Chapter 29 Respiratory System Function, Assessment, and Therapeutic Measures

Answers CHAPTER 29 RESPIRATORY SYSTEM FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Jenna Treats Mr. Jackson’s Dyspnea 1. He was in a tripod position, using his accessory muscles to breathe, and he had cyanotic mucous membranes, a respiratory rate of 24/minute, and oxygen saturation (SpO2) of 88%. 2. Checked oxygen patency and flow rate, helped him with pursed lip breathing, collaborated with registered nurse (RN) to obtain nebulized mist treatment with albuterol. 3. In patients with chronic respiratory disease, 88% to 92% is high enough to prevent acute dyspnea but not so high as to reduce respiratory drive. VENTILATION REVIEW 1, 3, 5, 2, 4, 6 ADVENTITIOUS LUNG SOUNDS 1. (5) 2. (1) 3. (6) 4. (4) 5. (3) 6. (2) CHEST DRAINAGE VOCABULARY 1. dyspnea 2. crepitus 3. thoracentesis 4. barrel 5. excursion 6. adventitious 7. tracheotomy 8. tidaling 9. apnea 10. tracheostomy ANATOMY REVIEW 1, 4, 6, 5, 7, 8, 3, 2 1 2 Chapter 29 Answers THE RESPIRATORY SYSTEM Larynx Trachea Carina Bronchial tree Left primary bronchus Left secondary bronchus Secondary bronchi Tertiary bronchi Bronchioles Left tertiary bronchus Bronchioles Alveolar sacs CRITICAL THINKING 1. Mr. Howe’s cough should be assessed using the WHAT’S UP? technique. He should be asked how it feels, how bad it is, what makes it better or worse, and when it started. In addition, he should be asked about amount, color, odor, and consistency of sputum. 2. Night sweats, cough, and weight loss are symptoms of tuberculosis (TB). Bloody sputum is also common. These symptoms should alert the nurse to ask the health care provider about the likelihood of TB and the need for isolation to protect staff and other patients. 3. A chest x-ray and sputum culture and sensitivity will be ordered. Additional tests for TB are discussed in Chapter 31. 4. Mr. Howe should be kept NPO (nothing by mouth) according to institution policy before the bronchoscopy. An injection of atropine may be ordered to dry secretions. After the test, Mr. Howe’s vital signs and respiratory Chapter 29 status should be closely monitored. Mr. Howe will remain NPO until his gag reflex returns. The nurse should consult the health care provider’s orders for additional postprocedure instructions. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. (1, 2, 3) are incorrect. 2. (2) is correct. (1, 3, 4) are incorrect. 3. (4) is correct. (1, 2, 3) are incorrect. 4. (2) is correct. (1, 3, 4) are incorrect. 5. (3) is correct. (1, 2, 4) are incorrect. 6. (3) is correct. Cilia help remove potential pathogens. (1, 2, 4) are not affected by changes in cilia. 7. (2) is correct. Wheezes sound like a violin. (1) is incorrect. Crackles sound like Velcro being pulled apart. (3) is incorrect. A friction rub sounds like leather rubbing together. (4) is incorrect. Crepitus is not an adventitious sound. 8. (1) is correct. Pursed-lip breathing helps excrete carbon dioxide. (2, 3, 4) are not promoted by pursed-lip breathing. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 9. (2) is correct. The first concern is increasing oxygenation, and replacing the oxygen will help. (1, 3) may be appropriate, but oxygen should be tried first. (4) is incorrect. Normal oxygen saturation is 95% to 100%. 79% is not adequate. 10. (4) is correct. “Good lung down” has been shown to increase oxygenation. (1, 2, 3) do not increase oxygenation. Answers 3 11. (1) is correct. The catheter must be cleaned two to three times a day to prevent plugging with mucus. (2) is incorrect. Transtracheal oxygen usually prevents the need for another oxygen source. (3) is incorrect. Removal of the catheter for this length of time may cause the tract into the trachea to close. Also, if removed, another oxygen source would be needed. (4) is incorrect. A transtracheal catheter is not hooked to humidification. 12. (4) is correct. Chest physiotherapy helps mobilize secretions. (1) is incorrect. It does not affect chest muscles. (2) is incorrect. It does not use humidification. (3) is incorrect. It does not promote expansion. 13. (1, 3, 4, 5) are correct. (2) is incorrect. The dressing should not be removed. 14. The chamber on the chest drainage system that prevents air from being reintroduced into the chest.