BIOLOGY 102 Medical-Surgical Nursing Critical Thinking in Client Care, CHAPTER 37 -39

Medical-Surgical Nursing Critical Thinking in Client Care, 4th Edition Priscilla LeMon

CHAPTER   37 -39

CHAPTER 37

1. A review of a client’s medication list is an important part of an assessment prior to any addition of new medications. A client has been advised to take an over-the-counter decongestant. Which other class of medications that the client is currently taking would possibly contraindicate the use of a decongestant?

a. Nonsteroidal anti-inflammatory drug (NSAID)

b. Anticoagulant

c. Antihypertensive

d. Antihistamine

2. An older adult is hospitalized with a respiratory illness. Labs are drawn and a chest x-ray is completed. The white blood cell (WBC) count is elevated. What type of infection does this most likely indicate?

a. Bacterial

b. Viral

c. Fungal

d. Atypical

3. The nurse is preparing an educational program for the community prior to the influenza (flu) season. The primary focus will be on:

a. Recognition of signs and symptoms of influenza.

b. Promotion of yearly flu vaccine.

c. Use of antiviral drugs such as Tamiflu if exposed.

d. Complimentary therapies that are recommended.

4. During an office visit, the nurse is collecting data regarding a client’s health history and current medication list. The client states “I can’t seem to stop coughing since I have this cold.” The nurse anticipates a cough suppressant will be prescribed with which of the following directions for frequency?

a. Take in the morning before beginning activities.

b. Take at mealtimes and before bed.

c. Take in the evening before bedtime.

d. Take in the morning and before bed.

5. Following sinus surgery, a client might have a nursing diagnosis of Nutrition, Imbalanced: Less than Body Requirements. Common contributing factors for this diagnosis can include: (Select all that apply.)

a. Presence of nasal packing.

b. Mouth discomfort.

c. Numbness of upper teeth.

d. Side effects of antibiotics.

6. When providing discharge instructions to a client diagnosed with streptococcal pharyngitis, what information should be stressed?

a. “Make your follow-up appointment for two weeks from today.”

b. “Take all of your antibiotic until gone.”

c. “The only medication you need is over-the-counter pain medication.”

d. “You will need a repeat CBC (complete blood count) in seven days.”

7. A parent asks when his teenager with a diagnosis of bacterial pharyngitis can return to school. The best response by the nurse would be:

a. “Once the full course of antibiotics is complete.”

b. “Your physician will check her throat at the follow-up appointment and tell you then.”

c. “Once she has been on antibiotic therapy for 24 hours.”

d. “ After her fever returns to normal.”

: C

Rationale: A client is no longer contagious once she has had antibiotic therapy for 24 hours, not the full course of therapy. The client might still have a low-grade fever, but is no longer contagious after 24 hours of antibiotics. A follow-up appointment is typically not necessary.

Implementation: Physiological Integrity: Application

8. A client presents with a two-day history of sore throat, painful swallowing, drooling, and stridor. A diagnosis of epiglottitis is suspected. What would it be important for the nurse to communicate to the nurses on the next shift?

a. The throat should not be visualized using a tongue blade.

b. Oxygen should be applied only by nasal cannula.

c. The client will most likely go to surgery after the diagnosis is confirmed.

d. Any visitors need to wear a mask when entering the room.

: A

Rationale: Visualization of the oropharynx should be done using a flexible fiber optic laryngoscope by a physician, not a tongue blade by the nurse. Using a tongue blade could trigger laryngospasm and airway obstruction. Oxygen might be needed, but can be delivered by nasal cannula or by mask. No surgery is recommended for epiglottitis, although intubation might be necessary. No infection control precautions are implemented with this diagnosis.

Implementation: Safe, Effective Care Environment: Application

9. The nurse caring for a client notes a grayish membrane covering the pharynx. A diagnosis of diphtheria is made by the physician. Infection control measures are implemented after the diagnosis. The nurse will need which of the following due to the exposure to diphtheria?

a. Antitoxin

b. Booster immunization shot

c. Epinephrine

d. Antibiotics

: B

Rationale: The nurse would have been required to be up-to-date on immunizations if providing client care. Booster immunization shots are given to people who have not been immunized within the past five years, and to those exposed to the infection. People who are not immunized would need the immunization and antibiotics. Diphtheria antitoxin is given to clients with a diagnosis of diphtheria. Epinephrine is readily available if the client experiences an anaphylactic reaction to the antitoxin.

