Situation: Tomás, a 58-year-old man, is in the medical ICU on day 3 of mechanical ventilation following aspiration pneumonia. Background: He has a history of type 2 diabetes and hypertension. Assessment: Current ABG results show pH 7.28, PaCO2 52 mmHg, HCO3 24 mEq/L, PaO2 58 mmHg on FiO2 0.70, PEEP 10 cmH2O. He is febrile at 38.9°C, SpO2 88%, bilateral crackles on auscultation, and chest X-ray shows diffuse bilateral infiltrates. The nurse reviews his chart and notes his family has not been asked about goals of care. His wife arrives at the bedside and states, 'He told me he never wanted to be kept alive on machines, but I don't see anything in his chart about that.' Which action should the nurse take first?
- Adjust the ventilator settings to correct the respiratory acidosis before addressing the family's concerns.
- Document the wife's statement in the chart and reassess the client's respiratory status before escalating.
- Inform the wife that ventilator support cannot be withdrawn without a written advance directive in the chart.
- Notify the primary health care provider of the family's statement about the client's previously expressed wishes regarding life-sustaining treatment.