Which respiratory system assessment finding of an older client does the nurse determine is most concerning?
1. Coughing during the night while sleeping
2. Purposefully sitting up straighter to get a deep breath
3. Shortness of breath when crossing a large parking lot
4. Three episodes of diagnosed bronchitis in twelve months
1. Coughing during the night while sleeping
Explanation: 1. Coughing during sleep can be a sign of asthma, heart failure, or other condition, but it is not normal and must be investigated.
2. Decreased muscle tone, increased abdominal girth, thoracic rigidity, and other issues can lead to incomplete chest expansion. The client who is aware of this may purposefully sit up straighter to take a deeper breath.
3. There is an increase in stiffness of the chest wall, decreased vital capacity, and increased residual volume occur with aging. Walking a significant distance can result in shortness of breath. If the client becomes short of breath when walking in the house, that is cause for concern.
4. Immune changes can cause increased frequency of respiratory infections. If infections occur more closely together or the client just never seems to get well, this is cause for increased concern.
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