An older adult with pneumonia and COPD is weak after prolonged endotracheal intubation with mechanical ventilation. Which single action should the nurse implement first?

• A. Reinforce deep breathing exercises.
• B. Administer a bronchodilator every hour.
• C. Encourage long periods of bed rest.
• D. Limit oral intake to clear liquids.

Answer: (A)

Restoring lung expansion and clearing secretions is the immediate priority after prolonged intubation in an older adult with pneumonia and COPD. Encouraging deep breathing exercises (and using incentive spirometry) helps reopen collapsed alveoli, improves ventilation, and promotes effective coughing to mobilize mucus. This reduces atelectasis and supports better oxygenation, aiding recovery and readiness for weaning. While a bronchodilator is helpful for COPD, giving it hourly doesn’t address the current need to re-expand the lungs and clear secretions as the first step. Prolonged bed rest worsens deconditioning, and limiting oral intake isn’t relevant to improving pulmonary function in this moment.