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HPI: Ms. Jones is a pleasant 28-year-old
African American woman who presented to the
clinic with complaints of shortness of breath
and wheezing following a near asthma attack
that she had two days ago. She reports that
she was at her cousin’s house and was
exposed to cats which triggered her asthma
symptoms. At the time of the incident she
notes that her wheezes were a 6/10 severity
and her shortness of breath was a 7-8/10
severity and lasted five minutes. She did not
Ms. Jones is a 28 year old well developed experience any chest pain or allergic
African American Female who presents to the symptoms. At that time she used her albuterol
office today complaining of increased inhaler and her symptoms decreased although
shortness of breath as well as increase use they did not completely resolve. Since that
and need of her inhaler that began two days incident she notes that she has had 10
ago. Ms. Jones has allergies to cats which episodes of wheezing and has shortness of
exacerbate her asthma and has had recent breath approximately every four hours. Her last
exposure to 3 cats at her cousins, she also episode of shortness of breath was this
admits to sensitivty to seasonal allergies as morning before coming to clinic. She notes that
well as dust. She admits to increased cough her current symptoms seem to be worsened by
with wheeze but denies nasal drainage or a lying flat and movement and are accompanied
productive cough. She does not take any by a non-productive cough. She awakens with
medications for her allergies other than her night-time shortness of breath twice per night.
Albuterol inhaler 90 mcg 2-3 puffs q4 hours prn She complains that her current symptoms are
wheeze/sob, and over the counter beginning to interfere with her daily activities
acetaminophen and advil prn for headache and and she is concerned that her albuterol inhaler
cramping. She does report having increased seems to be less effective than previous.
shortnes of breath with increased activty as Currently she states that her breathing is
well as when she is lying flat. Ms. Jones sleeps normal. Diagnosed with asthma at age 2.5
with one pillow and has no difficulty sleeping. years. She has no recent use of spirometry,
Ms. Jones also presents with an elevated does not use a peak flow, does not record
blood glucose and admits to non compliance attacks, and does not have a home nebulizer
with medicaiton and regular glucose or vaporizer. She has been hospitalized five
monitoring. times for asthma, last at age 16. She has never
been intubated for her asthma. She does not
have a current pulmonologist or allergist.
Social History: She is not aware of any
environmental exposures or irritants at her job
or home. She changes her sheets weekly and
denies dust/mildew at her home. She uses a
hypoallergenic pillow cover and her mattress is
one year old. She denies current use of
tobacco, alcohol, and illicit drugs. She did
smoke marijuana for 5 or 6 years, her last use
was at age 21 years. She does not exercise.
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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Review of Systems: General: Denies changes
in weight, fatigue, weakness, fever, chills, and
night sweats. • Nose/Sinuses: Denies
rhinorrhea with this episode. Denies stuffiness,
sneezing, itching, previous allergy, epistaxis, or
sinus pressure. • Gastrointestinal: No changes
in appetite, no nausea, no vomiting, no
symptoms of GERD or abdominal pain •
Respiratory: Complains of shortness of breath
and cough as above. Denies sputum,
hemoptysis, pneumonia, bronchitis,
emphysema, tuberculosis. She has a history of
asthma, last hospitalization was age 16, last
chest XR was age 16.
Objective General: Ms. Jones is a pleasant, obese 28-
year-old African American woman in no acute
Ms. Jones does not appear to be in any distress. She is alert and oriented and sitting
distress. Her breathing is normal she is not upright on exam table. She maintains eye
gasping or having any air hunger. Her lips are contact throughout interview and examination.
pink. Ms. Jones answers questions without • Respiratory: Chest expansion is symmetrical
difficulty and speeks normally. Her bilateral with respirations. Normal fremitus, symmetric
posterior upper and lower lobes have noted bilaterally. Chest resonant to percussion; no
wheeze. Her pulse ox is 97% on room air. Her dullness. Bilateral expiratory wheezes in
spirometer reading is FVC 3.9/L and FEV1 posterior lower lobes. Bilateral muffled words
3.15/L. Her inhaler is noted to be up to date with notable expiratory wheezes in posterior
and correct dose. There is no abnormality lower lobes. No crackles. In office spirometry:
when her chest was inspected,palpated and FVC 3.91 L, FEV1/FVC ratio 80.56%. SpO2:
percussed. 97%.
Assessment
Ms. Jones has increased need for her inhaler
in recent as well as when she is exposed to
allergens and with increased activity. She also
has diabetes for which she is noncompliant Mild-persistent asthma with exacerbation
with medication. Ms. Jones needs further
education regarding the necessity for blood
glucose control. She also should try to avoid
exposure to allergens that exacerbate her
asthma.
