L.B. is brought to the ER after

L.B. is brought to the ER after a motor vehicle accident. He was going through an intersection when someone ran a red light and hit his car. Initial assessment: Subjective: Patient is complaining of chest pain rated 6/10. The pain gets worse with deep breaths. Patient complains of neck pain. Objective: Lacerations on his face and hands from broken glass Bruising on chest where he hit the steering wheel Vital Signs: Pulse 110, RR 25 and shallow, BP 110/60, Pulse ox 95% Lab Values: hemoglobin 15, Hematocrit 45%, Troponin negative, Na 139, KCl 4 ECG: Normal sinus rhythm X-ray: Factured ribs 3-5 on left side ABG: pH 7.35, PaCO2 42, Bicarbonate 22, PaO2 90 What type of respiratory distress (ventilatory or oxygenation failure) are we concerned about? What complications may occur? L.B. is discharged from hospital with hydrocodone/APAP 5/325 for pain. Two days later the wife brings L.B. back to ER Subjective data: Wife states patient has become sleepy with periods of confusion Wife has been giving Hydrocodone Q 4 hours as instructed by ER personnel at discharge Last dose of Hydrocodone was 1 hour ago Patient arouses with difficulty and oriented to person only Objective data: RR 10 with shallow breathing Vitals: pulse 120, RR 10, BP 95/50, pulse ox 88% ABG: pH 7.30, PaCO2 50, Bicarbonate 22, PaO2 70 Lungs diminished bilaterally Patient placed on mask 30% oxygen and transferred to the medical inpatient floor Evaluate the ABG from the ER. What is happening? As the nurse taking care of L.B. What are your three priority interventions with rationale? SCIENCE HEALTH SCIENCE NURSING NU 225

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