The nurse is reviewing newly written prescriptions for a client diagnosed with acute bronchitis. The client has a productive cough with green sputum and shortness of breath. The nurse would question the primary care provider regarding which medication order?

Choice A reason: Elevating the client’s head of the bed to 45 degrees is important for promoting optimal lung expansion and reducing the risk of aspiration. However, it is not the first priority when preparing for tracheostomy care. Ensuring adequate oxygenation is more critical in the immediate preparation phase.

Choice B reason: Hyper-oxygenating the client using an Ambu bag is the first priority. This step is crucial to ensure that the client has sufficient oxygen reserves before the tracheostomy care procedure begins. Hyper-oxygenation helps prevent hypoxia during suctioning, which can be particularly important for clients with COPD who may already have compromised respiratory function.

Choice C reason: Opening the suction and tracheostomy kits is necessary for the procedure, but it should be done after ensuring the client is adequately oxygenated. Preparing the equipment is important, but patient safety and oxygenation take precedence.

Choice D reason: Suctioning the client using aseptic technique is a critical part of tracheostomy care to maintain a patent airway and prevent infection. However, this should be done after the client has been hyper-oxygenated to ensure they are stable and to minimize the risk of hypoxia during the procedure.

Choice A reason: Albuterol is a bronchodilator that helps to open up the airways, making it easier to breathe. It is commonly used in the treatment of acute bronchitis, especially if the patient is experiencing wheezing or shortness of breath. Albuterol works by relaxing the muscles around the airways, which helps to relieve symptoms of bronchospasm.

Choice B reason: Guaifenesin is an expectorant that helps to thin and loosen mucus in the airways, making it easier to cough up and clear out. This can be particularly helpful for a patient with a productive cough and green sputum, as it aids in clearing the respiratory passages. Guaifenesin is often used in the management of acute bronchitis to help alleviate symptoms.

Choice C reason: Methylprednisolone is a corticosteroid that helps to reduce inflammation in the airways. It can be beneficial in severe cases of acute bronchitis where there is significant inflammation and swelling of the bronchial tubes. Corticosteroids like methylprednisolone are used to decrease the inflammatory response and improve breathing.

Choice D reason: Dextromethorphan is a cough suppressant that works by affecting the signals in the brain that trigger the cough reflex. However, in the case of acute bronchitis with a productive cough, suppressing the cough can be counterproductive. The goal is to clear the mucus from the airways, and suppressing the cough can lead to mucus retention and potentially worsen the condition. Therefore, the use of a cough suppressant like dextromethorphan is not recommended in this scenario.