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The nurse is planning the care of a complex elderly patient who has been admitted to the medical ward for the treatment of cellulitis. The nurse notes that the patient has a longstanding history of chronic obstructive pulmonary disease (COPD). What assessment finding would most clearly indicate the need for oxygen therapy?

SaO2 of 86% on room air Explanation: Crackles, coughing, and increased RR are all consistent with COPD. However, the decision on whether to apply oxygen therapy is most commonly made on the basis of oxygen levels as determined by pulse oximetry.

In which position should the client be placed for a thoracentesis?

Sitting on the edge of the bed

The nurse is caring for an asthmatic patient hospitalized with an acute asthma exacerbation. What drugs would the nurse anticipate being ordered for this patient to gain underlying control of persistent asthma?

Anti-inflammatory drugs Explanation: Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of anti-inflammatory medications. Rescue inhalers, antibiotics, and antitussives do not aid in the control of persistent asthma.

Mrs. Fawcett is a 70-year-old woman who has a diagnosis of emphysema and who receives long-term oxygen therapy. She has presented to the emergency department because she states that she is experiencing an exacerbation of her chronic obstructive pulmonary disease (COPD), and she is in visible respiratory distress. How can the nurse best assess Mrs. Fawcett's dyspnea?

Ask her to rate her shortness of breath on a scale of 0 to 10.

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive?

Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for women ages 9 to 26.

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway?

Correct response: Teaching the client how to perform controlled coughing Explanation: Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

what finding is a late indicator of hypoxia?

Cyanosis

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?

Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries Explanation: The diagnosis of pulmonary hypertension associated with COPD is suspected in patients complaining of dyspnea and fatigue that appear to be disproportionate to pulmonary function abnormalities. Enlargement of the central pulmonary arteries on the chest X-ray, echocardiogram suggestive of right ventricular enlargement, and elevated plasma BNP may be present.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

It helps prevent early airway collapse. Explanation: Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

The patient is having pulmonary function studies performed. The patient has a spirometry test and has a FEV1/FVC ratio of 60%. This finding suggests:

Obstructive lung disease. Explanation: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is a FEV1/FVC ratio less than 70%.

A resident of a long-term care facility has lived with chronic obstructive pulmonary disease (COPD) for many years but has experienced a gradual increase in dyspnea despite the use of long-term oxygen therapy. In recent weeks, dyspnea has interfered with the resident's ability to eat, and the nurse recognizes the potential nursing diagnosis of altered nutrition: less than body requirements. How can the nurse best foster this resident's nutritional status?

Order small, frequent meals and nutritional supplements for the resident.

pulmonary edema

Pink, frothy sputum may be an indication of

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in tension iincreased carbon dioxiden arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis Explanation: Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure.

sibilant wheezes

They can be heard during inspiration and expiration

purpose of the vascular and ciliated mucous lining of the nasal cavities?

Warm and humidify inspired air

pulmonary angiography

a contrast medium is injected into the femoral artery. When the medium is infused, the client will feel a sense of warm and flushed with an urge to cough. The client will feel a pressure when the catheter is inserted.

Funnel chest occurs when

a depression occurs in the lower portion of the sternum, which may result in murmurs.

Sibilant wheezes

are associated with asthma and bronchospasm.

Fine crackles

are associated with pulmonary fibrosis.

Crackles

are secondary to fluid in the airways or alveoli or to delayed opening of collapsed alveoli.

barrel chest occurs .

as a result of over inflation of the lungs

atelectasis

collapsed lung

cellulitis

diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling

Pigeon chest occurs as a result of .

displacement of the sternum, resulting in an increase in the anteroposterior diameter

Kyphoscoliosis is characterized by

elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax.

Pulse oximetry

is a noninvasive method of monitoring oxygen saturation of hemoglobin. A probe is placed on the fingertip, forehead, earlobe, or bridge of nose. Inaccuracy of results may be from anemia, bright lights, shivering, nail polish, or peripheral vascular disease.

Biot's respiration

is characterized by periods of normal breathing (3 to 4 breaths) followed by a varying period of apnea (usually 10 to 60 seconds).

orthopena

placed in a high Fowler's position to facilitate breathing

bronchoscopy

procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort

MRI can visualize .

soft tissues, characterize nodules, and help stage carcinomas.

Crackles

soft, high-pitched, discontinuous popping sounds that occur during inspiration.

thoracentesis

surgical puncture to remove fluid from the pleural space

MRI

uses magnetic fields and radiofrequency signals to produce a detailed diagnostic image. MRI can visualize soft tissues, characterize nodules, and help stage carcinomas. The other options describe different studies.

Wheezes

usually heard on expiration, are continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways. Often, wheezes are associated with asthma

pulmonary function studies

one of a number of tests used to access volume and airflow rate of the lungs

pulmonary embolism

clot or other material lodges in vessels of the lung

pulmonary edema

crackles in the lung base