Question

Which nursing intervention has the highest priority for a client having difficulty breathing

a) provide oxygen via nasal canula

b) notify the physician and obtain an order for à bronchodilator

c) check to see that the respiratory airway is patent

d) place the patient in a sitting position by elevating the HOB

Answer 1

The nursing intervention which has the highest priority for a client having difficult breathing is (C) Check to see that respiratory airway is patent because if there is any obstruction in the airway usually by secretions like mucous or other foreign substance,it can be cleared subsequently. This can be tested by asking the patient to speak, if the voice sounds normal then the respiratory airway is patent.

If it is clear,then we can make the patient sit by elevating the head side of the bed, followed by giving him/her oxygen through nasal cannula after checking oxygen saturation levels as in COPD cases, the maximum is 92%.

These are the sequence of activities done before notifying the physician.