Nursing management of clients with COPD

1. What do the ABG results suggest and why are these findings indicative of COPD?

The ABG results show that the patient is having respiratory alkalosis, this means that the patient’s respiratory
system is having trouble bringing in oxygen as well as removing carbon dioxide from the blood, the results also
show that the patient can be classified as to be a “blue bloater”

2. After evaluating the ABG results, the practitioner orders 02 at 2L/min per nasal cannula. What is the result
for limiting the amount of oxygen administered to the client?

Increasing oxygen flow to the patient may raise the patient’s blood oxygen level this can suppress the patients
respiratory drive causing an increased retention of carbon dioxide

3. What criteria will the nurse use to evaluate the effectiveness of the clients oxygen therapy?

Effectiveness of the patient’s oxygen therapy can be assessed through the use of a pulse oximetry and an Arterial
blood gas test in order to evaluate blood oxygenation.

4. The next morning the client’s vital signs are: T: 101.5°f orally, apical rate 96bpm, respirations 30 and BP
150/88mmHg. The client has persistent productive cough that is mucopurulent and copious. What is the
priority problem at this time?

At this time the priority problem is the persistent productive cough, excessive amounts of sputum would cause
problems with the patients breathing. the nurse must insure that the patient has a effective airway so that the
patient would have adequate oxygenation, measures to maintain airway patency like suctioning and
physiotheraphy would be done.

5. Prioritize the following nursing interventions using 1 as the most Important intervention

_____ initiate infusion of intravenous antibiotic as prescribed

_____check 02 saturation

_____auscultate breath sounds

_____ administer tylenol for fever as prescribed

_____collect and send sputum specimen to laboratory as culture

6. From the scenario given above, give the subjective and objective cues manifested by the patient

Subjective cues: the patient had complaints of shortness of breath, wheezing and fatigue exacerbated by activity

Objective cues: 60 year old male, breath sounds diminish bilaterally, tachypneic, respiratory rate of 36, history of
smoking 1 and a half packs of cigarettes a day.
7. Give the 2 breathing exercises that the patient should do and explain briefly how it is done

Pursed lip breathing - a breathing technique that consists of exhaling through tightly pressed (pursed) lips and
inhaling through the nose with the mouth closed. Patient should inhale through the nose then exhale through the
mouth while puckering lips.

Diaphragmatic breathing - breathing in slowly through your nose then your stomach moves out against your hand.
The stomach muscles tighten, letting the air fall inward as the patient exhales through pursed lips. Patient should
start by lying on back with knees bent, patient should place one hand on the upper chest and another on his/her
belly or just below the rib cage. Then inhale deeply and through the nose and exhale through the mouth. The belly
should normally rise and fall while the chest remains still.

8. What is the purpose of pursed lip breathing?

Pursed lip breathing works by moving oxygen into your lungs and carbon dioxide out of your lungs.
This technique helps to keep airways open longer so that you can remove the air that is trapped in your lungs by
slowing down your breathing rate and relieving shortness of breath.

9. How do you position a patient with COPD that will promote adequate gas exchange?

The best position for a COPD patient is the tripod position, while doing tripod position the patient sits down and
leans forward while supporting the upper body with hand on knees. This position optimizes the mechanics of
breathing by taking advantage of the accessory muscles of the neck and upper body to get more air to the lungs.

10. What will be the diet for patient with COPD?

____Carbohydrate ____ Protein ____ Fat

11. How do you teach a client with COPD cough effectively?

Directed or controlled coughing is the most effective technique, it reduces fatigue associated with undirected
forceful coughing. First Instruct the patient to start by doing a slow, maximal inspiration followed by
breath-holding for several seconds and then instruct the patient to do two or three coughs.

12. The patient is to be given a precise amount of oxygen. What type of oxygen delivery system should be
used?

When administering a precise amount of oxygen to a patient the best delivery system is the Venturi mask, it is the
most reliable and accurate method for delivering precise concentrations of oxygen through non-invasive means.
Nursing management of clients with pneumothorax

1. How does hemothorax differ from pneumothorax?

A hemothorax involves blood in the pleural space. A pneumothorax refers to air in the pleural space. Like
a hemothorax, this may cause difficulty breathing. It can also be caused by penetrating injuries to the chest.
Hemothorax is an abnormal accumulation of blood between the chest wall and the lungs or inside the pleural
cavity while pneumothorax is a presence of air inside the pleural cavity. Both conditions can cause the lungs to
collapse by putting pressure on the outside of the lungs.

2. What action will the nurse take if bubbling in the suction bottle is present?

Air bubbling through the water seal chamber intermittently is normal when the patient coughs or exhales but
when persistent bubbling is happening in the suction bottle this would indicate an air leak which would need
further assessment of the tubing and the chest drain unit.

3. What are the signs of an air leak in the system and what steps should the nurse take to control the air leak?

o Assess for air leaks at least once per shift and as needed, based on your patient’s respiratory status. Start by
examining the air-leak detection chamber in the water seal of the drainage device. An air leak presents as small air
bubbles; the amount of bubbling indicates the degree of the leak. If you notice bubbling, determine location of the
leak. Leaks can occur outside the patient’s body (such as within the drain or tubing connections) or within the
patient (for instance, at the tube insertion site or inside the chest cavity).

o First determine where the leak is, clamp the tubing as close as possible to the patient. If bubbling continues,
suspect a leak in the tubing or damage to the drainage device. Commonly, air leaks occur at the point where the
distal end of the tube connects to the drainage device tubing. Check this juncture to ensure it hasn’t become loose.
Consider using securements, such as plastic fasteners, to help prevent accidental disconnection here.

o If bubbling disappears when you clamp the tubing, suspect an air leak at the insertion site or from within the chest
wall. Assess the insertion site; if you detect a leak, apply petroleum gauze and a sterile occlusive dressing to seal it
off. If the leak persists, suspect it’s coming from air remaining in the pleural space, a pleural injury, an exposed
tube eyelet, or inappropriate communication between the bronchial and pleural spaces.

4. What assessment is needed to be made when the client has a chest tube as a treatment for pneumothorax?

When caring for a client with chest tube for pneumothorax some important assessments are Patient assessment,
chest drain assessment, it is also important to assess the clients vital signs, heart rate, peripheral capillary oxygen
saturation (spO2), blood pressure, respiratory rate and any pain. it is also important to assess the patients
temperature and for any signs of infection.

5. When getting out of bed, the client pulls his chest tube out of his chest wall. What is the first response to the
part of the nurse to this incident?

If this happens immediately ask patient to exhale and then press your hand with a piece of gauze against the
wound or opening after the exhalation, call for help but do not leave the patient ask, patient to breath normally
while the nurse stays and maintains pressure on the wound, observe the breathing rate and chest symmetry.
Reassure the patient and give them oxygen if they become distressed.

6. What precautions must the nurse take when caring for a client with chest tube drainage?

When taking care of a client with attached chest tube drain, the nurse must be cautious of a few things first, make
sure that all the tubing is free from any kinks or occlusions, check if any tubing is beneath the patient or pinched
in the bed rails also the nurse should check for fluid-filled dependent loops, which can impede drainage. To
promote drainage, keep the CDU below the level of the patient's chest.