The nurse is performing a routine dressing change for a patient with a stage 3 pressure injury that is red with significant granulation.
The wound has a gauze dressing covering the area. Which action should the nurse implement?

The most likely diagnosis for this client isB. Pulmonary embolism and postpartum hemorrhage.

Here’s why:

1. Postpartum Hemorrhage:
   • The client has a large amount of lochia rubra, indicating significant blood loss.
   • Hemoglobin and hematocrit levels are low (7.5 g/dL and 22%, respectively), which is consistent with significant blood loss.
   • Symptoms like feeling lightheaded, pale appearance, and cool, clammy skin further support this diagnosis.
2. Pulmonary Embolism:
   • The client is experiencing shortness of breath, using accessory muscles to breathe, and has an oxygen saturation of 88% on room air.
   • Elevated D-dimer levels (1.5 µg/mL) suggest the presence of a clot.
   • Arterial Blood Gas (ABG) results show a low PaO2 (60 mmHg) and a slightly acidic pH (7.32), which can be seen in pulmonary embolism.
   • The client reports a feeling of tightness in her chest and has a rapid heart rate (120 beats per minute), which are also indicative of a pulmonary embolism.

Choice A rationale:

Tiotropium is a long-acting bronchodilator, not a rescue inhaler for sudden shortness of breath.

It takes several hours to reach its full effect and is not designed to provide immediate relief during acute symptoms.

Using tiotropium for sudden shortness of breath could delay the use of a more appropriate rescue medication, potentially worsening the situation.

Choice B rationale:

While tiotropium can help reduce mucus production and make secretions easier to clear, this is not its primary mechanism of action.

The client's statement focuses on a potential side effect rather than demonstrating a clear understanding of the medication's intended purpose.

Choice C rationale:

The frequency of inhaler use depends on the specific medications prescribed. Some inhalers are used daily, while others are used only as needed for symptoms.

It's essential to follow the healthcare provider's instructions for each inhaler to ensure proper use and avoid potential drug interactions.

Choice D rationale:

This statement correctly reflects the appropriate use of tiotropium.

It's typically taken once daily via a handihaler device to maintain open airways and prevent COPD symptoms. Regular daily use is crucial for optimal effectiveness.