A client with respiratory failure has a respiratory rate of 6 breaths/min and an oxygen saturation (SpO2) of 88%. The client is increasingly lethargic. Which intervention will the nurse anticipate?

Choice A reason: Tracheostomy is used for long-term airway management in chronic respiratory failure or airway obstruction. A respiratory rate of 6 breaths/min and SpO2 of 88% with lethargy indicate acute respiratory failure requiring immediate ventilatory support. Tracheostomy is invasive and time-consuming, making it less suitable than intubation for acute stabilization. Choice B reason: A respiratory rate of 6 breaths/min, SpO2 of 88%, and increasing lethargy indicate severe hypoventilation and hypoxemia, risking respiratory arrest. Endotracheal intubation with mechanical ventilation ensures airway protection and adequate gas exchange, correcting CO2 retention and hypoxemia. This is the most effective intervention for acute respiratory failure in this critical scenario. Choice C reason: Continuous positive airway pressure (CPAP) supports breathing in patients with adequate respiratory effort, like in obstructive sleep apnea. A respiratory rate of 6 breaths/min and lethargy suggest inadequate ventilation, requiring controlled mechanical support. CPAP is non-invasive but insufficient for severe hypoventilation, making it inappropriate for this acute situation. Choice D reason: A non Yvonne-rebreather mask delivering 100% O2 can improve hypoxemia but does not address hypoventilation (respiratory rate 6 breaths/min) or CO2 retention, which contribute to lethargy. Mechanical ventilation via intubation is needed to correct both hypoxemia and hypercapnia, making this a less effective intervention for the client’s critical condition.