A nurse is admitting a client with a possible diagnosis of chronic bronchitis. The nurse collects data from the client and notes which of the following signs supports this diagnosis? Select all that apply. A. Scant mucus B. Early onset cough C. Marked weight loss D. Purulent mucus production E. Mild episodes of dyspnea Correct Answer: B, D, & E. Key features of pulmonary emphysema include dyspnea that is often marked, late cough (after the onset of dyspnea), scant mucus production, and marked weight loss. By contrast, chronic bronchitis is characterized by an early onset of cough (before dyspnea), copious purulent mucus production, minimal weight loss, and milder severity of dyspnea. Option A: Most patients with emphysema present with very nonspecific symptoms of chronic shortness of breath and cough with or without sputum production. As the disease process advances, the shortness of breath and cough progressively get worse. Option B: The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. The characteristic cough of bronchitis is caused by the copious secretion of mucus in chronic bronchitis. Option C: As COPD advances, patients can lose significant body weight due to systemic inflammation and increased energy spent in the work of breathing. Also, there are frequent intermittent exacerbations as the obstruction of the airways increases. Option D: The airways become clogged by debris and this further increases the irritation. A productive cough with sputum is present in about 50% of patients. The sputum color may vary from clear, yellow, green, or at times blood-tinged. The color of the sputum may be dependent on the presence of secondary bacterial infection. Option E: During an acute exacerbation of chronic bronchitis, the bronchial mucous membrane becomes hyperemic and edematous with diminished bronchial mucociliary function. This, in turn, leads to airflow impediment because of luminal obstruction to small airways. NURSESLABS-SATA-2-002 A nurse, assigned to a client with emphysema, is providing a shift report. Which nursing interventions would be appropriate to include? Select all that apply. A. The nurse should reduce fluid intake to less than 850 ml per shift. B. The nurse should teach diaphragmatic, pursed-lip breathing. C. The nurse should administer low-flow oxygen. D. The nurse should keep the client in a supine position as much as possible. E. The nurse should encourage alternating activity with rest periods. F. The nurse should teach the use of postural drainage and chest physiotherapy. Correct Answer: B, C, E, & F. Emphysema isthe most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping). Option A: Fluid intake should be increased to 3,000 ml/day, if not contraindicated, to liquefy secretions and facilitate their removal. Provide warm or tepid liquids. Recommend the intake of fluids between, instead of during, meals. Using warm liquids may decrease bronchospasm. Fluids during meals can increase gastric distension and pressure on the diaphragm. Option B: Diaphragmatic, pursed-lip breathing strengthens respiratory muscles and enhances oxygenation in clients with emphysema. This provides the client with some means to cope with or control dyspnea and reduce air-trapping. Option C: Low-flow oxygen should be administered because a client with emphysema has chronic hypercapnia and a hypoxic respiratory drive. Administering humidified oxygen prevents drying out the airways, decreases convective moisture losses, and improves compliance. Option D: The client should be placed in high Fowler’s position to improve ventilation. Elevation of the head of the bed facilitates respiratory function by use of gravity; however, the client in severe distress will seek the position that most eases breathing. Option E: Alternating activity with rest allows to perform activities without excessive distress. During severe, acute or refractory respiratory distress, the patient may be totally unable to perform basic selfcare activities because of hypoxemia and dyspnea. Rest interspersed with care activities remains an important part of the treatment regimen. Option F: If the client has difficulty mobilizing copious secretions, the nurse should teach the client and family members how to perform postural drainage and chest physiotherapy. These techniques will prevent possible aspirations and prevent any untoward complications