Medical Surgical COPD #7

Question

The nurse caring for a client with emphysema walks into the client’s hospital room and finds the client sitting on the side of the bed while leaning on the overbed table. Which statement is accurate?

Answers

  1. “Please call the staff before leaning over the table as it is unsafe.”
    • Rationale:

      This answer is not correct because although the table should be locked and stable, it does not apply to the question stem related to client position. The client may need staff to help positioning into the tripod position. Sitting on the side of the bed while leaning on the overhead table may facilitate breathing since and ease the work of breathing.

  2. “Next time sit upright instead of leaning over the table.”
    • Rationale:

      This answer is not correct because sitting upright without leaning forward and reclining in the chair will not ease breathing effort. Sitting on the side of the bed while leaning on the overhead table may facilitate breathing since and ease the work of breathing.

  3. “You need to recline in the bed-side chair to relax the diaphragm.”
    • Rationale:

      This answer is not correct because the reclining position will actually increase the client’s work of breathing. The client should be upright and leaning forward to ensure full chest expansion during breathing.

  4. “You are demonstrating the correct position to enhance breathing.”
    • Rationale:

      This answer is correct because sitting on the side of the bed while leaning on the overhead table may facilitate breathing since it will ease the work of breathing. Using pillows under folded arms may provide further comfort.

Overview

The focus of this question is assessing the positioning to facilitate breathing for a client with emphysema and determining whether further teaching by the nursing is necessary. Sitting upright while leaning forward is referred to as the tripod position and ensures full chest expansion which facilitates breathing in clients with emphysema.

Explanation

Learning Outcomes

Tripod breathing is a position used by COPD clients to maximize oxygenation and ventilation during distress. In the tripod position, the client sits or stands and leans forward while supporting the upper body with hands on the knees or other surfaces. This position optimizes the mechanics of breathing by taking advantage of the accessory muscles of the neck and upper chest in order to increase the amount of air within the lungs.

Test Taking Tip

Look at each answer choice closely and if there is one answer choice that is very different from the others, it might be the correct answer. Answer choice # 4 is the only option that portrays the client as performing the correct technique for breathing.

Video Rationale