A 78-year-old female with dyspnea, chronic renal failure and asthma missed dialysis; crackles in bases; SpO2 89%: Which action is indicated?

• A. Assist with the administration of her albuterol.
• B. Assist her ventilation with a BVM.
• C. Administer oxygen by non-rebreather mask.
• D. Administer oxygen by nasal cannula.

Answer: (C)

In this scenario the patient is likely experiencing pulmonary edema from volume overload due to renal failure and missed dialysis. The immediate need is to improve oxygenation because hypoxemia is driving the dyspnea and potential for respiratory decompensation. A non-rebreather mask delivers a high and relatively stable inspired oxygen concentration, typically around 60–95%, which is appropriate for a spontaneously breathing patient with SpO2 around 89%.

A nasal cannula, while comfortable, only provides up to about 44% oxygen and may be insufficient for significant pulmonary edema. Assisted ventilation with a bag-valve mask is reserved for patients who are not breathing adequately or are tiring and unable to protect their airway; if the patient is still breathing spontaneously and can maintain airway, starting with high-concentration oxygen via a non-rebreather is preferred. Albuterol targets bronchospasm; in fluid-overload pulmonary edema this is not the primary issue.

Providing high-concentration oxygen now helps raise the oxygen saturation and improves tissue oxygen delivery, which is the key immediate step in managing suspected pulmonary edema with hypoxemia.