4.1.4: FRAME 4- Generate Solutions

Stanley’s acute COPD exacerbation has subsided after the initiation of a venturi mask, bronchodilators, optimal position, and relaxation techniques. Now that Stanley is in stable condition, the nurse is reviewing additional orders placed by the provider.

Generate Solutions

QUESTION: Matrix Multiple Choice Scoring Rule: +/-

The nurse reviews the orders placed by the provider. For each intervention, indicate whether the intervention is appropriate or not appropriate

Potential Intervention	Appropriate	Not Appropriate
Administer and titrate oxygen therapy to maintain Sp02 levels between 88-92%
Administer Neb Salmeterol q12hr
Administer Neb Tiotropium daily
Administer PO Acetaminophen q6hr PRN for fever
Administer IV methylprednisolone q12hr
Administer IV ampicillin/sulbactam q6hr x5 days
Administer PO cough suppressant
Restrict PO fluids to 1,500 mL per day
Encourage pursed-lip breathing
Flutter valve and incentive spirometer q2hr while awake
Monitor WBC; am labs daily
Evaluation for non-invasive positive pressure ventilation (NPPV)
Encourage high-calorie foods, full-fat dairy, and cured-meats

Putting It All Together

DEBRIEF

Now that Stanley’s respiratory status is stable, the nurse can review additional interventions to continue the positive progression in Stanley’s healthcare status. Maintaining Stanley’s oxygen levels between 88-92% is appropriate for COPD clients to maintain an adequate respiratory drive. Administering bronchodilators and steroids will assist in alleviating the narrowing and inflammation of the airways. Using bronchodilators for clients affected with COPD relaxes the muscles in the lungs and widens the airways in the bronchi. Individuals may be prescribed bronchodilators that are shortacting, long-acting, or both. Short-acting bronchodilators are used to relieve a sudden, unexpected period of dyspnea. Long-acting bronchodilators are used more regularly to help maintain continued control of COPD. Administering an IV antibiotic is needed to control bacterial pneumonia; ampicillin/sulbactam contains penicillin and therefore is contraindicated for this client due to his allergy. The nurse would want to contact the primary provider for a different antibiotic. Administering acetaminophen to reduce Stanley’s fever secondary to pneumonia and monitoring WBC levels will help determine the antibiotic's efficacy. Encouraging pursed-lip breathing, the use of a flutter valve, and incentive spirometry will increase positive expiratory pressure (PEP) and help mobilize secretions with vibrations. Further evaluation for non-invasive positive pressure ventilation (NPPV) therapy should be considered as a part of the treatment plan for COPD clients experiencing multiple exacerbations. NPPV has been shown to improve outcomes and lowering complications and mortality rates (AHRQ, 2011). Managing symptoms of COPD include making healthier changes to diet. Nurses want to encourage COPD clients to partake in high-quality, high-density foods. Full-fat dairy products like ice cream, yogurt, cheese, butter, and buttermilk contain casomorphine. These chemicals increase mucus production. Therefore, alternative products such as soy or almond milk are recommended. Additionally, processed meats contain nitrates linked to worsening lung conditions (American Lung Association, 2023b) and would not be recommended for COPD clients.

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

Dietary changes can be a challenge for some clients. The nurse should assess Stanley’s willingness to change his diet and his understanding of the dietary recommendations. Effective health communication is critical to health and wellbeing. Health information and messages are often overly complex, making them hard to understand and use. Health care providers who communicate clearly and use methods like teach-back and shared decision-making can help people make informed health-related decisions (Healthy People 2030). The domain, Social and Community Context, addresses the importance of health literacy and sustainable nutrition. Does the community where Stanley lives have access to alternative calcium clad foods that are affordable enough for him to employ the dietary changes recommended.

What Do You Think About?

1. What is the significance of a venturi mask for individuals with COPD? How does it differ from a simple mask?
2. Consider the role of Stanley’s wife during a COPD exacerbation. How can family assist the nurse in a situation like this?
3. What community resources could assist Stanley with adherence to the recommended dietary changes?