Assessment: Health Promotion and Maintenance: Analysis

10. During a sporting event, a client gets hit with a ball in the nose. The injury is severe enough to require medical attention. After the bleeding is stopped, the nurse notes a clear, watery fluid dripping from the nose. What should the nurse do first?

a. Lower the head of the bed.

b. Apply some of the fluid to a glucose test strip.

c. Call the physician.

d. Have the client blow his nose.

: B

Rationale: Cerebrospinal fluid (CSF) might be leaking through the nose due to the injury. By applying some of the drainage to a glucose test strip, the nurse can determine if glucose is present in the fluid. A positive result indicates the presence of CSF. If would be best to check this before calling the physician. The head of the bed should remain up to decrease the risk of aspiration. Having the client blow his nose would be contraindicated until it is determined whether the fluid is CSF.

Evaluation: Physiological Integrity: Analysis

CHAPTER 38

1. A client has been diagnosed with bacterial pneumonia. The nurse prepares anticipatory teaching for this diagnosis. Which of the following classes of medications is expected to be prescribed? Select all that apply.

a. Antibiotics

b. Steroids

c. Bronchodilators

d. Antiemetics

: A; C

Rationale: Antibiotics are indicated in a bacterial infection. Bronchodilators are commonly prescribed to decrease bronchospasm and increase ventilation. Steroids are recommended in inflammatory, not bacterial, disorders. Antiemetics are not typically indicated for bacterial pneumonia.

Planning: Physiological Integrity: Application

2. When giving directions for the collection of a sputum specimen, the nurse must stress to the client:

a. That she must blow her nose first.

b. That secretions are needed from the lower respiratory tract.

c. That taking a drink of water will assist with the collection.

d. That she will be n.p.o. (nothing by mouth) for six hours before the collection.

: B

Rationale: Secretions from the lower respiratory tract, not the mouth or nasal passages, are needed for a sputum culture and sensitivity. Blowing the nose or drinking water is not necessary or helpful. Having the client remain n.p.o. is not a recommended practice for this specimen to be collected.

Implementation: Physiological Integrity: Application

3. A client with pneumonia has thick, viscous mucous secretions. A non-pharmacological measure that can improve this would be:

a. Application of oxygen by mask.

b. Increasing fruit intake.

c. Increasing fluid intake.

d. Decreasing carbohydrate intake.

: C

Rationale: Increasing fluid intake to 2,500–3,000 milliliters or more per day can help secretions to be more liquefied. This will make the secretions easier to cough up and remove. The application of oxygen, increasing fruit, and decreasing carbohydrate intake will not have this effect on the secretions.

Implementation: Physiological Integrity: Application

4. A clinic is being conducted to provide influenza (flu) and pneumonia vaccines for adults. Prior to administration of a flu vaccine, the nurse must assess for:

a. Current antibiotic therapy.

b. Pulse oximeter saturation level.

c. Allergy to mercury.

d. Allergy to eggs.

: D

Rationale: Assessing for an allergy to eggs or previous influenza vaccines is necessary prior to administration. A hypersensitivity to egg protein may be invoked after administration of the influenza vaccine due to additives in the vaccine. Pulse oximeter reading is not taken before the vaccine is administered. Current antibiotic therapy would not have a direct bearing on the vaccine.

Assessment: Health Promotion and Maintenance: Analysis

5. The client with a nursing diagnosis of Airway Clearance, Ineffective has a nursing intervention listed to assess respiratory status. Specific nursing assessments that would be done related to this would include: (Select all that apply.)

a. Assess skin color at least every four hours.

b. Assess breath sounds at least every four hours.

c. Assess oxygen saturation level at least every four hours.

d. Assess vital signs at least every four hours.

: A; B; C; D

Rationale: When monitoring a client with a respiratory illness that induces secretions, the client must be monitored for ineffective airway clearance.  By assessing the skin, vital signs, breath sounds, and oxygen saturation levels at least every four hours, the nurse will be able to detect subtle changes that could indicate impending changes with the client.

Assessment: Physiological Integrity: Application

6. A client has a diagnosis of severe acute respiratory syndrome (SARS). The client is in a medical–surgical unit. The nurse caring for the client is assessing for any early signs of respiratory failure. Early signs that would need to be reported include: (Select all that apply.)

a. Nasal flaring.

b. Restlessness.

c. Anxiety.

d. Decreased level of consciousness.

: A; B; C; D

Rationale: The above signs are all early indicators of respiratory failure or inability to maintain ventilatory effort. Other early signs include tachypnea, tachycardia, use of accessory muscles, intercostal retractions, and cyanosis.

