Respiratory: COPD

The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first? 1. Assist the client into a sitting position at 90 degrees. 2. Administer oxygen at six (6) LPM via nasal cannula. 3. Monitor vital signs with the client sitting upright. 4. Notify the health care provider about the client's status.

1. Assist the client into a sitting position at 90 degrees. Rationale: The client should be assisted into a sitting position either on the side of the bed or in the bed. This position decreases the work of breathing. Some clients find it easier sitting on the side of the bed leaning over the bed table. The nurse needs to maintain the client's safety. Why it's not the rest: O2 will be applied as soon as possible, but the least amount possible; if levels are too high, the client might stop breathing. VS need to be monitored, but are not priority. The HCP needs to be notified, but the client must be treated first; the nurse should get assistance if possible so the nurse can treat this client quickly.

Which statement made by the client indicates the nurse's discharge teaching is effective for the client diagnosed with COPD? 1. "I need to get an influenza vaccine each year, even when there is a shortage." 2. "I need to get a vaccine for pneumonia each year with my influenza vaccine." 3. "If I reduce my cigarettes to six (6) a day, I won't have difficulty breathing." 4. "I need to restrict my drinking liquids to keep from having so much phlegm."

1. "I need to get an influenza vaccine each year, even when there is a shortage." Rationale: Clients diagnosed with COPD should receive the influenza vaccine each year. If there is a shortage, these clients have top priority. Why it's not the rest: The pneumococcal vaccine should be administered every five (5) to seven (7) years. Reducing the number of cigarettes smoked does not stop the progression of COPD, and the client will continue to experience signs and symptoms such as SOB or dyspnea on exertion. Clients diagnosed with COPD should increase their fluid intake unless contraindicated for another health condition; the increased fluid assists the client in expectorating the thick sputum.

The nurse is caring for the client diagnosed with end-stage COPD. Which data warrant immediate intervention by the nurse? 1. The client's pulse oximeter reading is 92%. 2. The client's arterial blood gas level is 74. 3. The client has SOB when walking to the bathroom. 4. The client's sputum is rusty colored.

1. 4. The client's sputum is rusty colored. Rationale: Rusty-colored sputum indicates blood in the sputum and requires further assessment by the nurse. Why it's not the rest: The client with end-stage COPD has decreased peripheral O2 levels. The client's ABGs would normally indicate a low O2 level. The client who develops dyspnea on exertion should stop the exertion but does not require intervention by the nurse if the dyspnea resolves.

Which client problems are appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? Select all that apply. 1. Impaired gas exchange. 2. Inability to tolerate temperature extremes. 3. Activity intolerance. 4. Inability to cope with changes in roles. 5. Alteration in nutrition.

1. Impaired gas exchange. 2. Inability to tolerate temperature extremes. 3. Activity intolerance. 4. Inability to cope with changes in roles. 5. Alteration in nutrition. Rationale: The client diagnosed with COPD has difficulty exchanging O2 with CO2, which is manifested by physical signs such as fingernail clubbing and respiratory acidosis as seen on ABGs. The client should avoid extremes in temperatures. Warm temperatures cause an increase in the metabolism and increase the need for O2. Cold temperatures cause bronchospasms. The client has increased respiratory effort during activities and can be fatigued. Activities should be timed so rest periods are scheduled to prevent fatigue. The client may have difficulty adapting to the role changes brought about because of the disease process. Many cannot maintain the activities involved in the meeting responsibilities at home and at work. Clients should be assessed for these issues. Clients often lose weight because of the effort expended to breathe. Why it's not the rest: N/A.

Which outcome is appropriate for the client problem "ineffective gas exchange" for the client recently diagnosed with COPD? 1. The client demonstrates the correct way to pursed-lip breathe. 2. The client lists three (3) signs/symptoms to report to the HCP. 3. The client will drink at least 2,500 mL of water daily. 4. The client will be able to ambulate 100 feet with dyspnea.

1. The client demonstrates the correct way to pursed-lip breathe. Rationale: Pursed-lip breathing helps keep the alveoli open to allow for better O2 and CO2 exchange. Why it's not the rest: Outcome 2 is appropriate for a knowledge-deficit problem. Outcome 3 does not ensure the client has an effective airway; increasing fluid does not ensure an effective airway. Outcome 4 is not appropriate for any client problem because the client should be able to ambulate w/o dyspnea for 100 feet.

The nurse is assessing the client diagnosed with COPD. Which data require immediate intervention by the nurse? 1. Large amounts of thick white sputum. 2. Oxygen flowmeter set on eight (8) liters. 3. Use of accessory muscles during inspiration. 4. Presence of a barrel chest and dyspnea.

