Asthma and COPD Q 12

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A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client?

  

     A. Increased oxygen saturation with exercise.

     B. Hypocapnia

     C. A hyperinflated chest on x-ray film.

     D. A widened diaphragm noted on chest x-ray film.

    

    

Correct Answer: C. A hyperinflated chest on x-ray film.

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Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm as the disease is advanced. The inflammatory response and obstruction of the airways cause a decrease in the forced expiratory volume (FEV1) and tissue destruction leads to airflow limitation and impaired gas exchange. Hyperinflation of the lungs is often seen on imaging studies and occurs due to air trapping from airway collapse during exhalation.

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Option A: Patients may have acute respiratory failure and physical findings of hypoxemia and hypercapnia. Arterial blood gas analysis, chest imaging, and pulse oximetry are indicated. A 6-minute walk test is commonly performed to assess the submaximal functional capacity of a patient. This test is performed indoors on a flat and straight surface. The length of the hallway is usually 100 feet and the test measures the distance the patient walks over a period of 6 minutes.

Option B: The inability to fully exhale also causes elevations in carbon dioxide (CO2) levels. As the disease progresses, impairment of gas exchange is often seen. The reduction in ventilation or increase in physiologic dead space leads to CO2 retention. Pulmonary hypertension may occur due to diffuse vasoconstriction from hypoxemia.

Option D: Radiographic imaging includes a chest x-ray and computed tomography (CT). Chest x-rays may show hyperinflation, flattening of the diaphragm, and increased anterior-posterior diameter. In cases of chronic bronchitis, bronchial wall thickening may be present.

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