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Difficulty: MediumEstablishing Priorities

Shift report has just concluded on a progressive respiratory care unit. Which individual should the nurse evaluate immediately?

  1. The individual admitted for status asthmaticus who is now exhibiting a silent chest on auscultation and paradoxical breathingAnswer
  2. B
    The individual diagnosed with advanced emphysema whose baseline pulse oximetry reading is 89% while receiving continuous low-flow oxygen
  3. C
    The individual who underwent a bedside thoracentesis two hours prior and describes localized pleural discomfort when taking a deep breath
  4. D
    The individual with a 12-hour-old tracheostomy who is expectorating scant amounts of blood-tinged secretions during routine suctioning

Answer

The individual admitted for status asthmaticus who is now exhibiting a silent chest on auscultation and paradoxical breathing must be evaluated immediately.
The correct answer identifies a medical emergency. In a client with status asthmaticus, a 'silent chest' (the sudden cessation of wheezing) combined with paradoxical breathing means the airways are so severely constricted that air is no longer moving through the lungs. This indicates impending respiratory failure and requires immediate, life-saving interventions such as intubation and mechanical ventilation.

Step-by-Step Solution

1
Analyze each client's clinical presentation using the Airway-Breathing-Circulation (ABC) framework and the acute versus chronic principle.
Identify whether the symptoms represent an expected, stable condition or an unexpected, life-threatening deterioration.
Prioritization requires identifying the client with the most immediate threat to life.
2
Evaluate the asthmatic client with a 'silent chest'.
Determine that the sudden absence of wheezing accompanied by paradoxical breathing indicates complete airflow obstruction and impending respiratory arrest.
This is a severe, acute airway emergency.
3
Compare the acute airway emergency to the other presentations.
Conclude that the other three clients exhibit expected, stable, or chronic findings for their respective conditions.
The client with impending respiratory failure is the highest priority and requires immediate medical intervention.

Key Concept

Establishing Priorities: Acute vs. Chronic and Unexpected vs. Expected Findings
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Topics

Establishing Priorities

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