Which of the following are cues for Acute Poststreptococcal Glomerulonephritis (APSGN)?

Choice A rationale

Bradycardia is not a typical assessment finding for a client with emphysema. Instead, these clients often experience tachycardia as a compensatory mechanism for chronic hypoxia. The heart rate increases to pump oxygenated blood more quickly to the tissues in response to decreased gas exchange efficiency in the alveoli. Therefore, a slow heart rate would be unexpected unless the client has a coexisting cardiac conduction disorder or is taking certain medications like beta-blockers.

Choice B rationale

Dyspnea, or shortness of breath, is a hallmark symptom of emphysema due to the destruction of alveolar walls and the loss of elastic recoil in the lungs. This leads to air trapping and hyperinflation, making it difficult for the client to exhale fully and inhale fresh air. As the disease progresses, dyspnea occurs even at rest because the physiological dead space increases, significantly reducing the surface area available for effective gas exchange and oxygenation.

Choice C rationale

Deep respirations are generally not found in emphysema; rather, clients tend to have rapid, shallow breathing patterns. Because of the hyperinflation of the lungs and the flattened diaphragm, the chest cannot expand and contract effectively for deep breaths. Clients often use accessory muscles to assist with breathing and may adopt a tripod position to help move air. The inefficiency of the respiratory pump in emphysema prevents the client from achieving significant tidal volumes.

Choice D rationale

A barrel chest is a classic clinical sign of emphysema resulting from chronic air trapping in the alveoli. Over time, the lungs stay hyperinflated, which increases the anteroposterior diameter of the thorax relative to the lateral diameter. This anatomical change reflects the permanent overdistension of the air spaces distal to the terminal bronchioles. It is a physical manifestation of the long-term struggle to exhale against obstructed airways and lost lung elasticity.

Choice E rationale

Clubbing of the fingers is a clinical sign characterized by the bulbous enlargement of the distal phalanges and a loss of the normal angle at the nail bed. It is often associated with chronic hypoxemia, which occurs in advanced emphysema. The exact mechanism involves increased capillary growth and fibroblast activity in the fingertips in response to low systemic oxygen levels. Its presence indicates long-standing respiratory insufficiency and significant impairment in pulmonary gas exchange.

Choice A rationale

Encouraging the client to take showers without specific precautions is dangerous for someone with a tracheostomy. Water can easily enter the stoma and be aspirated directly into the lungs, leading to drowning or severe aspiration pneumonia. If a client with a tracheostomy showers, they must use a specialized shield or cover to prevent water entry. This intervention is not a standard part of tracheostomy care and requires significant safety education to prevent life-threatening respiratory complications.

Choice B rationale

Suction should never be applied while inserting the catheter into the tracheostomy tube. Applying suction during insertion increases the risk of mucosal trauma and depletes the client's oxygen levels by removing air from the lungs before the procedure even begins. Suctioning should only be performed intermittently while withdrawing the catheter using a rotating motion. This technique minimizes damage to the tracheal wall and reduces the incidence of hypoxia, which can cause cardiac arrhythmias or distress.

Choice C rationale

Cleaning the inner cannula with soap and water is inappropriate for tracheostomy care. Standard protocol requires using sterile saline or a mixture of sterile saline and hydrogen peroxide, depending on the facility policy and the amount of crusting. Soap can leave residues that irritate the respiratory mucosa or cause chemical pneumonitis if inhaled. Using sterile solutions ensures that the airway remains free from pathogens and irritants, maintaining the integrity of the respiratory tract and the stoma site.

Choice D rationale

Using sterile technique is mandatory for tracheostomy care in the hospital setting to prevent healthcare-associated infections like tracheobronchitis or pneumonia. The tracheostomy bypasses the upper airway's natural filtering and humidification systems, leaving the lower respiratory tract vulnerable to environmental pathogens. Sterile gloves and equipment must be used when handling the inner cannula and performing suctioning to maintain a sterile field. This practice is vital for protecting the client's compromised airway from colonization by pathogenic bacteria.