NR 302 Respiratory Case Study

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Pt Summary
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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
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What are possible causes of the SOB?
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Asthma, pneumonia, COPD exacerbation, heart failure, pleural effusion
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What type of assessment is most appropriate?
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A focused assessment because this is nonemergent. Check the patients use of accessory muscles, respiratory rate, pulse ox, auscultate the lungs, check capillary refill
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What questions would you ask?
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-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?
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What should be included in the physical assessment?
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-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
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What diagnostic studies might be ordered?
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-Chest x-ray -ABG -EKG -CBC -BMP -Sputum culture
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To promote the release of surfactant, the RN encourages the patient to
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take deep breaths
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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
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decrease in intrathoracic pressure relative to pressure at the airway
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The nurse can best determine adequate arterial oxygenation of the blood by assessing
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arterial oxygen tension
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When teaching a pt about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the RN discuss?
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alveolar macrophages
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A student nurse asks the RN what can be measured by ABGs. The RN tells the student that the ABG can measure
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acid base balance, oxygenation status, acidity of blood, and bicarbonate in arterial blood
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To detect early signs or symptoms of inadequate oxygenation, the RN would examine the pt for
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apprehension and restlessness
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During the respiratory assessment of the older adult, the RN would expect to find
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increased residual volume and increased anteroposterior chest diameter
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When assessing activity-exercise patterns related to respiratory health, the RN inquires about
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dyspnea during rest or exercise
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When auscultating the chest of an older patient in respiratory distress, it is best to
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begin listening at the lung bases
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Which assessment finding of the respiratory system does the nurse interpret as abnormal?
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bronchial breath sounds in the lower lung fields
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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?
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Thoracentesis

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