Question with exam question

[Dressagern]

So I am trying to find evidence for 2 exam questions I do not agree on from my last exam.

The first question was a priority question. If you walked into a COPD patients room and they were SOB what would you do first? I went with the ABC and prioritized raising the head of the bed to help facilitate in a better position for breathing and airway clearance

The correct answer was facilitate with Purse lip breathing..

I do not agree on this.... as I agree that PRL is important but not a priority action...if given those two choices! I am allowed to question the answer but need evidence based knowledge...so as anyone seen info on this...I have looked everywhere and haven't.

The second is with suctioning..the question asked what would you do before and after suctioning a client ( it did not state that client had any trach tube ). So I would answer you would assess the clients airway and breath sounds before suctioning and after as you do not want to do any unnecessary suctioning as that can cause bronchiospasms, and you would want to asses after to see if you suctioning was successful... So again I am looking for evidence based knowledge...as I was told you would hyper-oxygenate any person before suctioning...I am only finding you would hyper-oxygenate a person with a trach tube? Also again wouldn't your priority action be to asses lung sounds to see if suctioning is necessary?? thanks for any help!

[bas22]

The COPD question is a tricky one- but here’s my take. COPD, of course is a pulmonary disease characterized by airway collapse (among other things). In order to maintain adequate ventilation and gas exchange the small and large airways must expand- COPD inhibits this action and alveoli are unable to do so. Pursed lip breathing is thought to counter this action by creating back pressure through slow exhalation. This back pressure will allow the alveoli to remain inflated for a longer period of time, thus relieving dyspnea and improving ventilation and gas exchange. Both answers are correct (PLB and EHOB), but between the two PLB would be the most effective.

You are correct, your priority action in determining the need for suction would be to assess lungs sounds- BUT that is not what the question is asking. The question is asking what you would do before and after suctioning a patient; so it must be assumed you have already assessed and determined the need for suction. Now that the need for suction has been determined, your priority is to prevent associated complications- at this stage hyperoxygenation takes precedence.

Oh how I hate these types of questions- they are so incredibly tricky and drive me mad!! It doesn't help when every source says something just a little different- very frustrating!!

[NHGN]

Interesting to think about -- so does PLB enhance PEEP?

[MissyNik]

The hyperoxygenation is correct because during suctioning they need to have residual O2 available while the suctioning is occurring. I remember talking about this in school.

[nurseprnRN, BSN, RN]

Interesting to think about -- so does PLB enhance PEEP?

Precisely. By increasing the resistance to exhalation, the pressure inside the airways stays up, partially decreasing airway collapse (remember the effects of repeated bronchial infections on the integrity of airway walls).