rate of 16 breaths per minute. His most recent arterial blood gas (ABG) results are: pH = 7.33; PaO2 = 85 mm Hg; PaCO2 = 55 mm Hg.

What is the nurse's interpretation of these results?

A) Ventilation is adequate to maintain oxygenation.
B) Ventilation is excessive; respiratory alkalosis is present.
C) Ventilation is inadequate; respiratory acidosis is present.
D) Ventilation status cannot be determined from the information presented.

The ABG results show that the pH is below the normal range indicating acidosis and the PaCO2 is higher than the normal range for a male, which is likely indicative of respiratory acidosis. The PaO2 is within the normal range. Despite the patient's tidal volume and respiratory rate falling within standard ranges, they are insufficient to maintain proper CO2 levels, leading to the conclusion that ventilation is inadequate, resulting in respiratory acidosis.

Explanation:

The patient's Arterial Blood Gas (ABG) values can be interpreted in the following way: pH: 7.33, which is less than the normal range (7.35-7.45), indicating acidosis. PaCO2: 55 mm Hg, which is higher than the normal range for a male (35-48 mm Hg), suggesting that this is likely respiratory acidosis since excess CO2 is present in the blood. Lastly, the PaO2 is 85 mm Hg, which falls within a normal range.

Respiratory acidosis is often problematic as excess CO2 is present in the blood. Typically, bicarbonate levels would be normal initially, but if compensation has occurred, they would increase in an attempt to reestablish the correct ratio of bicarbonate and carbonic acid/CO2. Considering these factors, this interpretation suggests that the ventilation is inadequate, and the individual is experiencing respiratory acidosis (option C). The tidal volume of 500 mL and the respiratory rate (RR) of 16 breaths per minute presented in this question reflect the work of breathing. Under non-exertion conditions, on average, the human respiratory rate is 12–15 breaths/minute. Although the reported RR in this instance is within the normal range, it has not been sufficient to maintain proper CO2 levels in this patient.

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