The nurse is caring for a client with a history of coronary artery disease who reports waking up with a sudden onset of vise-like chest pressure.

The client reports that the pain decreases at rest but continues to feel a constant mid-chest pressure. What intervention should the nurse perform in the immediate management of the client?

What intervention should the nurse perform in the immediate management of the client?

Management of respiratory distress in a long-term smoker requires knowledge of oxygen delivery systems and airway humidification. The nurse must apply principles of respiratory therapy to select equipment that ensures precise flow regulation and moisture addition to prevent mucosal drying during supplemental oxygen administration.

Choice A rationale: Lamb’s wool is occasionally used to protect skin from pressure sores caused by medical tubing. However, it is not a standard or essential component for initiating oxygen therapy, as modern medical-grade foam dressings or specialized tubing protectors are more commonly utilized in clinical practice.

Choice B rationale: Sterile water is essential for the humidification process when oxygen flow rates exceed 4 liters per minute. It serves as the reservoir liquid in the humidifier bottle to ensure the inhaled gas is moist, preventing the drying of sensitive respiratory mucosa and secretions.

Choice C rationale: Tape is generally avoided when securing nasal cannulas because it can cause skin irritation or breakdown on the face. The cannula is designed to be secured using the integrated sliding bolo or by looping the flexible tubing comfortably behind the patient's ears.

Choice D rationale: A suction canister is used for removing secretions from the oropharynx or trachea. While it may be present at the bedside for safety, it is not a functional component of the oxygen delivery system itself, which focuses on gas inhalation rather than extraction.

Choice E rationale: A humidifier bottle is necessary to add water vapor to the dry oxygen gas provided by the wall source. Humidification is vital for patient comfort and to maintain the integrity of the mucociliary escalator, especially for patients with chronic lung irritation from smoking.

Choice F rationale: The nasal cannula is the primary interface for delivering low-to-medium concentrations of oxygen. It consists of two prongs that fit into the nares, allowing the patient to breathe supplemental oxygen while still being able to speak and consume fluids or meals.

Choice G rationale: A flowmeter is a critical device that attaches to the oxygen wall outlet to regulate the liters per minute delivered. It allows the nurse to accurately titrate the oxygen dose according to the healthcare provider's specific orders and the patient's oxygenation needs.

Choice A rationale
The absence of coarse crackles is not necessarily an indication that chest physiotherapy (CPT) has been effective for a client with chronic obstructive pulmonary disease (COPD). Coarse crackles are often heard in conditions where there is fluid in the airways, such as pneumonia or heart failure. While their absence might indicate that there is no fluid in the airways, it does not necessarily mean that secretions have been effectively mobilized.
Choice B rationale
An increase in breath sounds is a good indication that chest physiotherapy (CPT) has been effective for a client with COPD3. CPT is a group of therapies designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system. When these secretions are effectively mobilized and removed, breath sounds can become clearer and more easily heard.
Choice C rationale

The absence of fine crackles is not necessarily an indication that CPT has been effective for a client with COPD. Fine crackles are often heard in conditions where there is fluid in the airways or alveoli, such as pneumonia or heart failure. While their absence might indicate that there is no fluid in the airways or alveoli, it does not necessarily mean that secretions have been effectively mobilized.
Choice D rationale
An increase in respiratory rate is not necessarily an indication that CPT has been effective for a client with COPD. In fact, an increased respiratory rate could indicate respiratory distress, which could suggest that the therapy has not been effective or that the client’s condition has worsened.