The client has chronic obstructive pulmonary disease (COPD). Which does the nurse expect to find on physical assessment of the client? (Select all that apply.)
1. Wheezing
2. Hypercapnia
3. Upright posture
4. Small lung fields
5. Diminished chest excursion
6. Anteroposterior ratio of 1:1
1, 2, 3, 5
1. The nurse expects to find wheezing in a client with COPD because the parenchyma loses its elasticity and is unable to recoil with lung expansion. This results in air trapping, bronchospasm, wheezing, and increasing chest size.
2. Clients with COPD accumulate carbon dioxide as a result of air trapping and an impaired ability to exhale.
3. Many clients with COPD sit upright to assume a posture facilitating chest expan-sion.
5. The chest expansion of a client with COPD diminishes because lost elasticity al-lows the clients to inhale but impairs exhalation.
4. Over time, air trapping slowly increases the size of the lungs from accumulated air.
6. A healthy chest has a 1:1 anteroposterior ratio; however, the client with COPD has an oversized anterior chest because trapped air expands the size of the lungs, pushing them up and out.
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