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. Obtain a prescription for supplemental oxygen: This is the correct answer. The patient is experiencing hypoxia, and ensuring adequate oxygenation is the priority. Oxygen supplementation is essential to correct the hypoxia, which can exacerbate metabolic disturbances like diabetic ketoacidosis (DKA). Improving oxygenation will also support other treatments, such as insulin administration, by improving tissue perfusion.
B. Obtain a prescription to administer insulin: While insulin is a key treatment for DKA, addressing hypoxia first is more urgent. Hypoxia can impair the effectiveness of insulin and other therapies, so stabilizing the patient’s oxygen levels should be prioritized before insulin administration.
C. Obtain a prescription to administer intravenous fluids: Administering fluids is important in DKA management, especially for rehydration and correcting electrolyte imbalances. However, addressing hypoxia first is the priority to stabilize the patient and ensure optimal perfusion for further interventions like fluid resuscitation.
D. Obtain a prescription to check the client's glucose level: This is not necessary, as the glucose level is likely already elevated, which is characteristic of DKA. The focus should be on stabilizing the patient's airway and oxygenation before monitoring glucose levels or starting insulin.

A. Discharge immediately following an open lung biopsy is unlikely. The patient will need observation post-procedure for complications such as bleeding, infection, or pneumothorax, and it usually requires a stay in the hospital for monitoring.
B. It is unlikely that supplemental oxygen will not be needed following an open lung biopsy. The patient may require oxygen post-procedure due to potential respiratory compromise, such as atelectasis or pneumothorax.
C. A chest tube is commonly inserted after an open lung biopsy to allow the lung to re-expand and to drain air or fluid that may accumulate in the pleural space. This is a standard part of the postoperative care for this procedure.
D. Collecting a sputum specimen is not typically necessary immediately after an open lung biopsy. The focus will be on monitoring the patient’s respiratory status, ensuring proper lung expansion, and preventing complications like pneumothorax or bleeding.