The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?
1. Normal breath sounds
A. Normal breath sounds
B. Prolonged inspiration
C. Normal chest movement
D. Coarse crackles and rhonchi
Correct Answer: D. Coarse crackles and rhonchi
Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. Crackles are usually due to airway secretions within a large airway and disappear on coughing. These crackles are scanty, gravity-independent, usually audible at the mouth, and strongly associated with severe airway obstruction.
Option A: In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. A reduction in breath sound intensity (BSI) is often seen in patients with COPD. Pardee et al. developed a scoring system for BSI. According to this system, the clinician listens sequentially over six locations on the patient’s chest: bilaterally over the upper anterior portion of the chest, in the midaxillary, and at the posterior bases.
Option B: Expiration, not inspiration, becomes prolonged. Patients with COPD often present with diminished breath sounds, prolonged expiratory time, and expiratory wheezing that initially may occur only on forced expiration.
Option C: Chest movement is decreased as lungs become overdistended. Additional findings on physical examination include hyperinflation of the lungs with an increased anteroposterior chest diameter (“barrel chest”); use of accessory muscles of respiration; and distant heart sounds, sometimes best heard in the epigastrium.
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