A patient with Chronic Obstructive Pulmonary Disease (COPD), who smokes two packs of cigarettes daily and is hospitalized due to a respiratory infection, reports difficulty managing respiratory distress at home when using the rescue inhaler.
Which statement from the patient suggests to the nurse that the inhaler is not being used correctly?

Choice A rationale

Keeping the head of the bed raised 45 degrees is a common practice in intensive care units to prevent aspiration pneumonia. However, in the context of septic shock, this intervention is not the highest priority.

Choice B rationale

Assessing the warmth of the extremities can provide information about peripheral perfusion. Cold extremities may indicate poor perfusion, a common symptom in septic shock. However, this is not the most critical intervention in the management of septic shock.

Choice C rationale

Maintaining strict intake and output records is crucial in the management of septic shock. Fluid balance is a key component of sepsis management. Monitoring fluid balance helps ensure that the patient is adequately hydrated, which is essential for maintaining blood pressure and organ perfusion.

Choice D rationale

Monitoring the patient’s blood glucose level is important, especially if the patient is receiving insulin or has a history of diabetes. However, in the context of septic shock, this is not the highest priority.

Choice A rationale

Using the inhaler only when the patient is really short of breath is not an incorrect use of the inhaler. However, it might indicate that the patient is not managing their COPD effectively, as rescue inhalers like albuterol are meant to be used for quick relief of acute symptoms.

Choice B rationale

Having a hard time inhaling and holding the breath after squeezing the inhaler might suggest that the patient is not using the inhaler correctly. However, the patient’s statement that they “do their best” suggests that they are aware of the correct technique and are trying to follow it.

Choice C rationale

Swallowing after squeezing the inhaler is a clear indication of incorrect use. The medication from the inhaler is meant to be inhaled into the lungs, not swallowed. Swallowing the medication would lead to less of it reaching the lungs, reducing its effectiveness. The wave of nausea the patient experiences could be a side effect of swallowing the medication.

Choice D rationale

Shaking the inhaler several times before starting is actually part of the correct technique for using many types of inhalers.