Which action would the nurse take first for a patient with a tracheostomy who appears anxious and is having difficulty in coughing up thick respiratory secretion?

A. A peak flow of more than 40% would indicate that the patient's asthma is not in an acute exacerbation. This patient's symptoms, such as confusion and inability to speak, suggest a severe asthma attack, and the peak flow would likely be much lower.
B. Bradycardia is not typically associated with severe asthma exacerbations. Tachycardia is more commonly observed as the body attempts to compensate for hypoxia.
C. Loud and prominent wheezing is usually seen in less severe cases of asthma. In this case, the inability to speak and confusion suggest severe respiratory distress, where wheezing might be diminished or absent due to poor air movement.
D. Deteriorating arterial blood gas (ABG) results, with low oxygen levels (hypoxemia) and elevated carbon dioxide levels (hypercapnia), would be expected in a patient with severe asthma exacerbation. These signs indicate respiratory failure and the need for urgent intervention.

A. A BMI of 28 kg/m² is considered overweight, but it does not meet the threshold for bariatric surgery, which typically requires a BMI of 40 or more.
B. While a BMI of 32 kg/m² may be relevant when combined with significant co-morbidities (like type 2 diabetes or hypertension), the standard guideline for bariatric surgery generally requires a BMI of 40 or higher, or 35 with comorbid conditions.
C. A BMI of 30 kg/m² is classified as obese, but bariatric surgery is generally considered for those with a BMI of 40 or higher, or 35 with severe comorbidities.
D. A BMI of 40 kg/m² or more is the standard criteria for bariatric surgery, particularly when other treatments (such as diet, exercise, and medication) have failed, or when obesity-related health issues are present.