What is the primary purpose of Directly Observed Therapy (DOT) in the treatment of tuberculosis (TB)?

Choice A rationale

Respiratory alkalosis is not expected in a client with stable COPD and emphysema. Instead, these clients are prone to respiratory acidosis due to chronic carbon dioxide retention. As alveolar walls are destroyed, the lungs lose their elastic recoil, leading to air trapping and impaired gas exchange. This results in an elevated partial pressure of carbon dioxide and a lower pH. Normal arterial pH is 7.35 to 7.45, and a PCO2 above 45 mmHg indicates CO2 retention.

Choice B rationale

An increased anteroposterior diameter of the chest, often called a barrel chest, is a classic finding in emphysema. This structural change occurs because of chronic air trapping in the overdistended alveoli. The rib cage stays partially expanded all the time, making the chest appear rounded. The nurse expects to see this because the loss of lung elasticity prevents the lungs from fully deflating, forcing the thoracic cavity to adapt to the permanently increased volume of residual air.

Choice C rationale

An oxygen saturation level of 96 percent is generally considered normal for a healthy individual but is often higher than what is seen in a client with significant COPD. Clients with emphysema typically have lower baseline saturations, often ranging from 88 percent to 92 percent. Their drive to breathe may become dependent on low oxygen levels rather than high carbon dioxide levels. Expecting a high normal saturation would be unrealistic for someone presenting with shortness of breath and emphysema.

Choice D rationale

Petechiae, which are small red or purple spots caused by minor hemorrhage into the skin, are not a manifestation of COPD or emphysema. Petechiae are more commonly associated with platelet disorders, certain infections, or trauma. In the context of respiratory assessment, a nurse would be more likely to look for cyanosis, which is a bluish discoloration of the skin or mucous membranes indicating poor oxygenation, rather than petechiae, which have no direct scientific link to alveolar destruction.

Choice A rationale

Pursed-lip breathing is a technique that creates mild resistance to exhalation, which provides a form of positive end-expiratory pressure. This pressure keeps the smaller airways and alveoli open longer, allowing for more complete emptying of the lungs. In COPD, air trapping is a primary concern, and this maneuver helps decrease the work of breathing, improves oxygenation, and helps control the rate of respiration by prolonging the expiratory phase of the respiratory cycle.

Choice B rationale

Clients with COPD actually require a high-protein and high-calorie diet rather than a low-protein one. The work of breathing in these patients is significantly increased, leading to higher metabolic demands and energy expenditure. Malnutrition is common in advanced COPD and can lead to muscle wasting, including the respiratory muscles. Protein is essential for tissue repair and maintaining the strength of the diaphragm and intercostal muscles, which are vital for effective ventilation and overall physical function.

Choice C rationale

Restricting fluid intake is contraindicated for patients with COPD unless they have a co-existing condition like heart failure. Adequate hydration, typically 2 L to 3 L per day, is necessary to thin thick pulmonary secretions. When mucus is thin, it is much easier for the client to expectorate through coughing, which helps maintain airway patency and reduces the risk of secondary infections like pneumonia. Normal fluid intake recommendations usually range from 2000 mL to 3000 mL daily.

Choice D rationale

Scheduling exercise in the early morning is often inappropriate for COPD patients. Many of these individuals experience increased mucus accumulation overnight, leading to more significant dyspnea and productive coughing upon awakening. It is generally better to schedule activities for later in the day when the patient has had time to clear their airways and their energy levels are higher. Physical activity should be balanced with rest periods to prevent excessive fatigue and maintain functional independence.