The nurse is caring for a client who has been admitted with a diagnosis of esophageal cancer.
The client reports a pain level of 8 on a 0 to 10 pain scale, dysphagia, anorexia, anxiety, and a hoarse voice. Which nursing problem is the priority for this client?

Rationale for Choice A:

Pursed-lip breathing:

Creates back pressure in the airways, which helps to keep them open longer during exhalation.

Slows down the breathing rate, allowing for more complete exhalation and better emptying of the lungs. Prevents air trapping, which can worsen shortness of breath.

Promotes relaxation and reduces anxiety, which can also help to improve breathing.

Rationale for Choice B:

Side-lying position with knees bent:

May not be the most effective position for improving gas exchange in a client with emphysema. Could potentially restrict chest expansion and make breathing more difficult.

May not be comfortable for all clients.

Rationale for Choice C:

Increasing breathing rate:

Can lead to hyperventilation, which can worsen shortness of breath and anxiety. Can also cause fatigue and muscle exhaustion.

Rationale for Choice D:

Raising hands above the head:

Does not significantly expand the diaphragm or improve gas exchange. May actually make breathing more difficult for some clients.

Choice D rationale:

Highlights daily use: Tiotropium is a long-acting bronchodilator, meaning it works to relax and open the airways over an extended period. It's crucial for managing COPD symptoms and preventing exacerbations. Daily use is essential to maintain its effectiveness.

Emphasizes the Handihaler: The Handihaler is the specific inhalation device designed for tiotropium delivery. It ensures proper medication administration and optimal lung deposition.

Demonstrates understanding of instructions: Choosing this option indicates the client has correctly grasped the intended frequency and method of use.

Choice A rationale:

Misunderstanding of purpose: Tiotropium is not a rescue inhaler for sudden shortness of breath. It's a maintenance medication that works gradually to improve lung function. For acute symptoms, a short-acting bronchodilator, like albuterol, is required.

Potential delay in appropriate treatment: Reliance on tiotropium for acute episodes could lead to delayed use of the correct rescue medication, potentially worsening symptoms and increasing risks.

Choice B rationale:

Potential side effect, not primary goal: While tiotropium may reduce sputum thickness in some individuals, it's not the primary aim of therapy. Focusing on this aspect could overlook its broader benefits in managing COPD.

Variable response: The extent of sputum thinning varies among individuals and shouldn't be the sole indicator of effectiveness.

Choice C rationale:

Potential for overmedication: Using multiple inhalers without clear guidance from a healthcare provider could increase the risk of excessive medication and adverse effects.

Importance of individualized regimens: Inhaler use depends on the specific medications prescribed and the severity of COPD. Healthcare professionals tailor regimens to individual needs.