Assessment: Physiological Integrity: Analysis

7. An older adult is a resident in a long-term nursing care facility. He begins to develop symptoms that include a cough, weight loss, anorexia, and periodic fevers. The nurse notes the change in the client’s status and reports it to the physician. The nurse would anticipate which of the following actions as a result?

a. The client would be transferred to an acute-care facility.

b. The client would be started on antibiotics.

c. The client would have a tuberculin skin test.

d. The client would have a CBC (complete blood count) drawn.

: C

Rationale: Residents of nursing homes are at risk for acquiring tuberculosis. The symptoms listed are vague, but indicative of possible tuberculosis. A transfer to an acute-care facility would not be indicated at this time. Antibiotics would not be implemented until diagnostic testing was performed and the diagnosis was made. A CBC may be ordered at a later time, but is not diagnostic for this disorder.

Planning: Physiological Integrity: Analysis

8. Medications prescribed for the treatment of tuberculosis have many side effects that can also affect the client’s health. A side effect that would need to be reported by the client who has been prescribed INH and rifampin would be:

a. Fever.

b. Yellow tint to the skin.

c. Episodic pain in the left upper quadrant.

d. Diarrhea.

: B

Rationale: INH and rifampin can cause hepatitis. Jaundice could indicate hepatitis. A fever or diarrhea would not indicate hepatitis. The pain from hepatitis is on the right upper quadrant, not the left.

Implementation: Physiological Integrity: Application

9. A client with tuberculosis is found to be resistant to INH medication. The physician plans to start the client on ethambutol (Myambutol) as a replacement to the INH. Prior to initiating this drug therapy, the nurse tells the client she will have to:

a. Be assessed for an allergy to eggs.

b. Have a baseline visual exam.

c. Have an influenza (flu) vaccine.

d. Have a baseline ECG (electrocardiogram).

: B

Rationale: Before starting on ethambutol (Myambutol), a baseline visual examination is indicated. Eye exams also may be scheduled during the course of treatment. This medication can produce a toxic effect of optic neuritis. This is reversible. Assessment of an allergy to eggs or administration of a flu vaccine or an ECG is not warranted prior to the implementation of this medication.

Implementation: Physiological Integrity: Analysis

10. While assisting a client to move up in bed, the nurse realizes that the chest tube was caught on the bed rail. The tube was dislodged from the client. The first response by the nurse would be to:

a. Notify the physician.

b. Call for help.

c. Place a sterile occlusive gauze over the wound.

d. Raise the head of the client’s bed.

: C

Rationale: The wound of a chest tube insertion site must be covered immediately with a sterile, occlusive gauze and taped on three sides to prevent a tension pneumothorax from developing. Air would be prevented from entering the wound during inhalation, but allowed to escape during exhalation. The gauze is recommended to be lined with a substance such as petroleum jelly. The nurse may then call for help and then notify the physician. Raising the head of the bed is not directly indicated for this situation.

Implementation: Physiological Integrity: Analysis

Chapter 39

1.            Which findings would indicate immediate action by the nurse when assessing a                 client with a respiratory disorder, such as asthma?

                1. Tachycardia, tachypnea, prolonged expirations

                2.    Diffuse wheezing and the use of accessory muscles when inhaling

                3.    Retractions, fatigue, anxiety

                4.    Inaudible breath sounds, reduced wheezing, and an ineffective cough

: 4

Rationale:    During an asthma attack, tachycardia, tachypnea, and prolonged expirations are common. These would be early symptoms of the disease process that can easily be addressed without urgency. A progression of symptoms would include diffuse wheezing and the use of accessory muscles when inhaling. But airflow is still occurring; therefore, these are not as urgent as other symptoms presented. Retractions, fatigue, and anxiety are also a progression of symptoms that occur with an asthma attack that represent a more severe episode. But they are not the worst or most serious set of symptoms listed, because air is still moving and exchanging. Inaudible breath sounds, reduced wheezing, and ineffective cough reflect that little or no air movement into and out of the lungs is taking place. Therefore, this set of symptoms represents the most urgent need, which requires immediate intervention by the nurse to open up the lungs with drug management to prevent total respiratory failure.

Cognitive Level: Application

Nursing Process: Evaluation

Client Needs Category: Physiological Integrity: Physiological Adaptation

2.            Which statement by a client with asthma would reflect a need for additional       teaching by the nurse when discussing home management?

                1.    “I should hold my breath while compressing the multi-dose metered inhaler when using a spacer, after which I can exhale fully.”

