A nurse is collecting data for a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

A. Instruct the client to use a pursed-lip breathing technique.

Pursed-lip breathing is a technique commonly used to help relieve dyspnea, particularly in individuals with COPD. This technique involves breathing in through the nose and exhaling slowly through pursed lips, which helps to prolong exhalation, reduce airway collapse, and improve oxygen exchange. While pursed-lip breathing can be beneficial, it should not be the priority action when the client reports difficulty breathing. Before initiating any breathing techniques, the nurse should first assess the client's respiratory status to determine the severity of the breathing difficulty and whether additional interventions are necessary.

B. Evaluate the client's respiratory status.

This is the correct priority action in this scenario. When a client with COPD reports difficulty breathing, the nurse's first step should be to thoroughly assess the client's respiratory status. This assessment involves evaluating respiratory rate, depth, effort, oxygen saturation levels, auscultating lung sounds, and assessing for signs of respiratory distress. By conducting a comprehensive assessment, the nurse can determine the severity of the client's symptoms, identify any potential exacerbating factors or complications, and make informed decisions regarding appropriate interventions.

C. Increase the oxygen flow to 3 L/min.

While increasing the oxygen flow may be a consideration if the client's oxygen saturation is low, it should not be the immediate priority without first assessing the client's respiratory status. Increasing oxygen flow without proper assessment could potentially worsen hypercapnia in some COPD patients and may not address the underlying cause of the client's difficulty breathing. Therefore, this action should be based on assessment findings rather than being the initial response.

D. Have the client cough and expectorate secretions.

Coughing and expectorating secretions can be helpful in clearing the airways and improving breathing in individuals with COPD, especially if secretions are contributing to the difficulty breathing. However, similar to the pursed-lip breathing technique, this action should not be the priority without first assessing the client's respiratory status. The nurse should determine whether secretions are indeed present and causing the difficulty breathing before instructing the client to cough and expectorate. Therefore, this option should follow a thorough respiratory assessment.

A. Place tissue soiled with respiratory secretions in a paper bag for later disposal:

This instruction is not accurate or recommended for managing tissue soiled with respiratory secretions, particularly in the context of tuberculosis (TB) infection. TB is transmitted through the air via respiratory droplets, so proper disposal of contaminated materials is crucial to prevent the spread of the infection. Instead of placing tissue in a paper bag, it should be disposed of in a sealed plastic bag to minimize the risk of transmission. Additionally, individuals with TB should be instructed on proper respiratory hygiene practices, such as covering their mouth and nose with a tissue or their elbow when coughing or sneezing, to prevent the spread of infectious droplets.

B. Provide samples for sputum cultures every 6 weeks:

Sputum cultures are an essential component of monitoring and managing tuberculosis (TB) treatment. However, obtaining samples every 6 weeks is not frequent enough, especially during the initial phase of treatment. In the early stages of TB treatment, sputum cultures are typically obtained more frequently, often weekly or biweekly, to monitor the response to treatment, assess for drug resistance, and ensure treatment effectiveness. As treatment progresses and the patient's condition stabilizes, the frequency of sputum cultures may be adjusted based on clinical judgment and guidelines.

C. Consume alcohol in moderation while taking antituberculosis medications:

Alcohol consumption is generally discouraged while taking antituberculosis medications. Some antituberculosis drugs, such as isoniazid and rifampin, can interact with alcohol and cause adverse effects, such as liver toxicity or drug metabolism issues. Therefore, individuals undergoing treatment for tuberculosis should be advised to abstain from alcohol consumption or limit it to a minimum to avoid potential complications. Providing instructions on alcohol consumption is an important aspect of tuberculosis management and medication adherence.

D. Wear a mask while out or around crowds of people:

This instruction is crucial for individuals with pulmonary tuberculosis to prevent the spread of the infection to others. Tuberculosis is transmitted through the air via respiratory droplets, particularly when an infected person coughs, sneezes, or talks. Wearing a mask while out or in crowded settings helps reduce the risk of transmitting infectious droplets to others and is an important infection control measure. It is especially important during the early stages of treatment when the individual is still infectious and shedding bacteria. Proper mask use, along with other respiratory hygiene practices, can help protect both the individual with tuberculosis and those around them from the spread of infection.