here is a question for you

[bennettsmith]

a patient dx with emphysema is currently going into respiratory distress. as a nurse you would?

A.call the dr.

b.give 2L of O2 via nasal cannula for 5 hrs

c.provide Positive Pressure Ventilation

d. put the patient in a supine position

this was an example question that was given during class.

[Daytonite, BSN, RN]

If the patient is going into respiratory distress, they need treatment. Call the doctor--immediately.

[NurseMercy]

I concur with itsmejuli!

[dannibee]

I'm gonna go with calling the doc because the other answers are stinky, lol.

[dozndawg]

I vote for dannibee's answer call doc because all other answers are stinky!...however minus the 5 hours 2L of O2 is good then call doc by priority. However if we use what is given the least stinky answer is call the doc...

[morte, LPN, LVN]

have to agree, all the answers are "stinky", lol

[ChicagoRN2010]

I would give the O2 first then call the doctor. If they are in distress they need oxygen now and 2L will not increase the PaO2 levels enough to prevent their body from being stimulated to breathe. One you call the doc you can get the order.

[AOx1]

Positive pressure ventilation = use of vent and ET tube or use of bag/mask (such as an ambu bag) or neopuff in a newborn (but of course this is emphysema so not a newborn). Needs an order unless it is a code situation/resuscitation, at which point it is covered under BLS or ACLS. PPV would be more useful if the patient is breathing agonally, or not at all.

O2 may or may not require an order, depending on the flow rate, whether standard orders are in place, and your facility protocol (ours requires an order for all oxygen delivery unless during a resuscitation).

Supine will make it (dyspnea) worse.

One really important fact about emphysema is that some also have severe pulmonary obstruction as well. Some patients are what we call "gas trappers" but others aren't. As obstruction and alveolar damage carries on over time, gas exchange can get really impaired. This often leads to some of that gas remaining in the lungs. This is certainly not true of all COPDers, but in those that tend to retain a lot of gas, oxygen, especially if given high flow, will cause them not to breathe. You probably remember that hypoxia is the stimulus for the respiratory drive in this type of patient. But I don't want to overgeneralize, as this is certainly not true of ALL COPDers :)

The only decent option left is to call for an order.

[~Mi Vida Loca~RN, ASN, RN]

I would really like the poster to put the answer up LOL

[bennettsmith]

Yeah, the kicker is that I have no Idea what the best response is. Our teacher is good at making us panic. We told her we would give O2 at 2L/h and she looked down and gave no response -which means this question is going to be on the test. PPV seems a little drastic unless we have more info on the pt, call the Dr. is always wrong on the review test, and everyone knows not to put a pt in supine position while they are in resp distress. I never got the reasoning for the time frame on the O2 administration. It seems to make that answer wrong. so, the next best choice would be to call the Dr. and let him/her know what is going on. The bottom line is that I know it is not put the patient in supine -sorry.

[~Mi Vida Loca~RN, ASN, RN]

Let us know if you find out or this will forever bug me. Call the Dr is never right for us unless it's like a med error, like order says to give 100 mg of ambien, you know this is out of the normal range, what should you do. Times like that it is call Dr. and verify order.

But anytime it is one of the ABC their is an a immediate nursing action we are suppose to do before calling Dr on any of the tests I have taken thus far. I mean if it's an emergency you don't have time to call the doc. Bleck.

Anyway, let us know!