A nurse in the emergency department assesses 4 clients. Based on the laboratory results, which client is the highest priority for treatment?

Question

Quizplus · Accepted Answer

Carbon monoxide (CO) is a toxic inhalant that enters the blood and binds more readily to hemoglobin than oxygen does. When hemoglobin is saturated with CO, the pulse oximeter reading is falsely normal as conventional devices detect saturated hemoglobin only and cannot differentiate between CO and oxygen. The diagnosis of CO poisoning is often missed in the emergency department because symptoms are nonspecific (eg, headache, dizziness, fatigue, nausea, dyspnea) and the pulse oximeter reading often appears within normal limits. A serum carboxyhemoglobin test is needed to confirm the diagnosis. Normal values are <5% in nonsmokers and slightly higher (<10%) in smokers. This client with CO poisoning is the highest priority for treatment and requires immediate administration of 100% oxygen to increase the rate at which CO dissipates from the blood to prevent tissue hypoxia and severe hypoxemia (Option C). (Option A) Normal blood alcohol content is 0 mg/dL (0 mmol/L), and the legal level for driving under the influence is 80 mg/dL (0.08 mg% [17.4 mmol/L]). The client's abdominal pain and increased respiratory rate require adequate assessment but are not the highest priority. (Option B) The arterial blood gases indicate compensated respiratory acidosis, which is characteristic for a client with chronic obstructive pulmonary disease; this is not the highest priority. (Option D) Emesis of 100 mL coffee-ground gastric contents would indicate an older, not fresh, gastrointestinal bleed; the hemoglobin level is normal (13.2-17.3 g/dL [132-173 g/L] for males, 11.7-15.5 g/dL [117-155 g/L] for females). The cause of the gastrointestinal bleed must be determined, but this is not the highest priority. Educational objective: Clients with carbon monoxide (CO) poisoning have elevated serum carboxyhemoglobin levels (normal <5% in nonsmokers) and false-normal pulse oximeter readings. They require immediate administration of 100% oxygen to correct hypoxemia and eliminate toxic CO from the blood.

A Nurse in the Emergency Department Assesses 4 Clients