                2.    “I should wait 20–30 seconds between the first and second puff of same medication.”

                3.    “Dry powder inhalers (PDI) should not be refrigerated or placed in a humid                 environment, such as a bathroom.”

                4.    “I should rinse my mouth and brush my teeth after each dosage to prevent yeast infections in my mouth from the corticosteroid inhalers.”

: 1

The question is asking which information is incorrect and requires additional teaching by the nurse. “I should hold my breath while compressing the multi-dose metered inhaler when using a spacer, after which I can exhale fully” is incorrect, and requires additional teaching by the nurse to correct the error in the client’s thinking: The inhalation phase should occur for 3–5 seconds with the compression of the inhaler to bring in all of the medication possible; then the breath should be held for 10 seconds; and finally one can exhale after removing the mouthpiece from the lips. “I should wait 20–30 seconds between the first and second puff of same medication” would be correct; by waiting for 20 to 30 seconds between puffs, a greater absorption of the medication into the bloodstream is likely to occur. “Dry powder inhalers (PDI) should not be refrigerated or placed in a humid environment, such as a bathroom” would be correct; moisture introduced into the PDI will cause clogging or clumping of medication that will not allow small particle distribution of the medication and therefore will alter absorption in the lungs. “I should rinse my mouth and brush my teeth after each dosage to prevent yeast infections in my mouth from the corticosteroid inhalers” would be correct; corticosteroids will alter the pH of the oral cavity, and can increase the risk of yeast developing if not removed by brushing the teeth and rinsing the mouth after inhalation.

Bloom’s: Application

Nursing Process: Evaluation

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

3.            A client with chronic obstructive pulmonary disease (COPD) has the following    symptoms: a pulse oximetry reading of 93%, polycythemia, increase in WBC bands count, temperature of 101°F, pulse 100, respirations 35, and a chest x-ray reporting a flattened diaphragm with infiltrates noted. Which order would the          nurse question for this client?

                1.    Antibiotic therapy

                2.    Initiation of oxygen by nasal cannula at 3–4 L/minute

                3.    Bronchodilators (adrenergic stimulating drugs such as methlyxanthines or anticholinergic agents)

                4.    Nonsteroidal anti-inflammatory agents

: 2

Rationale: This question focuses upon the inappropriate order that requires clarification before the nurse follows it. So the “correct” response is the  option that needs additional clarification. “Incorrect”  response means the information is an appropriate order for the client described in the stem. The nurse should question the order for initiation of oxygen by nasal cannula at 3–4 L/minute for a COPD client. This amount of oxygen is too much for a COPD client. The COPD client’s breaths are stimulated by a hypoxic drive and they are CO₂ retainers. If you give oxygen to a client at 3–4 L/minute (normal) levels, you can increase his PaCO₂ levels, leading to respiratory failure. Therefore, if oxygen is ordered, it is ordered at a lower rate of flow, such as 1–2 L/minute, with close assessments of the client’s breathing status. The nurse would not question the order for antibiotic therapy, since the fever and increase in WBC bands indicate potential infection. Bronchodilators will open up the alveoli and increase exchange of oxygen and carbon dioxide more effectively. Therefore, this is an expected order for this client. Nonsteroidal anti-inflammatory agents are commonly ordered to decrease the inflammation and swelling of lung tissues to maximize oxygen and carbon dioxide exchange and to improve symptoms. Therefore, the nurse should expect this drug order for this client.

Bloom’s: Analysis

Nursing Process: Evaluating

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

4.            A nurse should expect which NANDA-approved nursing diagnosis statement for a client with cystic fibrosis? Select all that apply.

                1.    Airway Clearance, Ineffective

                2.    Anticipatory Grieving

                3.    Nutrition, Imbalanced: Less than Body Requirements

                4.    Noncompliance

                5.    Caregiver Role Strain

: 1; 2; 3; 5

                Airway Clearance, Ineffective is related to the thickened mucus production of the respiratory tract that makes it difficult to expectorate. The life span and lifestyle of client with cystic fibrosis are limited. Grieving for lack of independence, financial burdens, constant need for medical assistance, risks of early death, and the inability to reach expected potentials are all topics for the client to anticipate or experience a perceived (or actual) loss. Due to the pancreatic enzyme deficiency and impaired digestion, nutrition is altered even with medication to improve the process. If the client does not comply with her medical regime, then death from respiratory failure and nutrition deficit is likely. Therefore,            noncompliance is not expected in the clients with cystic fibrosis. Family support requires a constant vigilance over the client for medications, breathing treatments, and prevention of infections, which can increase stress and create a caregiver role strain.