Plan Diagnostics • Obtain office oxygen saturation
Medication • NMT in office x 1 • Initiate step-up
Ms. Jones should be given steroids as well as medication therapy with inhaled corticosteroid •
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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a nebulizer treatement in office and set her up Continue albuterol inhaler Education •
so she can have a unit at home. I would also Encourage Ms. Jones to continue to monitor
recommend her to see a pulmonologist for a symptoms and log her episodes of asthma
pulmonary fuction test. Ms. Jones also needs symptoms and wheezing with associated
to better control her blood glucose and educate factors and bring log to next visit • Encourage
her on proper glucose control and why it is to wash bedding and consider dust mite covers
important especially since we are ordering her to decrease allergic nighttime symptoms •
steroids which can cause hyperglycemia and Educate to increase intake of water and other
diabetic patients. I would also recommend her fluids • Create Asthma Action Plan
to see an allergist to deteremine if there is any Referral/Consultation • Refer to allergy
other cause or allergen that may contribute to specialist for evaluation and testing Follow-up
her acute respiratory issues. She should restart Planning • Order PFTs to be completed after
her metformin and regularly check her blood exacerbation to have baseline available for
glucose levels. I would also recommend future comparison • Instruct Ms. Jones on
scheduling a phone follow up in a few days as when to seek emergent care including
well as an office appointment in a few weeks. episodes of chest pain or shortness of breath
unrelieved by rest, worsening asthma
symptoms or wheezing, or the sense that
rescue inhaler is not helping • Revisit clinic in
2-4 weeks for follow up and evaluation
Student Pre-Survey Activity Time: 1 min
Thank you for your feedback!
Lifespan Activity Time: 21 min
Tina’s second cousin was diagnosed with asthma at age 5. What would be
included in your treatment plan? What factors might concern you related to
compliance?
Student Response: Asthma tends to run in families, I would instruct Tina to inform her cousin to see
a medical professional if she has trouble breathing and should see a practitioner for further
evaluation. Asthma is related to lower socioeconomial status as well as exposure to specific irritants
as young children or infants. Factors that concern me related to compliance are educational as well
as transportation to appointments and insurance.
Model Note: Younger patients with asthma are treated with the same medication as adults. Some
medication dosages are based on weight. She should use an inhaler with a spacer attached for
proper medication administration and her caregiver should always assist her. Studies have shown
that nebulizer treatments are a less efficient way to administer medication. The provider should
acknowledge that she may have an asthma attack while in school, and therefore needs a note to
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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allow her to use it as needed. The patient and her caregiver should be educated about the
importance of having her inhaler close-by and how to use it.
Consider that Tina’s uncle is now 68 years old and has smoked heavily every day
since he was fifteen. What would you expect to find in his respiratory
assessment? How would this affect your oxygenation goals for this patient?
Student Response: Tina's uncle would presumably suffer from COPD and would have O2 level at
baseline due to perfusion oxygenation ratio. His respiratory assessment without complication would
be diminished breath sounds in the bases with probable rhonchi or coarseness throughout. He
would also have the probable "smokers cough" and depending on the amount of cigarettes per day
he may have a barrel chest and be sob at rest and especially on exertion with minimal activity. The
oxygenation goals for a patient with COPD differ from a patient without chronic respiratory disease.
A patient does not require as much oxygen for adequate respiratory drive. A patient with COPD may
only require a oxygen saturation of 88-92% depending on ABG levels. Increasing the amount of
oxygen in COPD patients actually decreases their stimulus to breathe or slow respirations thus
increasing the CO2 levels in the body. COPD patients become accustomed to low levels of oxygen
and function better with a lower pulse oxygenation or hypoxic drive.
Model Note: He likely has decreased breath sounds on auscultation due to emphysematous
changes to his lungs from smoking. As alveoli get destroyed from chronic inflammation and irritation,
the surface area in the lungs is decreased. This leads to less area for gas exchange and subsequent
decreased oxygen saturation. As his body adjusts to chronic oxygen deprivation, attention must be
given to how much supplemental oxygen is given. The goal with someone with severe COPD is to
keep oxygen saturation 88% to 92%. If he is given too much oxygen his drive to breathe with be
decreased and puts him at risk for death.
Review Questions Activity Time: 14 min
If Tina had mentioned that she was just diagnosed with pneumonia, what would
you have expected to find during percussion?
Correct: Dull percussion sounds are expected over the areas of diffuse infiltrate (accumulation of
fluid and by products of inflammation) in a patient with pneumonia.
