In the critical care unit, which client should be assigned to the most experienced nurse based on ABG data?

• A. The client with diabetic ketoacidosis (DKA) with pH 7.29, PaO2 98, PaCO2 30, HCO3 15.
• B. The client with COPD with pH 7.35, PaO2 78, PaCO2 54, HCO3 20.
• C. The client with a myocardial infarction with pH 7.4, PaO2 91, PaCO2 43, HCO3 25.
• D. The client with a pulmonary embolism with pH 7.35, PaO2 88, PaCO2 44.

Answer: (A)

Interpreting ABG data means оценивing acid-base status and how unstable the patient is, guiding who needs the most experienced nurse. The client with diabetic ketoacidosis shows metabolic acidosis: pH is low, bicarbonate is low, and the PaCO2 is lowered from respiratory compensation. This combination indicates active ketoacidosis with dehydration and a real risk of rapid deterioration. It requires aggressive management—intravenous fluids, electrolyte repletion (notably potassium, which can shift when insulin is started), and insulin therapy—plus close, skilled monitoring for complications. Oxygenation is currently good, so the urgency centers on correcting the metabolic derangement and its systemic effects, which demands an experienced nurse.

In contrast, the COPD case has elevated PaCO2 and a near-normal pH, suggesting chronic respiratory failure with some acute change but not as immediately unstable or complex to manage. The myocardial infarction case shows a normal ABG, indicating no acute acid-base issue requiring intensive interpretation. The pulmonary embolism case has relatively stable ABG aside from mild hypoxemia, which is less immediately complex than managing DKA.