A patient who has a history of chronic obstructive pulmonary ...

[iveyjurea]

A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89 to 90).
 
  In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?
  a. Start giving the patient discharge teaching on the day of admission.
  b. Have the patient repeat the instructions immediately after teaching.
  c. Accomplish the patient teaching just before the scheduled discharge.
  d. Arrange for the patient's caregiver to be present during the teaching.

Question 2

The nurse observes a student who is listening to a patient's lungs who is having no problems with breathing. Which action by the student indicates a need to review respiratory assessment skills?
 
  a. The student starts at the apices of the lungs and moves to the bases.
  b. The student compares breath sounds from side to side avoiding bony areas.
  c. The student places the stethoscope over the posterior chest and listens during inspiration.
  d. The student instructs the patient to breathe slowly and a little more deeply than normal through the mouth.

[sabina576]

Answer to Question 1

ANS: D
Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Because the patient is likely to be distracted just before discharge, giving discharge instructions just before discharge is not ideal. The patient is likely to be anxious and even more hypoxemic than usual on the day of admission, so teaching about discharge should be postponed.

Answer to Question 2

ANS: C
Listening only during inspiration indicates the student needs a review of respiratory assessment skills. At each placement of the stethoscope, listen to at least one cycle of inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a little deeper than normal through the mouth. Auscultation should proceed from the lung apices to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress or will tire easily. If so, start at the bases (see Fig. 26-7). Place the stethoscope over lung tissue, not over bony prominences.