A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate?
a. Have the patient rest in bed with the head elevated to 15 to 20 degrees.
b. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed.
c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward.
d. Place the patient in the Trendelenburg position with several pillows behind the head.
ANS: C
Patients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated in a semi-Fowler's position would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.
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