A client newly diagnosed with asthma is being given discharge instructions. The nurse works collaboratively with the client, instructing the client to use a metered dose inhaler (MDI). What is the first priority and last priority step in the procedure?

Choice A reason: Suctioning the client at least every two hours is not typically necessary for a non-productive cough. Suctioning is more appropriate for patients with excessive secretions that they cannot clear on their own. Overuse of suctioning can cause irritation and discomfort.

Choice B reason: Encouraging fluids up to 3000 mL/day unless contraindicated is crucial for a client with pneumonia. Adequate hydration helps to thin mucus, making it easier to expectorate and clear from the lungs. This can improve the client’s ability to cough effectively and reduce the risk of complications such as atelectasis. Hydration also supports overall bodily functions and helps in maintaining electrolyte balance.

Choice C reason: Encouraging a right side-lying position is not the best intervention for a client with right lower lobe pneumonia. This position may not promote optimal lung expansion and drainage. Instead, positioning the client to maximize lung expansion and facilitate drainage, such as sitting up or lying on the unaffected side, is more beneficial.

Choice D reason: Administering codeine elixir PRN following prescription is not the priority intervention. While codeine can help suppress a cough, it is generally not recommended for a non-productive cough in pneumonia because it can suppress the cough reflex needed to clear secretions. Additionally, codeine can cause respiratory depression and other side effects.

Choice A reason: A decreased anteroposterior diameter of the chest is not typically associated with COPD and emphysema. In fact, patients with COPD often have an increased anteroposterior diameter, known as a “barrel chest,” due to hyperinflation of the lungs. This change in chest shape is a compensatory mechanism to accommodate the increased lung volume and is a common physical finding in advanced COPD.

Choice B reason: Oxygen saturation level below 95% is a common finding in patients with COPD and emphysema. These conditions impair the lungs’ ability to oxygenate the blood effectively, leading to lower oxygen levels. Chronic hypoxemia is a hallmark of COPD, and monitoring oxygen saturation is crucial in managing these patients. Normal oxygen saturation levels typically range from 95% to 100%, so levels below 95% indicate a need for supplemental oxygen or other interventions.

Choice C reason: Petechiae on the chest are not a typical finding in COPD or emphysema. Petechiae are small, red or purple spots caused by bleeding into the skin and are usually associated with conditions affecting blood clotting or platelet function. They are not related to the respiratory pathology seen in COPD and emphysema.

Choice D reason: Respiratory alkalosis is not commonly associated with COPD and emphysema. These conditions are more likely to cause respiratory acidosis due to chronic retention of carbon dioxide (CO2). In COPD, the damaged alveoli and airways lead to impaired gas exchange, resulting in elevated CO2 levels and a decrease in blood pH. Respiratory alkalosis, characterized by low CO2 levels and increased pH, is more often seen in conditions causing hyperventilation, such as anxiety or acute asthma attacks.