A nurse is reviewing the arterial blood gas (ABG) result for a client diagnosed with progressive chronic obstructive pulmonary disease (COPD). The nurse should expect which of the following ABG findings for a client diagnosed with progressive COPD?

A. Reports routinely list the identification number of any equipment involved: This practice is appropriate and helps in tracking any equipment-related issues. Including identification numbers can assist in identifying problems with specific devices or tools and does not represent a problem that needs to be reported.
B. Reports routinely include the client's hospital number: Including the client's hospital number in reports is standard practice for maintaining accurate records and ensuring proper tracking of incidents related to specific patients. This does not indicate a problem and is essential for accountability in healthcare reporting.
C. Reports routinely are completed within 24 hr after the incident: Timeliness in completing incident reports is important, and completing them within 24 hours is a best practice. This indicates a proactive approach to addressing incidents and does not represent a problem that needs to be reported to the risk manager.
D. Reports routinely omit the names of witnesses to the occurrence: This is a significant issue that should be reported to the risk manager. Witnesses can provide valuable information about the circumstances surrounding an incident, and their names should be documented for follow-up and investigation. Omitting this information could hinder the thoroughness of the incident review and the organization’s ability to address and prevent future occurrences effectively.

• Asthma: The client’s symptoms of wheezing, chest tightness, and persistent dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading of 90% indicate that the client is experiencing bronchoconstriction and reduced airflow, which are hallmark features of an asthma exacerbation.
• Plan to administer bronchodilator: Administering a bronchodilator is essential in treating asthma as it helps relax the bronchial muscles, leading to bronchodilation and improved airflow. This intervention is crucial for alleviating wheezing and shortness of breath associated with an asthma attack.
• Measure the client's peak airflow: Measuring peak airflow using a peak flow meter helps assess the severity of the asthma and the effectiveness of the bronchodilator therapy. It provides objective data on the client’s lung function, allowing the nurse to evaluate changes in the client’s condition over time and make necessary adjustments to the treatment plan.
• Prepare to administer an antibiotic: This action is not appropriate for asthma since antibiotics are ineffective against viral conditions and are typically used for bacterial infections such as pneumonia. Since the client is experiencing asthma symptoms rather than an infection, this intervention does not address the underlying problem.
• Request a prescription for a diuretic: This action is also not appropriate in this scenario. Diuretics are used to manage fluid overload conditions, such as pulmonary edema or heart failure, and would not be indicated for a client with asthma experiencing wheezing and shortness of breath.
• Teach the client pursed lip breathing: This technique is more commonly used in COPD to prevent airway collapse rather than in asthma, where bronchodilators provide more immediate relief.
• Oxygen saturation: Monitoring oxygen saturation is critical for assessing the effectiveness of treatment in clients with asthma. A low oxygen saturation level indicates inadequate oxygenation, which necessitates immediate intervention. Tracking this parameter helps ensure the client is receiving adequate oxygen during their treatment.
• Pulmonary function tests: While pulmonary function tests are useful for assessing long-term lung function, they provide valuable information on how well the lungs are functioning. Pulmonary function tests (PFTs), including forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR), help evaluate the degree of airway obstruction and response to treatment. Monitoring PFTs over time provides insight into asthma control and treatment effectiveness.
• Weight: Monitoring weight is not a primary concern in managing asthma exacerbations. While it can be relevant in certain chronic conditions or for assessing fluid retention, it is not directly related to monitoring respiratory status or the effectiveness of asthma treatment.
• Temperature: While it is important to monitor temperature in general to identify potential infections, it is not specifically relevant to assessing asthma status unless there are other indications of an underlying infection contributing to the respiratory symptoms. In the context of asthma management, oxygen saturation and peak airflow are more critical parameters.
• Urine output: Monitoring urine output is not a direct indicator of asthma status. It is more relevant in assessing kidney function and fluid balance, which are not primary concerns in the acute management of asthma exacerbations.
• COPD typically presents with a long history of smoking, chronic cough, and progressive respiratory symptoms. In this scenario, the client is a nonsmoker, and the acute nature of the symptoms is more indicative of asthma rather than COPD.
• Pulmonary edema often presents with symptoms such as cough with frothy sputum, severe shortness of breath, and hypoxia, typically related to heart failure. The client’s symptoms are more consistent with asthma rather than fluid overload.
• Pneumonia: Pneumonia usually presents with symptoms such as productive cough, fever, chills, and localized lung findings. While wheezing can occur, the lack of fever and the specific nighttime worsening of symptoms align more closely with asthma than with pneumonia.
• Asthma: The client’s symptoms of wheezing, chest tightness, and dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading indicate bronchoconstriction and reduced airflow, consistent with an asthma exacerbation.