In COPD patient there is compensatory polycythemia develop in patient. Most important priority in this patien… - PGIMER NO - 2020

PGIMER NO - 2020

Medical Surgical Nursing

Hard

Appeared in: PGIMER NO - 2020

Explanation

The fundamental problem in COPD is impaired respiratory function, which manifests as an ineffective breathing pattern and leads to chronic hypoxia.
According to the Airway, Breathing, Circulation (ABC) framework of prioritization, addressing breathing is a higher priority than addressing potential circulation issues.
Compensatory polycythemia is the body's response to the chronic low oxygen levels caused by the poor breathing pattern.
Therefore, managing the root cause—the ineffective breathing pattern—is the most critical nursing intervention to improve oxygenation and prevent the worsening of complications.

Option B: This addresses a potential 'Circulation' problem. While the risk of thrombosis is real due to polycythemia-induced blood viscosity, it is a secondary complication. The primary, life-sustaining priority is 'Breathing'.
Option C: Malnutrition is a significant long-term issue in COPD due to the high energy expenditure of breathing. However, it is not an acute, life-threatening priority compared to maintaining adequate ventilation and oxygenation.
Option D: This is incorrect because the patient has multiple, clearly defined health problems that require prioritized nursing interventions. Ineffective breathing is a major and immediate concern.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prioritization of Nursing Care in Chronic Obstructive Pulmonary Disease (COPD) to guide bedside assessment, documentation, and the next nursing action.
The primary nursing role is to manage the patient's breathing. This includes teaching energy-conserving breathing techniques like pursed-lip and diaphragmatic breathing, administering bronchodilators, and ensuring proper oxygen therapy.
Nurses must conduct a dual assessment: continuously monitor respiratory status (rate, effort, oxygen saturation) while also observing for signs of thrombosis (e.g., unilateral leg swelling, calf pain, sudden chest pain, or neurological changes).
Patient education is crucial. The nurse must teach the patient to recognize and report symptoms of both respiratory distress and potential clots.

How to Approach the Question

First, identify the question type. This is a priority-setting question involving a chronic disease (COPD) and its complication (compensatory polycythemia).
Analyze the relationship between the conditions. Recognize that COPD is the primary disease, and polycythemia is a compensatory response to the chronic hypoxia caused by COPD.
Apply a standard prioritization framework. The ABCs (Airway, Breathing, Circulation) are the most effective tool here.
Categorize the options based on the framework: 'Ineffective breathing pattern' relates to 'B' (Breathing). 'Thrombosis formation' relates to 'C' (Circulation). 'Nutritional pattern' is a lower-level need.
Select the option that addresses the highest priority in the ABC hierarchy. 'Breathing' always takes precedence over 'Circulation' when the breathing problem is the root cause.

Concept Tested & Keywords

Concept Tested: Prioritization of Nursing Care in Chronic Obstructive Pulmonary Disease (COPD)
Stem keywords: COPD, compensatory polycythemia, priority
Lead-in keywords: Most important
Clinical cues: The presence of a compensatory mechanism (polycythemia) points to a chronic, underlying problem (hypoxia from COPD).

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 40-42

E6 Nursing Fundamentals Taylor p. 723-725