A client is being cared for in the emergency department (ED) with acute abdominal pain and a provisional diagnosis of pancreatitis. The nurse assesses the client and obtains the results from laboratory studies. Which information is most valuable in reporting the client’s status to the healthcare provider (HCP)?

Choice A reason: Lying on each side with abdominal breathing may aid relaxation but does not optimize gas exchange in emphysema. Pursed-lip breathing better maintains airway pressure, preventing alveolar collapse, which is critical for improving oxygenation and CO2 elimination in COPD.

Choice B reason: Increasing breathing rate for 30 seconds causes hyperventilation, worsening CO2 retention in emphysema by reducing effective tidal volume. This exhausts respiratory muscles, impairing gas exchange, making it counterproductive compared to pursed-lip breathing, which enhances alveolar ventilation.

Choice C reason: Pursed-lip breathing, inhaling through the nose and exhaling slowly through pursed lips, maintains positive airway pressure, preventing alveolar collapse in emphysema. This improves gas exchange by enhancing oxygenation and CO2 removal, making it the most effective instruction for dyspnea relief.

Choice D reason: Raising hands above the head may stretch the chest but does not address emphysema’s airflow limitation. It can strain respiratory muscles, worsening dyspnea, unlike pursed-lip breathing, which directly improves alveolar ventilation and gas exchange, making this choice ineffective.

Choice A reason: Daily use of tiotropium via its handihaler is correct, as this long-acting anticholinergic bronchodilator is administered once daily for COPD maintenance. It relaxes airway smooth muscles, improving airflow, and consistent use prevents exacerbations, indicating proper understanding of the medication’s administration schedule.

Choice B reason: Using tiotropium for sudden shortness of breath is incorrect, as it is not a rescue inhaler. Tiotropium provides sustained bronchodilation over 24 hours, not rapid relief. Short-acting beta-agonists like albuterol are used for acute symptoms, indicating a need for further teaching.

Choice C reason: Using another inhaler between tiotropium doses suggests misunderstanding, as tiotropium is a once-daily maintenance therapy. Additional inhalers may be prescribed, but this statement implies incorrect timing or overuse, which could lead to improper COPD management, requiring clarification.

Choice D reason: Expecting thinner sputum is incorrect, as tiotropium does not affect mucus viscosity. It dilates airways, not liquefying secretions, which is the role of mucolytics. This misunderstanding indicates a need for teaching about tiotropium’s bronchodilatory, not mucolytic, effects in COPD.