A nurse is caring for a client who has a T-4 spinal cord injury.
Which of the following client findings should the nurse identify as an indication the client is at risk for experiencing autonomic dysreflexia?

Rationale for correct condition
The client’s episodic wheezing, chest tightness, and nocturnal dry cough are classic signs of asthma. Use of accessory muscles and bilateral inspiratory and expiratory wheezing support airway obstruction typical in asthma. The absence of fever, crackles, or peripheral edema excludes infection or heart failure. The client’s history of GERD can exacerbate asthma symptoms via microaspiration and airway irritation. The rapid onset and progression over two days also favor asthma exacerbation over chronic conditions.

Rationale for correct actions
Administering a bronchodilator targets bronchospasm by relaxing airway smooth muscle via beta-2 adrenergic receptor stimulation, improving airflow and oxygenation. Bronchodilators rapidly reduce airway resistance, alleviating wheezing and dyspnea. Measuring peak expiratory flow quantifies airway obstruction severity, guiding treatment efficacy. Peak flow monitoring detects airflow limitation changes, enabling timely adjustments in therapy to prevent deterioration.

Rationale for correct parameters
Oxygen saturation reflects gas exchange efficiency, with normal range 95-100%; levels below 92% indicate hypoxemia requiring intervention. Monitoring saturation ensures oxygen therapy adequacy and early detection of respiratory failure. Pulmonary function tests (PFTs) objectively measure airway obstruction severity and reversibility, essential in asthma diagnosis and monitoring. PFTs detect changes in forced expiratory volume (FEV1) and forced vital capacity (FVC), indicating bronchoconstriction or improvement.

Rationale for incorrect conditions
COPD typically affects older smokers with chronic productive cough and progressive symptoms, unlike this nonsmoker with acute onset. Pneumonia presents with fever, productive cough, and focal lung findings such as crackles, absent here. Pulmonary edema involves fluid overload signs like peripheral edema and crackles, not observed in this client.

Rationale for incorrect actions
Teaching pursed-lip breathing is more beneficial in COPD to reduce air trapping, less effective in acute asthma. Antibiotics are not indicated without infection evidence, as this is a noninfectious exacerbation. Diuretics treat fluid overload in pulmonary edema, irrelevant in asthma.

Rationale for incorrect parameters
Temperature monitoring is not primary here, as no infection signs are present. Urine output assesses renal function or fluid status, not respiratory status. Weight monitoring is relevant in chronic heart failure management but not acute asthma.

Take home points

• asthma presents with episodic wheezing and nocturnal cough, often triggered by irritants
• bronchodilators and peak flow monitoring are critical in managing asthma exacerbations
• oxygen saturation and pulmonary function tests guide treatment effectiveness
• differentiate asthma from COPD, pneumonia, and pulmonary edema by clinical presentation and history

Choice A rationale

Dementia is a neurodegenerative disorder characterized by a progressive and irreversible decline in cognitive function, including memory, thinking, and reasoning. This deterioration is due to widespread neuronal loss and brain atrophy, leading to increasing dependence over time as the disease advances.

Choice B rationale

Dementia is not characterized by a sudden onset of confusion. Instead, its onset is typically insidious, with a gradual decline in cognitive abilities over months to years. A sudden onset of confusion is more indicative of delirium, which is an acute and often reversible state.

Choice C rationale

An altered level of consciousness is not typically associated with dementia. Clients with dementia generally maintain a clear level of consciousness, although they may experience confusion, disorientation, or difficulty with attention. Altered consciousness is a hallmark feature of delirium.

Choice D rationale

While high fever or dehydration can exacerbate cognitive impairment in individuals with underlying dementia, they do not trigger the development of dementia itself. These factors are more commonly associated with delirium, which is an acute confusional state, rather than the chronic progressive nature of dementia.