Bloom’s: Application

Nursing Process: Planning

Client Need: Safe, Effective Care Environment: Management of Care

5.   Which of the following topics would be appropriate for a teaching plan for a client with occupational lung disease? Select all that apply.

                1.    Teaching the client methods to conserve energy expenditure and increase rest

                2.    Restricting fluids due to increased edema

                3.    Counseling for caregiver role strain from chronic disease management

                4.    Teaching to avoid air pollutants and cigarette smoke

: 1; 3; 4

Teaching the client methods to conserve energy expenditure and increase rest would apply to this client; with progressive lung damage from asbestos, chemicals, coal, or other irritants, the client would have less tissue available to exchange air. Therefore, energy conservation would decrease the oxygen demand in the body when at rest by decreasing the basal metabolic requirements of the cells of the body. Caregiver role strain is a common problem, and should be discussed, especially since role changes are expected due to the progressive decline of the client, and increasing activity intolerance occurs as more lung tissue is damaged by the onset of the complication of COPD. Avoidance of air pollution and smoking will minimize additional damage and maximize airflow for a greater period of time. Therefore, this topic should be included by the nurse.

Restricting fluids due to increased edema is contraindicated for lung-diseased clients: Hydration is needed to keep the lung tissue moist and flexible for maximum air exchange and to liquefy secretions for easier expectoration.

Bloom’s: Application

Nursing Process: Planning

Client Need: Health Promotion and Maintenance

6.            The client has a femur fracture, and the nurse finds the following upon entering the room: sudden dyspnea, pleuritic chest pain, syncope with movement, cyanosis, tachycardia, and tachypnea. What would be the nurse’s first action?

                1.    Raise the head of the bed (HOB).

                2.    Administer oxygen per nasal cannula for the cyanosis and dyspnea.

                3.    Provide reassurance and keep the client calm by staying with the client.

                4.    Evaluate urinary output to assess cardiac output.

: 1

Raising the HOB to a high Fowler’s position facilitates maximum lung expansion and reduces venous return to the right side of the heart, lowering pressure put on the vascular system. Therefore, this is the first action the nurse should take. Oxygen therapy will increase the availability of air to the client, but lung expansion from raising the HOB will maximize the exchange while limiting venous return. Therefore, this should be the second nursing action. Staying with the client will minimize the stress of the situation; additional assistance can be called for through the intercom system. By keeping the client calm, the oxygen demand is reduced due to a decrease in heart rate caused by fear of unknown and stress of symptoms. Cardiac output will be helpful to assess, but urinary output must be measured by hourly volumes, and unless a catheter is in place, this action is the least important approach to managing cardiac and pulmonary status from possible emboli. Other assessments of blood pressure and neck vein distention would be better assessments at this point.

Bloom’s: Analysis

Nursing Process: Intervention

Client Need: Physiological Integrity: Reduction of Risk Potential

7.            In a client with a spinal cord injury, which of the following symptoms would reflect acute respiratory failure syndrome?

                1.    Arterial oxygen level (PaO₂) less than 50 mm Hg

                2.    Arterial CO₂ (PaCO₂) less than 40 mm Hg

                3.    Hyperventilation

                4.    Bradypnea

: 1

A decrease in oxygen below 50 mm of Hg is evidence of a decline in respiratory efforts, and leads to subsequent respiratory failure. Normal range is PaO₂ = 75–100 mm Hg. Normal arterial CO₂ (PaCO₂) levels = 35–45 mm Hg. Therefore, increasing PaCO₂ indicates respiratory acidosis from COPD from alveolar hyperventilation, not hypoventilation associated with respiratory failure. Respiratory failure can result from inadequate alveolar ventilation (hypoventilation), not hyperventilation. Increased respiratory rates (tachypnea) result from compensation mechanisms to reduce CO₂ buildup by blowing off CO₂ at a faster rate. Therefore, bradypnea (slower rate) would not be associated with respiratory failure.

Bloom’s: Analysis

Nursing Process: Evaluation

Client Need: Physiological Integrity: Physiological Adaptation

8.            A client is intubated and on a synchronized intermittent mandatory ventilator    (SIMV). Which order should the nurse question?

