The nurse in the emergency department is caring for a patient brought by ambulance for shortness of breath with a history of chronic obstructive pulmonary disease (COPD). The health care provider recommends a short-acting beta agonist to be administered STAT. Which medication should the nurse anticipate will be ordered?

Rationale for Correct Choices:

• Have ABGs drawn: Obtaining ABGs is the priority because this client has pneumonia with worsening respiratory status, oxygen saturation dropping to 90% on room air, and signs of hypoxia. ABGs provide immediate information about oxygenation, ventilation, and acid-base balance, which are critical for respiratory distress and guiding oxygen therapy.

• Administer antibiotics: Administering antibiotics is the next priority after collecting labs, as timely treatment of pneumonia and potential sepsis is critical. The client shows signs of worsening infection with elevated WBC and vital sign changes, and early antibiotic administration improves outcomes and prevents further deterioration.

Rationale for Incorrect Options:

• Collect blood for BMP: While a BMP is important to assess electrolyte imbalances and kidney function, it is secondary to evaluating respiratory function and oxygenation in this acutely ill client. BMP can be collected after addressing urgent respiratory needs.
• Encourage PO fluids: While encouraging oral fluids supports hydration and recovery, it may not be feasible or safe initially if the client is confused, agitated, or has respiratory distress. Prioritizing assessment through lab tests before interventions ensures a targeted approach.
• Implement fall precautions: While fall precautions are important due to the client’s confusion and restlessness, they are a safety measure rather than an immediate clinical intervention. These should be implemented concurrently but do not take precedence over diagnosing and treating the infection.
• Discontinue oxygen therapy: Discontinuing oxygen therapy is inappropriate given the client’s oxygen saturation drops to 90% without supplemental oxygen. Maintaining adequate oxygenation is essential, especially in pneumonia, and should not be stopped.

A. Speaking to the client sternly and instructing the client to open their mouth and cooperate immediately: A stern approach often increases anxiety and resistance in dementia patients. Such communication can escalate uncooperative behavior rather than promote cooperation.

B. Quickly performing oral hygiene without explanation since the client is uncooperative: Rushing through oral care without engaging the client disregards their dignity and may increase agitation. This method can also compromise safety, as the client may resist.

C. Involving the client in the process of oral hygiene, such as using the hand-over-hand technique to brush the client’s teeth: This approach engages the client, promotes cooperation, and respects autonomy. The hand-over-hand technique allows the caregiver to guide movements while giving the client a sense of participation and control.

D. Having another nurse aide assist in holding the client’s mouth open with a tongue depressor: Forcing the mouth open with a tongue depressor can cause injury and distress. It is considered unsafe, undignified, and should not be used as a strategy for routine oral care in dementia patients