You are caring for a patient admitted with chronic obstructive pulmonary disease. During your shift assessment, you find that your patient is experiencing a change in his respiratory and mental status.
You are aware that the most accurate measurement of the concentration of oxygen in the patient's blood is what?

Rationale for correct condition
The client’s episodic wheezing, chest tightness, and nocturnal dry cough are classic signs of asthma. Use of accessory muscles and bilateral inspiratory and expiratory wheezing support airway obstruction typical in asthma. The absence of fever, crackles, or peripheral edema excludes infection or heart failure. The client’s history of GERD can exacerbate asthma symptoms via microaspiration and airway irritation. The rapid onset and progression over two days also favor asthma exacerbation over chronic conditions.

Rationale for correct actions
Administering a bronchodilator targets bronchospasm by relaxing airway smooth muscle via beta-2 adrenergic receptor stimulation, improving airflow and oxygenation. Bronchodilators rapidly reduce airway resistance, alleviating wheezing and dyspnea. Measuring peak expiratory flow quantifies airway obstruction severity, guiding treatment efficacy. Peak flow monitoring detects airflow limitation changes, enabling timely adjustments in therapy to prevent deterioration.

Rationale for correct parameters
Oxygen saturation reflects gas exchange efficiency, with normal range 95-100%; levels below 92% indicate hypoxemia requiring intervention. Monitoring saturation ensures oxygen therapy adequacy and early detection of respiratory failure. Pulmonary function tests (PFTs) objectively measure airway obstruction severity and reversibility, essential in asthma diagnosis and monitoring. PFTs detect changes in forced expiratory volume (FEV1) and forced vital capacity (FVC), indicating bronchoconstriction or improvement.

Rationale for incorrect conditions
COPD typically affects older smokers with chronic productive cough and progressive symptoms, unlike this nonsmoker with acute onset. Pneumonia presents with fever, productive cough, and focal lung findings such as crackles, absent here. Pulmonary edema involves fluid overload signs like peripheral edema and crackles, not observed in this client.

Rationale for incorrect actions
Teaching pursed-lip breathing is more beneficial in COPD to reduce air trapping, less effective in acute asthma. Antibiotics are not indicated without infection evidence, as this is a noninfectious exacerbation. Diuretics treat fluid overload in pulmonary edema, irrelevant in asthma.

Rationale for incorrect parameters
Temperature monitoring is not primary here, as no infection signs are present. Urine output assesses renal function or fluid status, not respiratory status. Weight monitoring is relevant in chronic heart failure management but not acute asthma.

Take home points

• asthma presents with episodic wheezing and nocturnal cough, often triggered by irritants
• bronchodilators and peak flow monitoring are critical in managing asthma exacerbations
• oxygen saturation and pulmonary function tests guide treatment effectiveness
• differentiate asthma from COPD, pneumonia, and pulmonary edema by clinical presentation and history

Choice A rationale

Obtaining a prescription for an indwelling urinary catheter in a client with a T4 spinal cord injury who is at risk for urinary tract infections (UTIs) is generally discouraged for long-term management. Indwelling catheters significantly increase the risk of UTIs due to biofilm formation and the introduction of bacteria into the sterile urinary tract. Intermittent catheterization or other bladder management strategies are preferred to minimize this risk.

Choice B rationale

Encouraging fluid intake at and between meals is a critical intervention for preventing urinary tract infections in clients with spinal cord injuries. Increased fluid intake promotes frequent bladder emptying, which helps to flush bacteria from the urinary tract, reducing bacterial stasis and colonization. Adequate hydration maintains urine flow and dilutes bacterial concentrations, thereby lowering the risk of ascending infections.

Choice C rationale

Offering the client the bedpan every 2 hours might not be an effective strategy for preventing UTIs in a client with a T4 spinal cord injury. This injury level often results in a neurogenic bladder, where the client may not have normal sensation or control over bladder emptying. Regular, scheduled emptying, often through intermittent catheterization, is more effective in preventing overdistention and residual urine, which are risk factors for UTIs.

Choice D rationale

Cleansing the perineum from back to front is an incorrect technique and significantly increases the risk of urinary tract infections. This method can introduce fecal bacteria, such as Escherichia coli, from the anal area into the urethra, leading to ascending UTIs. The correct and scientifically sound method for perineal cleansing is from front to back, which prevents the migration of enteric microorganisms to the urinary meatus.