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Increased arterial oxygen: Clients with COPD typically experience chronic hypoxemia due to alveolar destruction, airway inflammation, and mucus production, which impair gas exchange. Rather than increased oxygen levels, they often have a decreased PaO₂, requiring supplemental oxygen therapy. However, excessive oxygen administration can suppress their respiratory drive, worsening CO₂ retention.

Increased pH: COPD is associated with respiratory acidosis due to chronic CO₂ retention from inadequate alveolar ventilation. While the kidneys compensate by increasing bicarbonate retention, the pH usually remains low or near normal in chronic cases rather than becoming elevated. A higher pH would indicate alkalosis, which is not typical in COPD unless there is an additional metabolic disturbance.

Decreased alveolar function: While COPD does lead to progressive alveolar damage and reduced gas exchange, this is a structural and functional change rather than a specific abnormality seen in arterial blood gases. The primary ABG finding in COPD is hypercapnia, which reflects inadequate ventilation and CO₂ retention rather than just decreased alveolar function alone.

"Your body will slowly develop an ability to smell through your stoma." The olfactory system relies on air passing through the nasal passages to detect scents. After a total laryngectomy, the airway is rerouted through a stoma, bypassing the nose entirely. The body does not develop an alternative way to smell through the stoma, making this statement inaccurate.

"Your sense of smell will gradually return after several months." Unlike temporary post-surgical changes, the loss of smell after a total laryngectomy is typically permanent unless the client learns to use techniques such as the "polite yawning" method (nasal airflow-inducing maneuver) to regain some olfactory function. It does not naturally return over time.

"As your appetite returns, your sense of smell will also return." Appetite and sense of smell are closely linked, but appetite improvement does not restore olfaction after a laryngectomy. Since air no longer flows through the nasal passages, the ability to detect smells is significantly impaired or lost.

Conduct a study about the time and money costs of implementing the change. While analyzing costs and time efficiency is important for evaluating resource utilization, it does not directly measure the effectiveness of the changes in reducing medication errors. The primary goal of quality improvement is to assess patient safety outcomes rather than financial impact alone.

Establish a benchmark to identify a standard of performance. Setting benchmarks is a useful strategy for quality control, but it is a preliminary step in the evaluation process. Benchmarks provide a target for improvement, but they do not measure whether the specific changes implemented have led to a reduction in medication errors.

Provide the staff with a questionnaire to quantify staff satisfaction with the changes. Staff feedback is valuable for assessing workflow and morale, but it does not directly measure the effectiveness of the intervention in reducing medication errors. A reduction in actual error rates provides a more concrete evaluation of the intervention’s success.

The client must remain in respiratory isolation until medication treatment ends. While respiratory isolation is essential for active TB, it is not required until the full course of treatment is completed. Isolation is typically maintained until the client has received at least two weeks of effective therapy, symptoms improve, and three consecutive sputum smears are negative for acid-fast bacilli (AFB).

The fact that the disease is self-limiting, but can take up to two years to resolve. TB is not self-limiting; without proper treatment, it can persist indefinitely, worsen, and become fatal. Standard treatment with first-line drugs such as isoniazid, rifampin, ethambutol, and pyrazinamide effectively eradicates the infection within 6 to 9 months in most cases.

The importance of participating in physical therapy to re-establish functional abilities. While TB can cause fatigue and weakness, physical therapy is not a primary focus of treatment. The priority is to eradicate the infection through strict medication adherence, as untreated TB can progress to severe pulmonary damage, systemic involvement, and complications.

Cultural differences. While cultural beliefs may influence end-of-life decisions, the primary issue in this scenario is not cultural misunderstanding but rather the conflict between the client’s documented wishes and the family's demands. Cultural differences typically pertain to variations in values, traditions, or beliefs, rather than legal and ethical dilemmas regarding patient autonomy.

Competition between groups. There is no indication that different groups, such as healthcare teams or family members, are competing for resources or control. The conflict stems from an ethical dilemma rather than rivalry or organizational disputes.

Scarcity, safety, and security. This situation does not involve limited resources, threats to safety, or security concerns. The distress is rooted in the ethical dilemma of honoring the client’s advance directive versus the family’s insistence on aggressive resuscitation measures.

Working to reduce wait times in the emergency department. Reducing wait times falls under the timeliness domain rather than efficiency. Timeliness ensures that patients receive care without unnecessary delays, improving access to treatment and patient outcomes. While efficiency and timeliness are related, reducing wait times primarily aligns with improving prompt care delivery rather than minimizing waste.

Using an interpreter for patients who do not speak the health-care provider's language. This action falls under the equity domain, which ensures that all individuals receive fair and unbiased care regardless of language, socioeconomic status, or cultural background. Providing language services improves access to quality healthcare but does not specifically address efficiency.

Utilizing the CAUTI bundle to prevent urinary tract infections when placing indwelling urinary catheters. This initiative falls under the safety domain, which focuses on preventing harm to patients through evidence-based practices. Implementing infection prevention measures improves patient safety but is not directly related to efficiency, which focuses on cost-effectiveness and resource management.

Encourage the client to take breaks from oxygen use to prevent tolerance. Oxygen therapy does not cause "tolerance," and taking breaks can lead to hypoxemia in COPD clients. Continuous low-flow oxygen is essential to maintaining adequate oxygenation while avoiding hypercapnia. Stopping oxygen therapy intermittently can increase the risk of respiratory distress.

Assess cheeks and posterior ears for signs of skin breakdown. While it is important to monitor for pressure injuries from nasal cannula tubing, this is a general nursing consideration for all patients receiving oxygen therapy. It is not the highest priority when managing oxygen therapy in clients with COPD, where maintaining appropriate oxygen levels is critical.

Teach the client how to safely increase oxygen flow when they deem necessary. Allowing a client with COPD to adjust their oxygen flow independently can be dangerous, as excessive oxygen can lead to hypercapnia and respiratory depression. Oxygen adjustments should be made based on clinical assessments and healthcare provider orders.