Respiratory Case Study Questions and Answers

Respiratory Case Study Questions and Answers Patient is admitted with a diagnosis of acute respiratory distress secondary to pneumonia. The patient is complaining of acute pain in the right lower lobe of the lung, which is where radiology says the pneumonia is located. As the nurse listens to that area, what should she expect to hear? Crackles, bronchial sounds in right lower lobe, decreased breath sounds The nurse also hears a rather loud rough sound when the patient breathes. What is the term used to define this sound? Pleural friction rub If the nurse also hears expiratory squeaks and high pitched noises, what would this be called and what would it indicate? Wheezes. Indicates asthma and bronchospasm. What are the first symptoms of hypoxemia in most patients? AGITATION, increased HR, SOB, restlessness, altered LOC, cyanosis, use of accessory muscles How would the nurse verify that the patient's symptoms indicate hypoxia? ABGs What are the other conditions besides stress and fatigue that could exacerbate the pleural friction rub? Upper respiratory infection, allergen exposure, decrease in anti-inflammatory meds, over reliance on bronchodilators, environmental pollutants, cold, dust, chemicals, smoke This patient is also a COPD patient. If using nasal cannula, what oxygen flow rate should you initially use with this patient and why? 2 liters per minute. Low flow What are the symptoms of CO2 narcosis? Decreased respiratory rate, hypercapnia, sleepiness, coma, death What type of oxygenation is used frequently with chronic respiratory patients that will deliver a precise % flow rate of oxygen? Venturi mask This patient continues with her pneumonia and now requires a central venous line to administer antibiotics. Following the insertion of the line, the patient begins to complain of pain on that side of the chest and SOB. What other signs and symptoms might the nurse expect to find when assessing this patient? Pleuritic chest pain with SOB, uneven chest wall movement, distant/absent breath sounds, hyper-resonant, tachycardia A chest tube is inserted in the chest to relieve the pneumothorax. The nurse knows that one of the purposes of placing a chest tube in this patient's chest is to restore _______ pressure to the intrapleural space. Negative What are the usual orders for setting up a chest tube? Suction no more than 20 cm H2O, underwater seal drainage connected to chest tube If the fluid in the water seal section of the chest tube is moving slightly up and down with each respiration, this is called tidaling. What does it mean if air is moving through that fluid? Due to pneumothorax Would the nurse expect to see that in this patient? Yes What are the nursing care requirements for a patient with a chest tube? Tubing coiled on bed. Drained into drainage container every 2 hours. Mark drainage every shift. Assess tidaling every 4 hours. Dressing change every shift.