A nurse is caring for a critically ill client receiving 100%… | MyMerci
Medical EmergenciesPA
Question
A nurse is caring for a critically ill client receiving 100% FiO2 via mechanical ventilation for 30 hours. Which assessment finding most warrants notifying the provider?
1Oral temperature 37.4°C, mild sinus tachycardia, and unchanged lung sounds suggesting expected mild stress response
3Serum glucose of 130 mg/dL, mild anxiety, and increased heart rate suggesting stress-induced hyperglycemia
4Urine output of 60 mL/hr, slightly decreased skin turgor, and dry mucous membranes suggesting mild dehydration
Explanation
Correct (2): Prolonged exposure to high FiO2 (>50%) for >24-48 hours causes pulmonary oxygen toxicity — substernal pain, dry cough, dyspnea, decreasing compliance from atelectasis and alveolar damage; can progress to ARDS-like injury. Lower FiO2 to
In-depth explanation
Memory Tip Oxygen toxicity = "Above 50, beyond 50" — FiO2 >50% for >50 hours. CPG Wean FiO2 using PEEP and prone positioning rather than relying on high FiO2.
Clinical scenario
Scenario 48-year-old male, ARDS on mechanical ventilation with FiO2 100% for 30 hours. New retrosternal chest discomfort, non-productive cough, and decreasing lung compliance on ventilator settings.
Key concepts
Pulmonary oxygen toxicity — Free radical injury from prolonged high FiO2; chest pain, dry cough, decreasing compliance.
PEEP — Positive end-expiratory pressure used to recruit alveoli and reduce FiO2 needs in ARDS.