2. Oxygen flowmeter set on eight (8) liters. Rationale: The nurse should decrease the O2 rate to two (2) or three (3) liters. Hypoxemia is the stimulus for breathing in the client with COPD. If the hypoxemia improves and the O2 level increases, the drive to breathe may be eliminated. Why it's not the rest: A large amount of thick sputum in a common symptom of COPD. It is common for COPD clients to use accessory muscles when inhaling. Clients with COPD commonly have the characteristic barrel chest from chronic hyperinflation and dyspnea.

The nurse observes the UAP removing the nasal cannula from the client diagnosed with COPD while ambulating the client to the bathroom. Which action should the nurse implement? 1. Praise the UAP because the prevents the client from tripping on the oxygen tubing. 2. Place the oxygen back on the client while sitting in the bathroom and say nothing. 3. Explain to the UAP in front of the client oxygen must be left in place at all times. 4. Discuss the UAP's action with the charge nurse so appropriate action can be taken.

2. Place the oxygen back on the client while sitting in the bathroom and say nothing. Rationale: The client needs the O2, and the nurse should not correct the UAP in front of the client; it is embarrassing for the UAP and the client loses confidence in the staff. Why it's not the rest: The client with COPD needs O2 at all times, especially when exerting energy such as ambulating to the bathroom. The nurse should not verbally correct a UAP in front of the client; the nurse should correct the behavior and then talk to the UAP in private. The primary nurse should confront the UAP and take care of the situation; continued unsafe client care would warrant notifying the charge nurse.

Which clinical manifestation should the nurse expect to assess in the client recently diagnosed with COPD? 1. Clubbing of the client's fingers. 2. Infrequent respiratory infections. 3. Chronic sputum production. 4. Nonproductive hacking cough.

3. Chronic sputum production. Rationale: Sputum production, along with cough and dyspnea on exertion, are the early signs/symptoms of COPD. Why it's not the rest: Clubbing of fingers is the result of chronic hypoxemia, which is expected with chronic COPD but not recently diagnosed COPD. COPD clients have frequent respiratory infections. These clients have a productive cough, not a nonproductive cough.

Which referral is most appropriate for a client diagnosed with end-stage COPD? 1. The Asthma Foundation of America. 2. The American Cancer Society. 3. The American Lung Association. 4. The American Heart Association.

3. The American Lung Association. Rationale: The American Lung Association has information helpful for a client with COPD. Why it's not the rest? The other options may have information useful for other clients, but none have information about COPD available for COPD clients.

The nurse is caring for the client diagnosed with COPD. Which outcome requires a revision in the plan of care? 1. The client has no signs of respiratory distress. 2. The client shows an improved respiratory pattern. 3. The client demonstrates intolerance to activity. 4. The client participates in establishing goals.

3. The client demonstrates intolerance to activity. Rationale: The expected outcome should be that the client has tolerance for activity; because the client is not meeting the expected outcome, the plan of care needs revision. Why it's not the rest: The expected outcome showing no signs of respiratory distress indicates the plan of care is effective and should be continued. An improved respiratory pattern indicates the plan should be continued. The client should participate in planning the course of care; the client is meeting the expected outcome.

Which statement made by the client diagnosed with chronic bronchitis indicates to the nurse more teaching is required? 1. "I should contact my health care provider if my sputum changes color or amount." 2. "I will take my bronchodilator regularly to prevent having bronchospasms." 3. "This metered-dose inhaler gives a precise amount of medication with each dose." 4. "I need to return to the HCP to have my blood drawn with my annual physical."

4. "I need to return to the HCP to have my blood drawn with my annual physical." Rationale: Clients should have blood levels drawn every six (6) months when taking bronchodilators, not yearly. This indicates the client needs more teaching. Why it's not the rest: When sputum changes color or amount, or both, this indicates infection, and the client should report this information to the HCP. Bronchodilators should be taken routinely to prevent bronchospasms. Clients use metered-dose inhalers because they deliver a precise amount of medication with correct use.

The nurse is assessing the client with COPD. Which health promotion information is most important for the nurse to obtain? 1. Number of years the client has smoked. 2. Risk factors for complications. 3. Ability to administer inhaled medications. 4. Willingness to modify lifestyle.

4. Willingness to modify lifestyle. Rationale: The client's attitude toward lifestyle changes is the most important consideration in health promotion, in this case smoking cessation. The nurse should assess if the client is willing to consider cessation of smoking and carry out the plan. Why it's not the rest: The number of years of smoking is information needed to treat the client but not most important. The risk factor for complications are important for planning care. Assessing the ability to deliver medications is an important consideration when teaching the client.