A patient with sepsis shows signs of declining blood pressure and increased heart rate. Which action should the nurse prioritize?

A. Increased bronchial diameter: Chronic bronchitis is characterized by obstructive changes that decrease rather than increase the airway lumen. Chronic inflammation leads to wall thickening and smooth muscle hypertrophy, which increases resistance to airflow. This pathological narrowing contributes significantly to the patient’s expiratory effort and dyspnea.

B. Alveolar destruction: The breakdown of alveolar walls and loss of elastic recoil are the primary pathophysiological hallmarks of emphysema rather than chronic bronchitis. While both conditions often coexist in COPD, bronchitis specifically involves the conducting airways. Alveolar destruction leads to permanent air trapping and impaired gas exchange.

C. Overproduction of surfactant: Surfactant is a lipoprotein that reduces surface tension to prevent alveolar collapse during expiration. In chronic inflammatory lung diseases, surfactant function is often impaired or inhibited by inflammatory exudates rather than being overproduced. Overproduction is not a recognized feature of the bronchitic disease process.

D. Decreased ciliary function: Chronic inhalation of irritants causes squamous metaplasia of the epithelium and direct damage to the mucociliary escalator. This impairment prevents the effective clearance of the excess mucus produced by hypertrophied goblet cells. The resulting stasis of secretions leads to the characteristic persistent productive cough.

A. Perform chest physiotherapy:This intervention is designed to mobilize secretions in chronic conditions like cystic fibrosis or bronchiectasis. In an acute asthma exacerbation, the primary issue is smooth muscle constriction, not necessarily mucus plugging. Chest percussion may actually worsen the patient's respiratory distress by increasing agitation.

B. Increase oxygen flow rate:While oxygen is supportive, it does not treat the underlying pathophysiology of bronchospasm. Without opening the narrowed airways, increasing oxygen flow may not effectively reach the alveoli for gas exchange. The immediate priority is reversing the mechanical obstruction of the bronchioles.

C. Encourage pursed-lip breathing:This technique is more effective for patients with emphysema to prevent airway collapse during expiration. While it may provide some psychological calm, it is not a potent enough intervention to reverse a significant drop in peak flow. It is a supportive measure rather than a rescue treatment.

D. Administer a short-acting beta-agonist inhaler:These medications, like Albuterol, rapidly stimulate beta-2 adrenergic receptors on bronchial smooth muscle to induce bronchodilation. This is the first-line "rescue" intervention to increase airway diameter and restore airflow. It directly addresses the physiological cause of wheezing and reduced peak flow.