                1.    Administration of histamine H2-receptor blocker q.i.d

                2.    Total parenteral nutrition (TPN) at 125 mL/hour

                3.    Perform endotracheal suctioning q 4 hours @ 200 mm Hg pressure.

                4.    Keep the endotracheal cuff pressure @ 20–25 mm Hg.

: 3

Endotracheal suctioning should be questioned by the nurse. The placement of the endotracheal tube becomes an irritant, and creates increased secretions. Suctioning should not be scheduled every four hours but performed as needed         (p.r.n.). Suctioning pressures should run only 80–100 mm Hg and never higher, or there is the risk of damage to lung tissue from too much pressure. Increased secretions that are not removed will limit the amount of air perfusion and lead to the risk of atelectasis. Administration of histamine H2-receptor blocker q.i.d is a correct action, and should not be questioned. The risk of stress ulcers in the gastrointestinal tract from mechanical ventilation is increased, and histamine H2-blocking drugs are often ordered as a prophylactic measure to prevent gastrointestinal stress ulcers. Total parenteral nutrition is a correct action, and should not be questioned. Long-term ventilation will require additional calories and an alternate form of supplying nutrition. A J tube, G tube, or NG tube might be used also to supply nutrition over the long-term. The effort of breathing increases the metabolic requirements, and additional calories should always be considered for respiratory clients. Keeping the endotracheal cuff pressure @ 20–25 mm Hg is a correct action, and it should not be questioned. A tight seal around the endotracheal tube by a pressure of 20–25 mm Hg is needed to prevent air leakage around the tubing for maximum exchange and inflation of lungs by the ventilator. Deflation of the cuff is needed periodically for a short time to prevent necrosis of tracheal tissue.

Bloom’s: Application

Nursing Process: Planning

Client Need: Physiological Integrity: Reduction of Risk Potential

9.            Which action would be appropriate for the nurse to include in the discharge teaching plan of a client with acute respiratory distress syndrome (ARDS)? Select all that apply.

                1.    Avoid smoking and air pollution.

                2.    Include examples of lifestyle modifications to decrease oxygen demands.

                3.    Restriction of fluids to prevent congestive heart failure (CHF)

                4.    Encourage the client and family to take immunizations for pneumococcal pneumonia and influenza annually.

: 1; 2; 3

Pollution and smoke can further damage already traumatized lung tissue, and therefore should be avoided. Lifestyle modifications to conserve energy and oxygen demands are needed, since lung tissues are still trying to recover from the damage of the disease processes. Exertional dyspnea will continue to increase if additional demands are made on the pulmonary and cardiovascular system that has been impacted by the damage from ARDS. Role changes, increased rest, and decreased activities are needed. Immunizations (for pneumonia and flu) are encouraged to minimize additional insults to lung tissue, since the entire physical status of lung tissue will require up to six months to recover. Fluids are needed to rehydrate lung tissue and to increase renal functions to dilute wastes from tissue repair. CHF from right-sided failure is possible, but not usually in the recovery phase (after discharge from the hospital).

Bloom’s: Application

Nursing Process: Planning

Client Need: Health Promotion and Maintenance

10.          In a community health promotion class presentation for clients with respiratory diseases, the nurse would include which of the following topics? Select all that apply.

                1.    Smoking and exposure to tobacco smoke are the greatest risks for causing chronic obstructive lung disease (COPD).

                2.    Stopping smoking will reverse the damage that is already present in COPD clients.

                3.    Increased fluids and calories are needed for most respiratory clients due to increased respiratory efforts and increased basal metabolic rates (BMR).

                4.    Pulmonary hypertension will lead to right-sided failure, and clients should be

                        assessing their blood pressures to watch for changes.

                5.    Immunizations for influenza and pneumonia are needed only by clients who are out and about in the community when people are sick.

: 1; 3; 4

Smoking and tobacco exposure are the greatest risk of damage to lung tissue, and should be avoided. Even secondhand smoke has proven to be as great a risk to lung damage as direct exposure. Due to increased efforts to breathe and exchange air in diseased lung tissue, additional calories are burned and moisture is lost with increased breathing rates. Additional fluids and calories are required for most respiratory clients. Pulmonary hypertension can occur in long-term respiratory clients due to pulmonary congestion causing a backup in the right side of the heart. Regular blood pressure checks should be done to follow the progression of cardiac functioning. Tissue that is damaged or scarred by disease will not become healthy again once smoking is stopped. Stopping smoking will prevent or additional changes to lung tissue from past exposure. Immunizations are needed as a preventive measure for all respiratory clients to minimize additional stress caused by infection in already damaged lung tissue. Therefore, all clients should receive the immunizations each year.

Bloom’s: Application

Nursing Process: Planning

Client Need: Health Promotion and Maintenance