5.1.2: FRAME 2- Analyze Cues

CORRECT Answer

Question Type: Matrix Multiple Response

Scoring: +/-

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

Associate the client’s objective assessment findings with the corresponding respiratory condition. Each column must have at least 1 assessment piece. Some may have more than one respiratory condition associated with them.

Clinical Manifestation	COPD	Pneumonia	Pulmonary Embolism	Asthma
Dyspnea	X	X	X	X
Barrel chest appearance	X
Expiratory Wheezing	X	X		X
Tachypnea	X	X
Digital clubbing	X
Productive Cough	X	X
Fever		X
Abnormal ABG results	X	X	X	X

RATIONALE

Clinical manifestations of COPD include dyspnea, increased anterior/posterior diameter (A/P diameter) or barrel chest appearance, expiratory wheezing, tachypnea, digital clubbing, and productive cough. Both an increased A/P diameter and clubbing of the digits is not a clinical manifestation of pneumonia, pulmonary embolism, or asthma. Sudden shortness of breath and chest pain are common symptoms of a pulmonary embolism, while wheezing is rare, and if a cough is developed oftentimes, it is dry or blood-tinged. Asthma is accompanied by shortness of breath and wheezing upon exhalation, which is the most common sign in children with asthma. COPD requires a multidisciplinary approach with healthcare professionals coordinating inputs and suitable therapies, medications, and monitoring equipment.

FOCUSED GUIDE

Clinical Manifestation
COPD	Chronic productive cough, dyspnea with everyday activities, wheezing, fatigue/lack of energy, unable to take a deep breath, frequent respiratory infections, larger A/P diameter due to air entrapment
Pneumonia	Fever, sweats, chills, shortness of breath, tachypnea, sharp/stabbing chest pain with deep inhale or cough, productive cough (green, yellow, tan, brown), nausea, vomiting or diarrhea
Pulmonary Embolism	Sharp and sudden chest pain, shortness of breath that worsens with exertion, dizziness, fainting, heart palpitations, cough may include blood
Asthma	Dyspnea, chest tightness or pain, wheezing upon exhalation (most common sign in children), dry cough, excessive coughing/wheezing with a respiratory virus such as the cold or flu

Nurse-led interventions outside the acute care setting allow for different techniques and approaches to client care. Ideally, a multidisciplinary team consists of providers, nurses, social workers, dieticians, and an exercise specialist (Kuzma et al., 2008). It is evident through a systematic review that nurse-led interventions demonstrate effectiveness in improving the quality of life, emotional state, and physical capacity of clients with COPD while also reducing hospital admissions. The nursing profession can provide great benefits for both clients and families both in acute settings and within the community (Aranburu-Imatz et al., 2022).

The SDOH domain, Neighborhood & Built Environment, is addressed in this case study when considering the causes of Stanley’s COPD and recurrent exacerbations. Both environmental and host factors should be considered. Environmental exposures, such as tobacco smoke and inhalation of particles, are the leading cause of COPD. Additional considerations may include occupational hazards, air quality, and genetic abnormalities. In addition, the exposures individuals occur at their workplaces can harm their health, such as secondhand smoke, unsafe air quality, and loud noises (Healthy People 2030). Stanley’s previous occupation exposed him to many years of fine dust particles, in addition to his smoking for many years. Recognizing the correlation of such risk factors is necessary when educating, advocating, and helping clients.

Healthy People 2030 summarizes literature on environmental conditions as a social determinant of health and recognizes it as a narrowly defined examination that is not intended to address all dimensions of the issue. Click HERE to review the literature summary and additionally have students outline local, state, and national policy changes by visiting appropriate websites for your region.