The nurse reviews discharge instructions with a client who has advanced chronic obstructive pulmonary disease. Which client statement indicates appropriate understanding? Select all that apply.

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Clients with chronic obstructive pulmonary disease (COPD) suffer from progressive inflammatory tissue damage, which eventually leads to lung scarring and airway remodeling. Through these mechanisms, COPD leads to chronic air trapping and reduced gas exchange by decreasing ventilation. Clients with COPD are at increased risk for respiratory infections, which can trigger an acute exacerbation of COPD. Therefore, it is vital that clients receive both routine influenza and pneumococcal vaccinations (Option D). It is also important that clients seek medical help for increased sputum (Option B), worsening shortness of breath, or lack of relief from prescribed emergency medications (eg, albuterol, ipratropium) (Option E). (Option A) COPD may lead to polycythemia (increased red blood cells), in which the body attempts to compensate for chronic hypoxia by increased proliferation of erythrocytes. This occurs when erythropoietin is released from the kidneys in response to hypoxemia and leads to erythropoiesis. This ultimately has the opposite effect of anemia, making supplementation with iron not necessary and possibly even harmful. (Option C) Clients with COPD have increased work of breathing and are often winded by simple activities (eg, eating). Clients should eat frequent, small, high-calorie meals to conserve energy and meet nutritional requirements. Educational objective: Clients with chronic obstructive pulmonary disease should be instructed to consume a high-calorie diet, seek medical attention for signs of infection (eg, increased sputum, worsening dyspnea, fever), and obtain appropriate vaccinations (eg, influenza, pneumococcal) to prevent exacerbations.

The Nurse Reviews Discharge Instructions with a Client Who Has