5.1.3: FRAME 3- Prioritize Hypothesis

CORRECT Answer

Question Type: Bow-Tie

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It is important for the nurse to quickly identify what condition Stanley is most likely experiencing. Complete the diagram below by selecting the condition the client is most likely experiencing, three actions the nurse should take, and three parameters the nurse should monitor to assess the client’s progress.

Actions to Take	Which Condition is the Client Most Likely Experiencing?	Parameters to Monitor
Lay the client down and prop pillows behind him so he is laying on his left side	COPD exacerbation	Pulse oximetry
Prepare to administer an air-entrainment mask	Worsening Pneumonia	Client’s respiratory patterns
Provide a calming atmosphere	Pulmonary Embolism	Client’s restlessness
Take the client’s temperature	Asthma attack	Client’s fever
Call the provider	Cor pulmonale	Client’s ability to drink fluids
Complete a full head-to-toe assessment		Activity tolerance

RATIONALE

Stanley is experiencing a COPD exacerbation and is unable to adequately oxygenate his body. This is evident by the decreased pulse oximetry, dyspnea, and use of accessory muscles. It is essential for the nurse to quickly evaluate and hypothesize to take appropriate action. Recognizing the decline in the client’s condition requires the nurse to call the primary provider to update on the client status.

The nurse will anticipate the provider to order a different kind of oxygen delivery therapy that would include an air-entrainment (venturi) mask. This oxygen device allows the healthcare provider to provide an exact FiO2. When administering oxygen to clients with COPD, the nurse should start with the lowest FiO2 to maintain adequate oxygenation and titrate based on the client’s response. Additionally, the nurse will want to maintain a calm atmosphere to reduce anxiety in the client. The nurse may call an unlicensed assistant personnel (UAP) into the room to assist with this. Increased anxiety in the client may worsen their respiratory patterns, further exacerbating the problem.

Laying the client down on his left side is not an optimal position and may cause a further decline in the client’s oxygenation status. Clients who are experiencing respiratory complications should be sat up to allow expansion of the rib cage. Completing a full head-to-toe assessment and taking the client’s temperature are not the priority actions for a client with a declining respiratory status.

FOCUSED GUIDE

COPD exacerbations, also termed “flare-ups,” are events of worsening respiratory symptoms that may last for multiple days. Symptoms may continue to get worse and do not go away. Clients manage exacerbations with medications and rest however, if symptoms become severe, medical attention and hospitalization are often needed. COPD exacerbations can be mitigated by avoiding the known triggers. Individual triggers vary; however, common COPD triggers include smoke, strong odors, dust, chemicals, pollen, air pollution, and respiratory infections (American Lung Association, 2023b).

It is essential for the nurse to recognize clients living with COPD have compromised lungs. Therefore, these individuals are at high risk for an exacerbation to occur, and recognizing potential triggers to avoid is necessary. It is recommended clients work with their healthcare provider to develop a personalized action and management plan. This plan includes what the client should do when their COPD is under control, what actions to take when symptoms worsen, and when to seek medical attention.

The American Lung Association (2023a) encourages clients to learn and track their COPD symptoms daily, along with their sleep patterns and how clients feel when they are having good days versus bad days. From this action, clients work with their healthcare provider to create an action plan that is divided into three zones (green, yellow, and red). Each zone outlines the degree of symptoms and actionable items for the client to do when they are in each zone. The green zone is ideal for clients to maintain their COPD and feel well. The yellow zone indicates an increase in symptoms, and the individual should call their healthcare provider if symptoms do not improve after individualized home management. The red zone means the individual is experiencing severe symptoms or an exacerbation and is unable to manage it at home, so it is recommended to seek medical care immediately.

COPD weakens the respiratory system, therefore increasing the vulnerability of an individual developing pneumonia. Because COPD weakens the airways and immune system, mortality rates increase compared to those without COPD who develop pneumonia (Vestbo et al., 2022). In Stanley’s current condition and experiencing a COPD exacerbation while in the hospital, the nurse will want to communicate symptoms to the provider immediately. Furthermore, seeking support from a respiratory therapist and additional nursing team members will be beneficial in managing the care of Stanley until the exacerbation can be resolved. To guide therapy of COPD clients through the multidimensional approach, the following four fundamental aspects have been identified (Global Initiative for Chronic Obstructive Lung Disease, 2023):

1. Severity of airflow limitation
2. Nature and magnitude of current symptoms
3. Previous history of moderate and severe exacerbations
4. Presence and type of other diseases (comorbidities)

The second SDOH domain addressed in this case study is Health Care Access & Quality. About one in ten people in the United States do not have health insurance. Individuals without health insurance are less likely to have a primary care provider and may not be able to afford health care services or medications needed. Recognizing COPD and other respiratory diseases impact clients beyond dyspnea and increasing the proportion of clients who understand their health information is more likely to lead to better health outcomes.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a collaboration of healthcare professionals and public health officials from around the world that work together to provide evidence-based treatments in the management of COPD and raise awareness to improve, prevent, and treat lung disease (GOLD, 2022). Providing guidelines that include both outpatient and inpatient care strategies to reduce respiratory exacerbations and improve client’s quality of life is a primary example increasing healthcare quality. Improving healthcare communication (HC/HIT02) and client understanding (HC-HIT-01) are both objectives of the Health Care Access & Quality domain.