Understanding Medical Surgical Nursing

Linda S. Williams, Paula D. Hopper

ISBN #9780803640689

5th Edition

441 Questions

3,135 Students Helped

Homework Questions

Summary

Learning Objectives

Key Concepts

Example Problems

Explanations

Common Mistakes

Summary

This chapter provides an in-depth review of the respiratory system’s anatomy and physiology, emphasizing the significance of thorough nursing assessments. It highlights the importance of diagnostic tests such as tidal volume and FEV1 in identifying respiratory issues and underlines targeted therapeutic interventions like smoking cessation and proper inhaler use. The chapter reinforces that accurate assessment and intervention are integral to effective respiratory care in the clinical setting.

Learning Objectives

Describe the normal anatomy and physiology of the respiratory system and differentiate between its upper and lower components.

Explain proper nursing assessment techniques, including patient history collection and interpretation of objective data such as tidal volume and FEV1.

Analyze and interpret common diagnostic tests used in respiratory assessment.

Identify and implement therapeutic interventions such as smoking cessation strategies and correct inhaler usage to manage respiratory disorders.

Key Concepts

CONCEPT

DEFINITION

Respiratory System Anatomy

The structure of the respiratory system, including both the upper (nasal cavity, pharynx, larynx) and lower (trachea, bronchi, lungs) components.

Physiology

The functions and processes of the respiratory system, including gas exchange and regulation of breathing.

Tidal Volume

The amount of air inhaled or exhaled during normal respiration; a key metric in assessing lung function.

FEV1 (Forced Expiratory Volume in 1 second)

The volume of air that can be forcibly exhaled in one second; an important diagnostic measure for respiratory health.

Therapeutic Interventions

Strategies such as smoking cessation and proper inhaler use aimed at managing and improving respiratory function.

Example Problems

Example 1

How should the nurse record smoking history on a patient who has smoked 2.5 packs of cigarettes per day for 10 years? 1. Patient has smoked cigarettes for 10 years. 2. Patient smokes 2.5 packs of cigarettes per day. 3. Patient has a 12.5 pack-year smoking history. 4. Patient has a 25 pack-year smoking history.

Example 2

Which term should be used to document the musical sounds generated by airflow through narrowed airways? 1. Crackles 2. Wheezes 3. Friction rub 4. Stridor

Example 3

Which laboratory result should alert the nurse to perform further assessment on a patient admitted with respiratory distress? 1. $\mathrm{PaCO}_{2}<50 \mathrm{~mm} \mathrm{Hg}$ 2. $\mathrm{HCO}_{3}^{-}<27 \mathrm{mEq} / \mathrm{L}$ 3. $\mathrm{Pao}_{2}<90 \mathrm{~mm} \mathrm{Hg}$ 4. $\mathrm{Spo}_{2}<90 \%$

Example 4

Place the following steps in the correct sequential order for obtaining a sputum specimen for culture. 1. Have the patient cough deeply from the lungs. 2. Teach the patient to inhale deeply several times. 3. Check the order for the test. 4. Send the specimen immediately to the laboratory. 5. Obtain the appropriate container.

Example 5

Which instruction is correct when teaching a patient how to use a traditional metered-dose inhaler? 1. "Inhale deeply, place canister in mouth, depress top of canister, exhale." 2. "Exhale, place canister in mouth, depress canister and inhale at the same time." 3. "Cough, place canister in mouth, inhale deeply, cough again." 4. "Exhale, depress canister, place in mouth, inhale deeply."

Step-by-Step Explanations

QUESTION

How do you interpret tidal volume measurements as part of a respiratory assessment?

STEP-BY-STEP ANSWER:

Step 1: Review the patient’s normal tidal volume range based on age, sex, and size.
Step 2: Compare the measured tidal volume value against the expected normal range.
Step 3: Consider any factors that could influence the measurement, such as patient effort or measurement technique.
Step 4: Note deviations from the normal range to indicate potential respiratory impairment.
Final Answer: Tidal volume measurements are interpreted by comparing them to standard value ranges, adjusting for patient-specific factors, and identifying any abnormalities that may suggest respiratory issues.

Interpreting Tidal Volume Measurements

QUESTION

What are the steps to assess and interpret FEV1 values?

STEP-BY-STEP ANSWER:

Step 1: Obtain a proper patient history and ensure the patient performs the test correctly.
Step 2: Conduct the forced expiratory maneuver using appropriate spirometry techniques.
Step 3: Record the FEV1 value and compare it with predicted values based on patient demographics.
Step 4: Identify decreases in FEV1 as potential indicators of obstructive pulmonary disorders.
Final Answer: FEV1 assessment involves correctly performing the test, recording the data, and analyzing it relative to predicted norms, with deviations indicating potential respiratory complications.

Assessing FEV1 Values

Common Mistakes

Overlooking the significance of comprehensive patient history in respiratory assessments.
Confusing the roles and interpretation of tidal volume and FEV1 measurements.
Failing to apply appropriate therapeutic interventions based on assessment findings.
Misunderstanding the proper techniques for inhaler usage and its impact on treatment efficacy.