A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?

A. Administration of a prescribed bronchodilator is typically recommended approximately 30 minutes prior to meals rather than 1 hour. This pharmacological timing helps reduce dyspnea and facilitates easier deglutition and mastication by improving airflow. Using it too early may result in the peak therapeutic effect tapering off before the client finishes the meal.

B. Consuming 3 large meals each day is contraindicated for clients with chronic obstructive pulmonary disease because a distended stomach can exert upward pressure on the diaphragm. This abdominal crowding significantly increases the work of breathing and leads to early satiety or respiratory distress. Clients are instead encouraged to eat 5 to 6 small, frequent, nutrient-dense meals.

C. The nurse should instruct the client to limit water or fluid intake during the actual mealtime to prevent premature gastric distention. Early fullness from fluids reduces the client’s ability to consume essential solid nutrients and calories required to support the increased metabolic demands of labored breathing. Fluids should be consumed between meals to maintain adequate hydration and thin secretions.

D. Reducing protein intake is inappropriate because these clients require high-protein and high-calorie diets to prevent muscle wasting and support the respiratory muscles. The metabolic cost of breathing in chronic obstructive pulmonary disease is significantly elevated, often leading to a state of malnutrition or cachexia. Protein is vital for tissue repair and maintaining the functional integrity of the diaphragm.

White coating in the mouth, also known as oral candidiasis or thrush, is a serious adverse effect of fluticasone/salmeterol, which is a combination of an inhaled corticosteroid and a long-acting beta2 agonist. It is caused by fungal infection of the oral cavity due to suppression of the normal flora by the corticosteroid component. The client should report this symptom to the provider, as it may require antifungal treatment and discontinuation of the medication.

a) Dry oral mucous membranes is a common and mild adverse effect of fluticasone/salmeterol, which can be relieved by drinking water, chewing sugarless gum, or using artificial saliva. It does not require reporting to the provider or stopping the medication.
c) Sedation is not an adverse effect of fluticasone/salmeterol, but it may be caused by other medications, such as antihistamines, opioids, or benzodiazepines. The client should avoid driving or operating machinery if sedated and consult with the provider about possible drug interactions.
d) Increased appetite is not an adverse effect of fluticasone/salmeterol, but it may be caused by other factors, such as stress, boredom, or hormonal changes. The client should maintain a balanced diet and exercise regularly to prevent weight gain and promote health.