When performing postural drainage on a patient with chronic obstructive pulmonary disease (COPD), which approach should the nurse use?
Obtain arterial blood gases (ABGs) prior to procedure.
Explain that the patient may be placed in five positions.
Perform the drainage immediately after meals.
Instruct the patient to breathe shallow and fast.
The Correct Answer is B
Choice A rationale:
While ABGs can provide valuable information about a patient's respiratory status, they are not routinely required prior to postural drainage in patients with COPD.
ABGs might be considered if the patient is experiencing acute respiratory distress or if there are concerns about their oxygenation or ventilation status.
However, in the absence of such concerns, obtaining ABGs would not be necessary and could potentially cause discomfort or anxiety for the patient.
Choice C rationale:
Performing postural drainage immediately after meals is not recommended for patients with COPD.
This is because eating can cause a feeling of fullness in the stomach, which can make it difficult for the patient to breathe deeply and effectively during the procedure.
Additionally, there is a risk of aspiration if the patient were to vomit during or after postural drainage.
It is generally recommended to perform postural drainage at least 1-2 hours after meals to reduce these risks.
Choice D rationale:
Instructing the patient to breathe shallow and fast is not appropriate for postural drainage.
The goal of postural drainage is to help the patient mobilize and expectorate secretions from the lungs.
This is best achieved by encouraging the patient to breathe deeply and slowly, which helps to open up the airways and promote mucus clearance.
Shallow, rapid breathing can actually make it more difficult to clear secretions and can lead to increased shortness of breath.
Choice B rationale:
Explaining that the patient may be placed in five positions is the most appropriate approach for postural drainage in a patient with COPD.
This is because different positions help to drain different areas of the lungs. The five positions typically used for postural drainage are:
Head down position (to drain the lower lobes)
Prone position (to drain the posterior segments of the lungs)
Right lateral position (to drain the right middle lobe and right lower lobe) Left lateral position (to drain the left lower lobe)
Sitting upright position (to drain the upper lobes)
By placing the patient in these different positions, the nurse can help to ensure that all areas of the lungs are drained effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale:
Isoniazid's Mechanism of Action:
It targets and inhibits the synthesis of mycolic acids, which are essential components of the cell wall of Mycobacterium tuberculosis, the bacteria that cause tuberculosis.
By disrupting cell wall formation, isoniazid prevents bacterial growth and multiplication, leading to the suppression and eventual eradication of the infection.
Clinical Manifestations of Active TB:
Persistent cough, often productive of sputum (phlegm), is a hallmark symptom of TB. The sputum may contain blood or have a rusty-colored appearance.
Other common symptoms include fever, night sweats, fatigue, weight loss, and chest pain. How Isoniazid Reduces Cough and Sputum:
As isoniazid effectively kills the TB bacteria, the inflammatory process within the lungs subsides.
This leads to a gradual decrease in the production of sputum, which is a direct result of the inflammatory response. Consequently, the frequency and severity of coughing episodes also diminish.
Monitoring Treatment Response:
Regular sputum smears and cultures are essential to assess the response to treatment.
A positive sputum smear indicates the presence of live TB bacteria, while a positive culture confirms their growth in the laboratory.
A gradual decrease in the number of bacteria seen on sputum smears, followed by negative cultures, signals a favorable response to treatment.
Timeframe for Improvement:
It's important to note that clinical improvement, including a reduction in cough and sputum, may not be immediately evident. It typically takes several weeks of consistent isoniazid therapy to achieve noticeable results.
Therefore, adherence to the prescribed treatment regimen is crucial for successful TB eradication. Addressing Other Choices:
Choice A: Decreased appetite and weight loss are often associated with active TB due to systemic inflammation and nutritional deficiencies. While isoniazid treatment may indirectly improve appetite and weight gain over time, these are not primary indicators of its effectiveness in suppressing the TB infection itself.
Choice C: Vertigo and tinnitus are potential side effects of isoniazid, but they do not reflect its efficacy in treating TB.
Choice D: A positive sputum smear and culture would indicate ongoing TB infection and a lack of response to treatment.
Correct Answer is A
Explanation
Choice A rationale:
Liquefying secretions is the most crucial action to address the client's immediate respiratory concerns. Thickened mucus obstructs airflow, leading to shortness of breath, productive cough, and difficulty breathing upon exertion. Increasing fluid intake thins mucus, making it easier to expel and improving ventilation. This directly addresses the client's current symptoms and promotes airway clearance.
Hydration and Mucociliary Clearance: Adequate hydration is indispensable for optimal mucociliary clearance, the natural mechanism that removes mucus from the airways. Fluids moisten the respiratory tract, allowing cilia (tiny hair-like structures) to effectively move mucus upwards, where it can be coughed out or swallowed.
Thinning Mucus: Water acts as a natural expectorant, thinning mucus and reducing its viscosity. This makes it easier for the client to cough up the mucus, clearing the airways and reducing the sensation of breathlessness.
Decreasing Mucus Production: Dehydration can trigger the body to produce more mucus as a protective response. By staying hydrated, the client can help prevent excessive mucus production, further easing symptoms.
Supporting Overall Respiratory Health: Proper hydration maintains the health of the respiratory system's tissues and cells, promoting efficient gas exchange and reducing inflammation.
Preventing Dehydration-Related Complications: Dehydration can exacerbate respiratory problems and lead to other complications, such as fatigue, headaches, and impaired immune function. Maintaining adequate fluid intake helps prevent these issues.
Key points to emphasize to the client:
Drink fluids throughout the day, even if not feeling thirsty.
Water is the best choice, but clear broths, juices, and herbal teas can also contribute to fluid intake. Avoid caffeine and alcohol, as they can be dehydrating.
Monitor urine output to ensure adequate hydration (urine should be pale yellow or clear).
Increase fluid intake during periods of increased mucus production, such as during respiratory infections or exercise.
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