NR 302 Respiratory Case Study

Pt Summary
70 yr African American male. Comes to EC with SOB. Using albuterol inhaler q4 but it is not helping. Has trouble sleeping or doing any activities because of SOB

What are possible causes of the SOB?
Asthma, pneumonia, COPD exacerbation, heart failure, pleural effusion

What type of assessment is most appropriate?
A focused assessment because this is nonemergent. Check the patients use of accessory muscles, respiratory rate, pulse ox, auscultate the lungs, check capillary refill

What questions would you ask?
-OLDCART & ICE
– Did/do you smoke?
– What medications are you taking?
– Do COPD meds help with breathing?
– Past medical history
-Have you had a flu/pneumonia vaccine
-Have you been in contact recently with someone who has a URI?
-Have you been tested for TB?
-Can you walk up a flight of stairs without getting SOB?
-Any pain, anxiety, or stress?
-Current/previous occupation
-Any activity intolerance?

What should be included in the physical assessment?
-Inspection, percussion, palpitation, auscultation
-Breath sounds
-Chest expansion
-Use of accessory muscles
-Skin color, finger nails
-Quality of breathing
-Mucous membranes
-Breathing positions (tripod)
-Vitals signs
-Peripheral edema

What diagnostic studies might be ordered?
-Chest x-ray
-ABG
-EKG
-CBC
-BMP
-Sputum culture

To promote the release of surfactant, the RN encourages the patient to
take deep breaths

A pt with a respiratory conditions asks “how does air get into my lungs?”. The RN bases her answer on her knowledge that air moves into the lungs because of
decrease in intrathoracic pressure relative to pressure at the airway

The nurse can best determine adequate arterial oxygenation of the blood by assessing
arterial oxygen tension

When teaching a pt about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the RN discuss?
alveolar macrophages

A student nurse asks the RN what can be measured by ABGs. The RN tells the student that the ABG can measure
acid base balance, oxygenation status, acidity of blood, and bicarbonate in arterial blood

To detect early signs or symptoms of inadequate oxygenation, the RN would examine the pt for
apprehension and restlessness

During the respiratory assessment of the older adult, the RN would expect to find
increased residual volume and increased anteroposterior chest diameter

When assessing activity-exercise patterns related to respiratory health, the RN inquires about
dyspnea during rest or exercise

When auscultating the chest of an older patient in respiratory distress, it is best to
begin listening at the lung bases

Which assessment finding of the respiratory system does the nurse interpret as abnormal?
bronchial breath sounds in the lower lung fields

The RN is preparing the patient for a diagnostic procedure to remove pleural fluids to analysis. The RN would prepare the patient for which test?
Thoracentesis

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