Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-ray.
C. Increased oxygen saturation with exercise.
D. A widened diaphragm noted on the chest x-ray.
Correct Answer: B. A hyperinflated chest noted on the chest x-ray.
Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Hyperinflation of the lungs is often seen on imaging studies and occurs due to air trapping from airway collapse during exhalation.
Option A: 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. Patients may have acute respiratory failure and physical findings of hypoxemia and hypercapnia.
Option C: Acute exacerbations of COPD are common and usually occur due to a trigger (e.g., bacterial or viral pneumonia, environmental irritants). There is an increase in inflammation and air trapping often requiring corticosteroid and bronchodilator treatment. Acute exacerbations of COPD usually present with increased dyspnea, productive cough, and wheezing.
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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