Hyperresonance
Tympany
Resonant
Dullness (Correct Response)
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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HPI: Ms. Jones is a pleasant 28-year-old
African American woman who presented to the
clinic with complaints of shortness of breath
and wheezing following a near asthma attack
that she had two days ago. She reports that
she was at her cousin’s house and was
exposed to cats which triggered her asthma
symptoms. At the time of the incident she
notes that her wheezes were a 6/10 severity
and her shortness of breath was a 7-8/10
severity and lasted five minutes. She did not
Ms. Jones is a 28 year old well developed experience any chest pain or allergic
African American Female who presents to the symptoms. At that time she used her albuterol
office today complaining of increased inhaler and her symptoms decreased although
shortness of breath as well as increase use they did not completely resolve. Since that
and need of her inhaler that began two days incident she notes that she has had 10
ago. Ms. Jones has allergies to cats which episodes of wheezing and has shortness of
exacerbate her asthma and has had recent breath approximately every four hours. Her last
exposure to 3 cats at her cousins, she also episode of shortness of breath was this
admits to sensitivty to seasonal allergies as morning before coming to clinic. She notes that
well as dust. She admits to increased cough her current symptoms seem to be worsened by
with wheeze but denies nasal drainage or a lying flat and movement and are accompanied
productive cough. She does not take any by a non-productive cough. She awakens with
medications for her allergies other than her night-time shortness of breath twice per night.
Albuterol inhaler 90 mcg 2-3 puffs q4 hours prn She complains that her current symptoms are
wheeze/sob, and over the counter beginning to interfere with her daily activities
acetaminophen and advil prn for headache and and she is concerned that her albuterol inhaler
cramping. She does report having increased seems to be less effective than previous.
shortnes of breath with increased activty as Currently she states that her breathing is
well as when she is lying flat. Ms. Jones sleeps normal. Diagnosed with asthma at age 2.5
with one pillow and has no difficulty sleeping. years. She has no recent use of spirometry,
Ms. Jones also presents with an elevated does not use a peak flow, does not record
blood glucose and admits to non compliance attacks, and does not have a home nebulizer
with medicaiton and regular glucose or vaporizer. She has been hospitalized five
monitoring. times for asthma, last at age 16. She has never
been intubated for her asthma. She does not
have a current pulmonologist or allergist.
Social History: She is not aware of any
environmental exposures or irritants at her job
or home. She changes her sheets weekly and
denies dust/mildew at her home. She uses a
hypoallergenic pillow cover and her mattress is
one year old. She denies current use of
tobacco, alcohol, and illicit drugs. She did
smoke marijuana for 5 or 6 years, her last use
was at age 21 years. She does not exercise.
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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Review of Systems: General: Denies changes
in weight, fatigue, weakness, fever, chills, and
night sweats. • Nose/Sinuses: Denies
rhinorrhea with this episode. Denies stuffiness,
sneezing, itching, previous allergy, epistaxis, or
sinus pressure. • Gastrointestinal: No changes
in appetite, no nausea, no vomiting, no
symptoms of GERD or abdominal pain •
Respiratory: Complains of shortness of breath
and cough as above. Denies sputum,
hemoptysis, pneumonia, bronchitis,
emphysema, tuberculosis. She has a history of
asthma, last hospitalization was age 16, last
chest XR was age 16.
Objective General: Ms. Jones is a pleasant, obese 28-
year-old African American woman in no acute
Ms. Jones does not appear to be in any distress. She is alert and oriented and sitting
distress. Her breathing is normal she is not upright on exam table. She maintains eye
gasping or having any air hunger. Her lips are contact throughout interview and examination.
pink. Ms. Jones answers questions without • Respiratory: Chest expansion is symmetrical
difficulty and speeks normally. Her bilateral with respirations. Normal fremitus, symmetric
posterior upper and lower lobes have noted bilaterally. Chest resonant to percussion; no
wheeze. Her pulse ox is 97% on room air. Her dullness. Bilateral expiratory wheezes in
spirometer reading is FVC 3.9/L and FEV1 posterior lower lobes. Bilateral muffled words
3.15/L. Her inhaler is noted to be up to date with notable expiratory wheezes in posterior
and correct dose. There is no abnormality lower lobes. No crackles. In office spirometry:
when her chest was inspected,palpated and FVC 3.91 L, FEV1/FVC ratio 80.56%. SpO2:
percussed. 97%.
Assessment
Ms. Jones has increased need for her inhaler
in recent as well as when she is exposed to
allergens and with increased activity. She also
has diabetes for which she is noncompliant Mild-persistent asthma with exacerbation
with medication. Ms. Jones needs further
education regarding the necessity for blood
glucose control. She also should try to avoid
exposure to allergens that exacerbate her
asthma.
