A nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. Which of the following actions should the nurse take?

A. "I’m glad my child will have normal bowel movements now.": This statement indicates a misunderstanding of Hirschsprung disease. Surgery for Hirschsprung disease involves removing the portion of the large intestine affected by the condition, which often results in a temporary or permanent colostomy. While surgery aims to improve bowel function, it may not immediately result in normal bowel movements, especially if complications arise or additional surgeries are needed.
B. "I want to learn how to use my child's feeding tube as soon as possible.": This statement suggests a focus on enteral nutrition rather than the surgical management of Hirschsprung disease. While enteral feeding may be necessary for some children with Hirschsprung disease, the primary focus of initial surgery is to remove the affected portion of the large intestine and create an ostomy if needed, rather than addressing feeding tube use.
C. "I want to learn how to empty my child's urinary catheter bag.": This statement pertains to urinary catheter care rather than the surgical management of Hirschsprung disease. While urinary catheters may be used during surgery and recovery, they are not directly related to the treatment of Hirschsprung disease itself.
D. "I'm glad that my child's ostomy is only temporary": This statement demonstrates an understanding of the surgical management of Hirschsprung disease. Many children with Hirschsprung disease require surgery to remove the affected portion of the large intestine and create an ostomy, which may be temporary or permanent depending on the extent of the disease and the child's response to treatment. Recognizing that the ostomy is temporary indicates an understanding of the potential outcomes of surgery and the possibility of eventual bowel anastomosis.

A. Clubbing of the fingers: Clubbing of the fingers is a common finding in clients with advanced emphysema. It is characterized by bulbous enlargement of the fingertips and nail changes, including increased curvature and softening of the nail beds. Clubbing results from chronic hypoxia and tissue oxygen deprivation, which leads to vascular changes and tissue proliferation in the fingertips.
B. Deep respirations: Deep respirations are not typically associated with emphysema. Instead, clients with emphysema often exhibit shallow, rapid respirations due to decreased lung elasticity and air trapping, which impair effective ventilation. As a compensatory mechanism, clients may adopt a pursed-lip breathing pattern to facilitate expiration and reduce airway collapse.
C. Bradycardia: Bradycardia is not a characteristic finding in clients with emphysema. Instead, clients with emphysema commonly experience tachycardia, which is a compensatory response to hypoxia and increased work of breathing. Tachycardia helps maintain cardiac output and tissue perfusion in the setting of impaired gas exchange.
D. Barrel chest: Barrel chest is a classic physical finding in clients with emphysema. It results from hyperinflation of the lungs and loss of lung elasticity, leading to a permanent increase in the anteroposterior diameter of the chest. This change in chest shape contributes to the characteristic appearance of a rounded, barrel-like chest.
E. Dyspnea: Dyspnea, or shortness of breath, is a hallmark symptom of emphysema. Clients with emphysema often experience dyspnea, especially with exertion, due to air trapping, decreased lung function, and impaired gas exchange. Dyspnea can significantly impact the client's quality of life and functional status, requiring careful management and symptom relief interventions.