A patient with Chronic Obstructive Pulmonary Disease (COPD), who smokes two packs of cigarettes daily and is hospitalized due to a respiratory infection, reports difficulty managing respiratory distress at home when using the rescue inhaler.
Which statement from the patient suggests to the nurse that the inhaler is not being used correctly?

Based on the provided information, the following assessment findings require immediate follow-up by the nurse:

• Difficulty breathing on a hike: This is a significant symptom of asthma exacerbation and needs immediate attention.
• Symptoms did not resolve after taking albuterol: Albuterol is a quick-relief medication for asthma symptoms. If symptoms do not improve after its use, it indicates that the asthma exacerbation is severe.
• Mild subcostal retractions: This is a sign of respiratory distress and indicates that the client is using accessory muscles to breathe.
• Wheezes noted throughout the lung fields: Wheezing is a common sign of asthma and indicates airway obstruction.
• The client is pale: Paleness can be a sign of decreased oxygenation.
• Heart rate of 122 beats/minute: A high heart rate can be a sign of distress or could be due to the body’s attempt to compensate for decreased oxygenation.
• Oxygen saturation of 91% on room air: Normal oxygen saturation is typically 95% or higher. A saturation of 91% indicates that the client is not getting enough oxygen.

Choice A rationale

While the client’s healthcare power of attorney is important information, it is not the most critical piece of information to report in this situation. The immediate concern is the client’s change in mental status and potential medical emergency.

Choice B rationale

The nurse should be aware of the client’s currently prescribed medications, but this information does not take precedence over the client’s sudden onset of confusion and agitation. Immediate action is needed to address the client’s altered mental status.

Choice C rationale

While the reason for the client’s admission is important background information, it is not the most urgent information to report in this situation. The priority is addressing the client’s acute change in mental status.

Choice D rationale

Increasing confusion and agitation in a client who recently underwent ORIF of the right femur is a significant change in condition and may indicate a medical emergency such as infection, delirium, or other complications. This information should be provided first to alert the healthcare provider to the client’s immediate needs.