An elderly client is admitted with a temperature of 102°F (38.8°C), chest pain, and fatigue.

A chest X-ray reveals an accumulation of fluid within the pleural cavity.

Purulent drainage is aspirated during a thoracentesis.

The nurse knows this purulent drainage is called a(n):

Choice A rationale

A pneumothorax involves the presence of air in the pleural space, leading to a collapsed lung. While it can cause respiratory distress and agitation, it usually presents with sudden, sharp chest pain and absent breath sounds on the affected side. Confusion can occur if the pneumothorax leads to severe respiratory failure, but it is not the most direct or common complication of oxygen therapy in a chronic obstructive pulmonary disease patient compared to other metabolic changes.

Choice B rationale

Hemothorax is the accumulation of blood in the pleural cavity, often resulting from trauma, surgery, or malignancy. It would present with signs of hypovolemia and decreased breath sounds. While it impairs gas exchange, it is an unlikely diagnosis for a patient receiving routine oxygen therapy for chronic obstructive pulmonary disease unless there was a specific acute injury or underlying pathology. It does not directly relate to the physiologic response of oxygen administration in this population.

Choice C rationale

In chronic obstructive pulmonary disease, the respiratory drive may become dependent on low oxygen levels or a hypoxic drive rather than high carbon dioxide levels. Providing continuous oxygen can sometimes suppress this drive, leading to carbon dioxide retention and narcosis, or the oxygen itself may not be sufficient if the patient's condition is worsening. Confusion is a hallmark sign of hypoxia, indicating that the brain is not receiving adequate oxygenation, which is a common and dangerous complication in these patients.

Choice D rationale

A pulmonary embolism occurs when a blood clot blocks a pulmonary artery, causing a sudden mismatch in ventilation and perfusion. While this can cause confusion due to a sudden drop in oxygen saturation, it is usually accompanied by acute chest pain, tachycardia, and hemoptysis. While a risk for any chronic patient, confusion in the context of continuous oxygen therapy for chronic obstructive pulmonary disease is more traditionally and frequently associated with the progression of hypoxia or hypercapnia.

Choice A rationale

Oxygen therapy, even at low flow rates like 2 liters per minute, has a significant drying effect on the delicate mucous membranes of the nasal passages. When the nasal mucosa becomes excessively dry, it can lead to crusting, irritation, and even minor bleeding. Adding humidification to the oxygen source introduces moisture into the inhaled gas, which helps to rehydrate the tissues, loosen dried secretions, and prevent further trauma to the nares.

Choice B rationale

Removing the nasal cannula is not a viable priority intervention because the patient was prescribed oxygen therapy for chronic obstructive pulmonary disease. This condition often results in chronic hypoxemia and hypercapnia, requiring a stable fraction of inspired oxygen to maintain adequate systemic oxygenation. Abruptly discontinuing the oxygen could lead to respiratory distress or a drop in arterial oxygen saturation levels, which would jeopardize the patient's respiratory stability and overall clinical safety.

Choice C rationale

Increasing the oxygen flow rate to 5 liters per minute would be counterproductive and potentially dangerous. Higher flow rates without humidification significantly increase the rate of evaporation from the nasal mucosa, which would exacerbate the crusting and bleeding already observed. Furthermore, in patients with chronic obstructive pulmonary disease who may rely on a hypoxic drive to breathe, excessive oxygen administration can suppress the respiratory drive, leading to dangerous carbon dioxide retention and respiratory acidosis.

Choice D rationale

Applying petroleum jelly or other oil-based products to the nostrils while a patient is receiving oxygen therapy is contraindicated due to a significant safety risk. Petroleum is a combustible substance, and in an oxygen-rich environment, it can pose a fire hazard or cause localized burns if an ignition source is present. Additionally, if petroleum jelly is inhaled into the lungs, it can lead to lipid pneumonia, which is a serious inflammatory condition of the lung parenchyma.