A client diagnosed with a pulmonary embolism is placed on a continuous Heparin infusion. A nurse should notify the health care provider for which of the following findings?

A. Limit oral fluids to minimize labored breathing: This action is not appropriate, as adequate hydration is important for thinning mucus secretions, making it easier for the client to expectorate them. Limiting fluids could lead to thicker secretions, which may worsen the client’s respiratory distress and increase the difficulty of clearing secretions. Therefore, this approach is not suitable for a client with pneumonia and respiratory compromise.
B. Perform pursed-lip breathing to expel trapped carbon dioxide from the alveoli: While pursed-lip breathing can help with exhalation and improve oxygenation, it does not directly address the need to mobilize and clear copious secretions. This technique is beneficial in managing dyspnea and improving ventilation but is not the priority action when the client has significant secretions that need to be cleared.
C. Lie in a low Fowler's position to promote lung expansion: A low Fowler's position (30 degrees) is less effective for promoting lung expansion compared to higher Fowler's positions. Semi-Fowler's (30-45 degrees) or high Fowler's (greater than 45 degrees) positions are more beneficial for improving lung expansion and facilitating breathing in clients with respiratory distress. Therefore, this option does not provide the most effective intervention for the client's condition.
D. Perform hourly incentive spirometry to inflate lungs and mobilize secretions: This is the priority action for the nurse to encourage, as incentive spirometry is specifically designed to help inflate the lungs and improve lung function. It promotes deep breathing, which can enhance ventilation, prevent atelectasis, and facilitate the mobilization of secretions. Regular use of incentive spirometry is essential in managing pneumonia and can significantly improve respiratory outcomes for the client.

A. An adverse event. An adverse event is an unintended injury or complication resulting from medical care rather than the patient’s underlying condition. In this case, the surgical site infection (SSI) developed as a complication of surgery, requiring additional treatment. While adverse events may prolong recovery, they do not always indicate negligence or preventability.
B. A never event. Never events are serious, preventable medical errors that should not occur under proper care, such as surgery on the wrong site, retained surgical instruments, or administering the wrong medication. While SSIs are concerning, they are not classified as never events because they can occur even when proper precautions are taken.
C. A near miss. A near miss refers to an event that could have caused harm but was prevented before reaching the patient. Since the infection did occur and required intervention, it does not qualify as a near miss. A near miss example would be identifying and correcting a medication error before administration.
D. A sentinel event. Sentinel events involve unexpected occurrences that result in serious injury, permanent harm, or death, such as patient suicide, wrong-site surgery, or a fatal medication error. Although the infection required prolonged treatment, it did not lead to severe harm or death, making it an adverse event rather than a sentinel event.