A nurse is caring for a patient diagnosed with emphysema.

The patient has a known history of alpha-1 antitrypsin deficiency.

The nurse understands that this genetic condition:

NGN Bowtie: Asthma Management

Rationale

• Condition:The patient's symptoms (dry cough at night, chest tightness, and wheezing) combined with a history of using "as-needed inhalers" are classic indicators of Asthma. While COPD presents similarly, the episodic nature and the description of the cough suggest asthma. Pneumonia and Pulmonary Edema typically present with fever or crackles (rales), respectively, which are absent here.
• Actions to Take:* Place the client upright:This is the immediate non-pharmacological priority to maximize lung expansion and decrease the work of breathing.
  • Administer a bronchodilator:This is the definitive medical treatment to reverse the airway constriction (bronchospasm) causing the wheezing.
  • Note:Antibiotics are for infections, and a bronchoscopy is an invasive diagnostic tool not indicated for an acute asthma flare.
• Parameters to Monitor:
  • Oxygen saturation:Essential to determine if the interventions are improving gas exchange (the current 90% is below the typical target of ≥94%).
  • Respiratory rate:A decrease in the rate (currently 28/min) indicates that the patient's respiratory distress is resolving and they are not tiring out.

Choice A rationale

While observing for confusion is important, especially in older adults who may experience post-operative delirium or hypoxia, it is not the absolute priority immediately after a bronchoscopy. Confusion can be a sign of many issues, but airway protection must be established first. Assessing the neurological status is part of a comprehensive post-procedural assessment, but it follows the immediate physiological safety checks required to prevent aspiration and ensure the patient is stabilized.

Choice B rationale

Auscultating breath sounds is a necessary part of the post-bronchoscopy assessment to check for complications like a pneumothorax or diminished air entry. However, the immediate risk following the administration of local anesthesia to the throat is the loss of protective airway reflexes. While breath sounds provide information about lung expansion, the ability to protect the airway from gastric contents or saliva takes precedence in the very first moments of the recovery phase to prevent aspiration.

Choice C rationale

Measuring blood pressure is a standard part of monitoring vital signs to ensure hemodynamic stability after any procedure involving sedation. While hypotension or hypertension can occur, it is generally considered a lower priority than airway management. Normal blood pressure is typically 120 over 80 mmHg. Monitoring vitals helps detect internal bleeding or reactions to anesthesia, but the immediate physical obstruction or aspiration risk is the most critical factor to address first.

Choice D rationale

The primary concern after a bronchoscopy is the return of the gag reflex. During the procedure, the pharynx is typically numbed with a local anesthetic to prevent coughing and gagging. Until this reflex returns, the patient is at a high risk for aspiration. The nurse must keep the patient NPO (nothing by mouth) and confirm the gag reflex is intact before allowing any oral intake. Ensuring airway protection is always the highest priority in the nursing process.