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A 72-year old woman is admitted with shortness of breath and difficulty breathing. The client’s vital signs are as follows: Temp: 37 C (98.6 F), BP 162/94, pulse 92, and respiratory rate 26 and shallow. Oxygen saturation is 90% on room air. Client states she has been sleeping in a recliner chair for the past three nights because of difficulty breathing. She also states she has lower back pain with a pain level of “5” on a 0-10 pain scale.

Upon assessment, the client states, “I am having difficulty breathing. I can’t catch my breath when I walk a few feet.” Client is oriented to person, place and time. She has a productive cough. Crackles and wheezing heard upon auscultation, diminished breath sounds at bases; capillary refill is four seconds, and slight clubbing of fingers is noted. Ankles and feet are swollen, 2+ pitting edema noted. The client has no known drug allergies. Medical history reveals hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (emphysema). The client takes the following medications:

• Furosemide 20 mg po daily
• Metoprolol 50 mg po daily
• Amlodipine besylate 5 mg po daily
• Atorvastatin calcium 10 mg po daily
• Albuterol 2 inhalations every 4-6 hours prn

The client is placed on 2 liters of oxygen via nasal cannula. Arterial blood gases (ABGs) are drawn. The client is started on intravenous (IV) fluids and is given acetaminophen 650 mg by mouth for her pain level of “5”.

Questions:

1. How should the nurse position this client and why?
2. List four signs and symptoms of respiratory distress the nurse may observe in a client with COPD.
3. The client wants her nasal oxygen turned up because she is experiencing increased difficulty breathing. What should the nurse say to the client?
4. Why is it important to address the client’s pain level?
5. List three non-pharmacologic interventions that the nurse could implement to help decrease the client’s difficulty breathing.
6. What are the normal ranges for each of the ABG components in an adult: pH, partial pressure of carbon dioxide (PaCO2), bicarbonate (HCO3), partial pressure of oxygen (PaO2) and oxygen saturation (SaO2)?
7. What ABG results would the nurse expect in a client with COPD?
8. Analyze each set of ABG results:
   1. pH=7.32 PaCO2=58 mmHg HCO3=32 mEq/L PaO2=60 mmHg
   2. pH=7.22 PaCO2=35 mmHg HCO3=20 mEq/L PaO2=80 mmHg
   3. pH=7.52 pCO2=28 mmHg HCO3=24 mEq/L PaO2=70 mmHg
9. List two nursing diagnoses for this client?