Read the client scenario and answer question.

COPD patient's chart - Nurse's Note (0800) 84-year-old male client with a chronic obstructive pulmonary disease (emphysema) history is admitted to the inpatient Med surge unit provider today. Upon admission, the client reports unusual increased shortness of breath and fatigue. The client is on 1 liter of oxygen via a nasal cannula; 02 saturation is 93%. The client's respiratory rate is 30 bpm with accessory muscle use, heart rate is 125 bpm, and blood pressure is 127/89 mmHg. The client has a barrel chest and extremities. On call provided paged, pending call back.

Identify listed assessment findings as expected or findings that need to be reported to the provider. Select only one answer per finding.

A) Cyanosis:
Cyanosis, which is a bluish discoloration of the skin and mucous membranes, typically occurs with severe hypoxia or oxygen deprivation, usually when oxygen saturation levels drop below 85%. Cyanosis is a late sign of hypoxia, not an early sign. In the early stages of hypoxia, the body attempts to compensate, and cyanosis does not typically appear until oxygen levels are significantly low.

B) Hypotension:
While hypotension can be a consequence of severe or prolonged hypoxia, it is generally a late sign. In the early stages of hypoxia, the body compensates through mechanisms such as tachycardia and vasoconstriction, so hypotension would not be expected at this stage. Hypotension in a hypoxic patient usually signals progression to severe respiratory or circulatory failure.

C) Bradycardia:
Bradycardia (slow heart rate) is not typically associated with early hypoxia. Instead, the body tries to compensate for reduced oxygen levels by increasing heart rate (tachycardia) in the early stages. Bradycardia can occur in more severe stages of hypoxia, particularly if the body begins to struggle with compensating or if the patient progresses to a more critical state. However, it is not an early sign of hypoxia.

D) Tachycardia:
Tachycardia (an elevated heart rate) is an early compensatory mechanism that the body employs when oxygen levels are insufficient. The heart increases its rate to pump more blood (and thus oxygen) to vital organs and tissues. Tachycardia is one of the earliest signs of hypoxia and occurs as the body attempts to compensate for the decreased oxygen levels in the bloodstream.

A) Crackles upon auscultation:
Left-sided heart failure occurs when the left ventricle is unable to effectively pump blood to the body, causing blood to back up into the lungs. This results in pulmonary congestion, which often manifests as crackles (also called rales) upon auscultation, particularly in the lower lobes of the lungs. The crackles are caused by the fluid accumulation in the alveoli, a hallmark sign of left-sided heart failure.

B) Palpable liver during assessment:
A palpable liver is more commonly associated with right-sided heart failure. In right-sided heart failure, the blood backs up into the venous system, causing congestion in organs such as the liver and spleen. This leads to hepatomegaly (enlargement of the liver), which can be palpated during physical examination. Therefore, a palpable liver is not typically a manifestation of left-sided heart failure.

C) Pitting Edema:
Pitting edema is more characteristic of right-sided heart failure. When the right ventricle is unable to pump blood effectively, blood backs up in the systemic circulation, leading to fluid retention and edema in the lower extremities, abdomen (ascites), or other dependent areas. While pitting edema can occur in left-sided heart failure, it is more commonly a finding in right-sided heart failure or congestive heart failure.

D) Distended jugular veins:
Distended jugular veins (JVD) are also a sign of right-sided heart failure, not left-sided heart failure. When the right side of the heart fails, blood backs up in the venous system, leading to increased venous pressure, which can be observed as jugular venous distension. This is a key finding in right-sided heart failure.