Plan Diagnostics • Obtain office oxygen saturation
Medication • NMT in office x 1 • Initiate step-up
Ms. Jones should be given steroids as well as medication therapy with inhaled corticosteroid •
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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a nebulizer treatement in office and set her up Continue albuterol inhaler Education •
so she can have a unit at home. I would also Encourage Ms. Jones to continue to monitor
recommend her to see a pulmonologist for a symptoms and log her episodes of asthma
pulmonary fuction test. Ms. Jones also needs symptoms and wheezing with associated
to better control her blood glucose and educate factors and bring log to next visit • Encourage
her on proper glucose control and why it is to wash bedding and consider dust mite covers
important especially since we are ordering her to decrease allergic nighttime symptoms •
steroids which can cause hyperglycemia and Educate to increase intake of water and other
diabetic patients. I would also recommend her fluids • Create Asthma Action Plan
to see an allergist to deteremine if there is any Referral/Consultation • Refer to allergy
other cause or allergen that may contribute to specialist for evaluation and testing Follow-up
her acute respiratory issues. She should restart Planning • Order PFTs to be completed after
her metformin and regularly check her blood exacerbation to have baseline available for
glucose levels. I would also recommend future comparison • Instruct Ms. Jones on
scheduling a phone follow up in a few days as when to seek emergent care including
well as an office appointment in a few weeks. episodes of chest pain or shortness of breath
unrelieved by rest, worsening asthma
symptoms or wheezing, or the sense that
rescue inhaler is not helping • Revisit clinic in
2-4 weeks for follow up and evaluation
Student Pre-Survey Activity Time: 1 min
Thank you for your feedback!
Lifespan Activity Time: 21 min
Tina’s second cousin was diagnosed with asthma at age 5. What would be
included in your treatment plan? What factors might concern you related to
compliance?
Student Response: Asthma tends to run in families, I would instruct Tina to inform her cousin to see
a medical professional if she has trouble breathing and should see a practitioner for further
evaluation. Asthma is related to lower socioeconomial status as well as exposure to specific irritants
as young children or infants. Factors that concern me related to compliance are educational as well
as transportation to appointments and insurance.
Model Note: Younger patients with asthma are treated with the same medication as adults. Some
medication dosages are based on weight. She should use an inhaler with a spacer attached for
proper medication administration and her caregiver should always assist her. Studies have shown
that nebulizer treatments are a less efficient way to administer medication. The provider should
acknowledge that she may have an asthma attack while in school, and therefore needs a note to
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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, https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow https://www.stuvia.com/user/passnursingnow
allow her to use it as needed. The patient and her caregiver should be educated about the
importance of having her inhaler close-by and how to use it.
Consider that Tina’s uncle is now 68 years old and has smoked heavily every day
since he was fifteen. What would you expect to find in his respiratory
assessment? How would this affect your oxygenation goals for this patient?
Student Response: Tina's uncle would presumably suffer from COPD and would have O2 level at
baseline due to perfusion oxygenation ratio. His respiratory assessment without complication would
be diminished breath sounds in the bases with probable rhonchi or coarseness throughout. He
would also have the probable "smokers cough" and depending on the amount of cigarettes per day
he may have a barrel chest and be sob at rest and especially on exertion with minimal activity. The
oxygenation goals for a patient with COPD differ from a patient without chronic respiratory disease.
A patient does not require as much oxygen for adequate respiratory drive. A patient with COPD may
only require a oxygen saturation of 88-92% depending on ABG levels. Increasing the amount of
oxygen in COPD patients actually decreases their stimulus to breathe or slow respirations thus
increasing the CO2 levels in the body. COPD patients become accustomed to low levels of oxygen
and function better with a lower pulse oxygenation or hypoxic drive.
Model Note: He likely has decreased breath sounds on auscultation due to emphysematous
changes to his lungs from smoking. As alveoli get destroyed from chronic inflammation and irritation,
the surface area in the lungs is decreased. This leads to less area for gas exchange and subsequent
decreased oxygen saturation. As his body adjusts to chronic oxygen deprivation, attention must be
given to how much supplemental oxygen is given. The goal with someone with severe COPD is to
keep oxygen saturation 88% to 92%. If he is given too much oxygen his drive to breathe with be
decreased and puts him at risk for death.
Review Questions Activity Time: 14 min
If Tina had mentioned that she was just diagnosed with pneumonia, what would
you have expected to find during percussion?
Correct: Dull percussion sounds are expected over the areas of diffuse infiltrate (accumulation of
fluid and by products of inflammation) in a patient with pneumonia.
Hyperresonance
Tympany
Resonant
Dullness (Correct Response)
._NR 509 Shadow Health Respiratory Assessment, NR 509 physical assessment guide, nursing respiratory exam practice, Shadow Health NR 509 study guide, respiratory assessment techniques, NR 509 clinical assessment prep, nursing skills practice 2025, Shadow Health exam review, respiratory nursing assessment, NR 509 practice questions_
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