5.1.4: FRAME 4- Generate Solutions

CORRECT Answer

Question Type: Matrix Multiple Choice

Scoring: 0/1

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

The nurse reviews the orders placed by the provider. For each intervention, click to 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%	X
Administer Neb Salmeterol q4hr	X
Administer Neb Tiotropium q12hr	X
Administer PO Acetaminophen q6hr PRN for fever	X
Administer IV methylprednisolone q12hr	X
Administer IV ampicillin/sulbactam q6hr		X
Administer PO cough suppressant		X
Restrict PO fluids to 1,500 mL per day		X
Encourage pursed-lip breathing	X
Flutter valve and incentive spirometer q2hr while awake after oxygen stabilization	X
Monitor WBC; am labs daily	X
Evaluation for non-invasive positive pressure ventilation (NPPV)	X
Encourage high-calorie foods, full-fat dairy, and cured-meats		X

RATIONALE

The nurse must identify expected outcomes and use hypotheses to define a set of interventions that are appropriate to achieve desirable outcomes. Now that Stanley’s respiratory status is stable, the nurse can review additional interventions to continue 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. While 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 provider for a different antibiotic. Administering acetaminophen to reduce Stanley’s fever secondary to pneumonia and monitoring WBC levels will help to determine the efficacy of the antibiotic.

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).

Part of managing symptoms of COPD includes making healthier changes to diet. Nurses want to encourage COPD clients to partake in high-quality, high-density foods. Full-fat dairy products such as ice cream, yogurt, cheese, butter, and buttermilk contain casomorphine. These chemical increases mucus production therefore, alternative products such as soy or almond milk are recommended. Additionally, processed meats contain nitrates that have been linked to worsening lung conditions (American Lung Association, 2023a) and would not be recommended as a food of choice for Stanley.

FOCUSED GUIDE

The venturi mask system is ideal for clients with COPD who have a low to moderate oxygen requirement but are also at risk for hypercarbia. Venturi masks deliver a FiO2 of 0.24 to 0.5 and an oxygen inflow of 4-15 L/min, and a total flow delivered to the client of 35 to 45 L/min. Because of the high gas flow rates, venturi masks do not allow for rebreathing to occur, and there is no increase in dead space. Therefore, this oxygen device is recommended for clients with COPD whose ventilation is dependent on their hypoxic drive (Science Direct, 2010). A simple mask should not be used on a client with COPD unless there is a specific circumstance, and it is prescribed by the provider. Simple masks can raise the carbon dioxide levels, further decompensating a client having a COPD exacerbation.

Dietary changes can be a challenge for clients with COPD or other respiratory diseases. The American Lung Association offers guidance for both clients and providers. The nurse should assess Stanley’s willingness to change his diet and his understanding of the dietary recommendations. It may benefit clients to involve their immediate family members in the needed lifestyle changes. By incorporating Stanley’s wife in needed dietary change, she may be able to assist with preparation and guidance.

Effective health communication is critical to health and well-being. 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. Encouraging the students to think about if Stanley’s community has access to alternative calcium clad foods that are affordable enough for him to employ the dietary changes recommended. Such SDOH play a significant role in the management of chronic disease processes.