nbme test 4 for discussion - drmaafo

[ArchivalUser]

A 78-year-old African American man with severe dementia is brought to the emergency department from the nursing care facility where he resides because of a 30-minute history of acute respiratory distress. The nurses report that 2 days ago, he had been eating his dinner in the dining room when he began choking. Since then, he has had gradually worsening respiratory difficulty. He has required hospitalization for aspiration pneumonia three times during the past year. During his last hospital stay, the patient's son, who has durable power of attorney, made a decision to not intubate the patient in the case of future infections. Now, in the emergency department, the patient is gasping for breath but does not appear to be in pain. Vital signs are temperature 37.0°C (98.6°F), pulse 96/min, respirations 44/min, and blood pressure 166/90 mm Hg. Auscultation of the lungs discloses coarse crackles in the right upper lobe posteriorly. Pulse oximetry on room air shows an oxygen saturation of 70%; oxygen saturation is 82% while the patient is breathing 100% oxygen through a closed face mask.

Which of the following is the most appropriate next step?

A ) Administer intravenous morphine
B ) Intubate the patient
C ) Place the patient in reverse Trendelenburg position
D ) Switch oxygen administration to nasal cannula at 4 L/min

[ArchivalUser]

TO BE ANSWERED