5.1.1: FRAME 1- Recognize Cues

CORRECT Answer

Question Type: Multiple Response Select All That Apply

Scoring: +/-

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

What findings from the admission to the medical-surgical floor are of immediate concern to the nurse? Select all that apply.

\(\bigotimes \) 101.9°F

\(\bigotimes \) SpO2 86% on 3 L NC.

\(\bigcirc \) Cachectic and poor appetite

\(\bigcirc \) Hypoactive bowel sounds

\(\bigotimes \) Course crackles bilateral lung fields

\(\bigotimes \) Productive cough

\(\bigotimes \) Accessory muscles while breathing

\(\bigcirc \) Digital clubbing

\(\bigcirc \) Smoking 15 cigarettes a day

\(\bigotimes \) Respiratory rate 23 breaths/minute

RATIONALE

The client’s oxygenation is compromised due to his recent COPD exacerbation. This is evident by the low pulse oximetry reading, tachypnea, utilization of the accessory muscles, and coarse crackles in the lung fields, making these priority concerns for the nurse. Additionally, the client’s fever and productive cough are of concern and could indicate an infectious process. The client’s poor appetite, cachectic appearance, digital clubbing, and smoking are not of immediate concern to the nurse. While these findings are important to the client’s holistic health picture, the nurse will want to act on the immediate compromised findings to improve the other findings

FOCUSED GUIDE

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. Of those deaths, nearly 90% occurred in low- and middle-income countries. The significance of a client’s social determinants of health is evident in the cases of COPD. COPD has been listed as the seventh leading cause of poor health worldwide when measured by disability-adjusted years (World Health Organization, 2023).

CLASSIFICATIONS OF COPD

There are two classifications of COPD, chronic bronchitis and emphysema, both of which restrict airflow. (1) Chronic bronchitis is an inflammation of the bronchial tubes, which carry air to and from the alveoli (air sacs) in the lungs. This inflammation causes an increase in the goblet cells, overproducing mucus. Due to this process, clients with chronic bronchitis are characterized by a persistent and productive cough (Mayo Clinic, 2020). Chronic bronchitis is also termed as “blue bloaters.” (2) Emphysema is a condition leading to damage of the alveoli and surrounding structures that are involved in gas exchange. This damage causes gas trapping, dynamic hyperinflation, and decreased expiratory flow (Price & Williams, 2020).

CAUSES

COPD develops gradually over time. This gradual progression can cause a combination of risk factors that include (American Lung Association, 2023b):

• Environmental Factors
  • Tobacco exposure (active smoking or passive exposure (second-hand smoke)) NOTE: this is the number one cause
  • Occupational exposures (dust, fumes, chemicals)
  • Air pollution (long-term exposure to nitrogen dioxides, motor vehicles, factories, powerplants, smoke exposure from coal or wood burning stoves (NOTE: this is more prevalent in low- and middle-income countries with high levels of smoke exposure from cooking)
• Host Factors
  • Rare genetic condition (alpha-1 antitrypsin deficiency)
  • Life events in birth and childhood (poor growth in utero, prematurity, abnormal lung development, frequent or severe respiratory infections as a child, asthma diagnosis as a child)

This case study focuses on an individual with recurrent COPD exacerbations. It addresses three of the five social determinants of health: Health Care Access & Quality, Neighborhood & Built Environment, and Social & Community Context. Each of these domains has a significant impact on individuals affected by COPD. The domain, Neighborhood & Built Environment, includes related objectives specific to respiratory diseases (RD-D04, RD-D03, RD-D01), such as COPD and asthma in both adults and children. Reducing the number of hospitalizations for these respiratory diseases, along with reducing environmental triggers and making sure people get the right medications is the focus of Healthy People 2030. Improving the health and safety in neighborhoods where people live will have a major impact on their health and well-being. Stanley’s reoccurring COPD exacerbations should not be overlooked from his home or neighborhood environment to help identify possible environmental triggers and other safety risks.

A community and environmental/home assessment will be discussed in the subsequent Stanley case study