COPD

The nurse is planning to teach a client with COPD how to cough effectively which of the following instructions should be included?

-Assume a side-lying position extend the arm over the head and alternating breathing with coughing -take a deep ABD breath, bend forward, and cough three or four time son exhalation -lie flat on the back, splint the thorax, take two deep breaths, and cough -take several rapid, shallow breaths and then cough forcefully rationale: The goal of effective coughing is to converse energy, facilitate removal of secretions. and minimize airway collapse. The client should assume a sitting position w/feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing exhale. after resuming and upright position, the client should use and breathing to slowly and deeply inhale. after repeating this process 3 or 4 times, the client should take a deep ABD breath, bend forward, and cough 3 or 4 times upon exhalation ("huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

When teaching a client with COPD to conserve energy the nurse should teach the client to lift objects

While exhaling through pursed lips while inhaling through an open mouth after exhaling but before inhaling while taking a deep breath and holding it rationale: Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting w/the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.

The nurse reviews in arterial blood gas report for a client with chronic obstructive pulmonary disease the results are: pH 7.35 PCO2 62 PO2 70 HCO3 34. The nurse should first:

Assess the vital signs rationale: client with chronic COPD CO2 retention in the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms such as dyspnea should be assessed.

When developing a discharge plan to manage the care of a client with COPD the nurse should advise the client to expect to:

Develop respiratory infections easily rationale: A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations.

A client with COPD is experiencing dyspnea and has a low PaO2 level. the nurse plans to administer oxygen as prescribed. which of the following statements is true concerning oxygen administration to a client with COPD?

High oxygen concentrations may inhibit the hypoxic stimulus to breathe -high oxygen concentrations will cause coughing and dyspnea -increased oxygen use will cause the client to become dependent on the oxygen -administration of oxygen is contraindicated in clients with COPD rationale: clients who have a long history of COPD may retain CO2. Gradually the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the rest. center. The major respiratory. stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this resp. stimulus and leads to hypoventilation. Oxygen can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.

Which of the following physical assessment findings are normal for a client with advanced COPD?

Increased anteroposterior chest diameter (barrel chest) rationale: Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli in the ribs are fixed in and inspiratory position. The result is the typical barrel chested appearance. Overly developed not under developed neck muscles are associated with COPD because of their increase use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

A client ABG values are as follows: pH 7.31 PaO2 80 PaCO2 65 HCO3 36

Irritability cyanosis flushed skin anxiety rationale: The high PaCO2 level causes flushing d/t vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect of the CNS. Cyanosis is s sign of hypoxia. Irritability and anxiety are not common w/a PaCO2 level of 65 but are associated w/hypoxia

The nurse administers theophylline to a client. when evaluating the effectiveness of this medication the nurse should assess the client for which of the following?

Less difficulty breathing suppression of the cline's respiratory. infection decrease in bronchial secretions thinning of tenacious, purulent sputum rationale: Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

Which of the following diets would be most appropriate for a client with COPD?

Low fat low cholesterol diet bland, soft diet low-sodium diet high-calorie, high-protein diet rationale: The client should eat high-calories, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased WOB. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients w/CAD. The client w/COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medially indicated. There is no need for the client to eat bland, soft foods.

Which of the following is a priority goal for the client with COPD?

Maintaining functional ability Minimizing chest pain increasing carbon dioxide levels in the blood treating infections agents *goal not not a priority rationale: a priority goal for the client w/COPD is to manage the signs and symptoms of the disease process so as to maintain the client's functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients w/COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client w/COPD.

The nurse is instructing a client with chronic obstructive pulmonary disease how d to do pursed lip breathing in which order should the nurse explain the steps to the client?

1. Relax your neck and shoulder muscles 2. breathe in normally through your nose for two counts (while counting to yourself one, two) 3. pucker your lips as if you were going to whistle 4. Breathe out slowly through pursed lips for four counts (while counting to yourself one, two, three, four)

When instructing clients on how to decrease the risk of COPD the nurse should emphasize which of the following?

Abstain from cigarette smoking rationale: cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants & chronic asthma. Participating in aerobic exercise will not decrease the risk of COPD. Insufficient protein intake & exposure to people w/resp. infections do not increase the risk of COPD.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection which of the following findings would be expected?

Course crackles and rhonchi normal breath sounds prolonged inspiration normal chest movement rationale: exacerbations of COPD are commonly caused by respiratory. infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. chest movement is decreased as lungs become overdistended.

The nurse teaches a client with COPD to assess for signs and symptoms of right sided heart failure which of the following signs and symptoms should be included in the teaching plan?

Peripheral edema clubbing of nail beds HTN increased appetite rationale: right-sided HF is a complication of COPD that occurs because of pulmonary HTN. S/S of R. sided HF include peripheral edema, JVD, hepatomegaly, and weight gain d/t increased fluid vol. Clubbing of nail beds is associated w/conditions of chronic hypoxemia. HTN is associated w/L. sided HF. clients w/heart failure have decreased appetites.

Which of the following is an expected outcome of pursed lip breathing for a client with emphysema?

to promote carbon dioxide elimination to promote oxygen intake to strengthen the diaphragm to strengthen the intercostal muscles rationale: pursed-lip breathing prolongs exhalation and prevents air trapping in alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

Which of the following indicates that the client with COPD who has been discharged to home understands the care plan?

The client agrees to call the position of dyspnea on exertion increases rationale: Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptoms of COPD. Clients with COPD use low flow oxygen supplementation 1 to 2 L /minute to avoid suppressing the respiratory drive, which, for these clients, and stimulated by hypoxia.

The client with COPD is taking theophylline the nurse should instruct the client to report which of the following signs of theophylline toxicity?

Nausea vomiting seizures insomnia rationale: The therapeutic range is 10 to 20 mcg/mL. If level below therapeutic range, pt @ risk for more frequent exacerbation s of disease