The nurse is changing a client’s abdominal dressing and notes a separation of the incision line. The underlying tissue is protruding from the wound. The nurse should plan to do which of the following in the initial care of this wound?

Choice A reason: A decreased anteroposterior diameter of the chest is not typically associated with COPD and emphysema. In fact, patients with COPD often have an increased anteroposterior diameter, known as a “barrel chest,” due to hyperinflation of the lungs. This change in chest shape is a compensatory mechanism to accommodate the increased lung volume and is a common physical finding in advanced COPD.

Choice B reason: Oxygen saturation level below 95% is a common finding in patients with COPD and emphysema. These conditions impair the lungs’ ability to oxygenate the blood effectively, leading to lower oxygen levels. Chronic hypoxemia is a hallmark of COPD, and monitoring oxygen saturation is crucial in managing these patients. Normal oxygen saturation levels typically range from 95% to 100%, so levels below 95% indicate a need for supplemental oxygen or other interventions.

Choice C reason: Petechiae on the chest are not a typical finding in COPD or emphysema. Petechiae are small, red or purple spots caused by bleeding into the skin and are usually associated with conditions affecting blood clotting or platelet function. They are not related to the respiratory pathology seen in COPD and emphysema.

Choice D reason: Respiratory alkalosis is not commonly associated with COPD and emphysema. These conditions are more likely to cause respiratory acidosis due to chronic retention of carbon dioxide (CO2). In COPD, the damaged alveoli and airways lead to impaired gas exchange, resulting in elevated CO2 levels and a decrease in blood pH. Respiratory alkalosis, characterized by low CO2 levels and increased pH, is more often seen in conditions causing hyperventilation, such as anxiety or acute asthma attacks.

Choice A reason: Tachycardia, or an increased heart rate, can occur as a side effect of some anesthetic agents, particularly those that stimulate the sympathetic nervous system. However, it is not the most common or severe adverse effect associated with anesthesia.

Choice B reason: Decreased respirations, or respiratory depression, is a known side effect of many anesthetic agents, especially opioids and sedatives used during anesthesia. While significant, it is typically managed with careful monitoring and supportive measures.

Choice C reason: Malignant hyperthermia is a rare but life-threatening reaction to certain anesthetic agents, such as succinylcholine and volatile anesthetics. It is characterized by a rapid increase in body temperature and severe muscle contractions. Immediate treatment with dantrolene and supportive measures are crucial to manage this condition.

Choice D reason: Hypokalemia, or low potassium levels, is not commonly associated with anesthetic agents. It is more often related to other medical conditions or treatments, such as diuretic use or gastrointestinal losses.