NORCET 3 - 2022 (Shift-1)
Medical & Surgical Nursing
Medium
What is the priority management for a patient with emphysema?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- Emphysema, a type of COPD, causes alveolar damage, leading to impaired gas exchange and hypoxemia (low blood oxygen).
- According to the ABCs of emergency care (Airway, Breathing, Circulation), correcting life-threatening hypoxemia is the top priority.
- Administering supplemental oxygen directly addresses the impaired breathing and oxygenation, making it the primary intervention.
- While hydration and other measures are supportive, they do not take precedence over ensuring adequate oxygen supply to vital organs.
Why Other Options Were Wrong
- Option A: Sodium bicarbonate is used to correct metabolic acidosis, not respiratory acidosis which is common in emphysema. It can also increase the body's carbon dioxide load, worsening the patient's condition.
- Option B: Administering carbon dioxide is strictly contraindicated. Patients with emphysema already retain CO₂ (hypercapnia), and giving more would lead to severe respiratory acidosis, coma, and death.
- Option D: Maintaining hydration is important for thinning respiratory secretions and facilitating airway clearance, but it is a secondary intervention. It does not address the immediate life-threat of hypoxemia.
Related Visual
- Visual 1: Diagram: A comparison of a healthy alveolus versus a damaged alveolus in emphysema, showing the reduced surface area for gas exchange.
- Visual 2: Chart: A visual guide to oxygen delivery devices (nasal cannula, Venturi mask) with their corresponding flow rates and FiO₂ concentrations.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Priority nursing management for emphysema (COPD) to guide bedside assessment, documentation, and the next nursing action.
- The nurse's primary role in an emphysema exacerbation is to administer oxygen safely and monitor the patient's response closely.
- It is critical to titrate oxygen to the lowest effective dose to achieve a target SpO₂ of 88-92%, preventing both hypoxemia and CO₂ narcosis.
- Nurses must be vigilant for signs of CO₂ retention, such as increasing drowsiness, headache, confusion, or a falling respiratory rate, and report them immediately.
How to Approach the Question
- First, identify the core of the question: it asks for the 'priority' management for emphysema, a severe respiratory condition.
- Apply the ABC (Airway, Breathing, Circulation) framework. Emphysema directly impairs 'Breathing' and gas exchange.
- Evaluate the options based on the ABCs. 'Administer O₂' is the only option that directly addresses the life-threatening problem of impaired breathing and hypoxemia.
- Consider the other options. Sodium bicarbonate and administering CO₂ are physiologically incorrect and harmful. Hydration is a supportive measure, not an immediate life-saving priority.
- Therefore, correcting the lack of oxygen is the most critical first step.
Concept Tested & Keywords
- Concept Tested: Priority nursing management for emphysema (COPD)
- Stem keywords: priority management, emphysema
- Lead-in keywords: priority
- Negative lead-in flag: false
Question ID
Q6Qo9hPGBBNk_SWdRm_Gi3
Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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