Question

• INSTRUCTOR'S GUIDE Critical Thinking: Respiratory Assessment Mrs. Johnson is a 69-year-old retired waitress who has smoked since she was 12. She now has severe emphysema and chronic obstructive pulmonary discase (COPD) and is admitted to the extended care facility where you work, because she is widowed and has no family to care for her. She uses oxygen 2 L per nasal cannula at all times and NIPPV at night. 1. What routine data should be collected to monitor Mrs. Johnson's respiratory status? 2. In addition to her chronic lung disease, what normal aging changes affect Mrs. Johnson's lungs? 3. You note that Mrs. Johnson's physician has documented that she has a barrel chest. What does this mean, and what causes it? 4. Why is Mrs. Johnson on only 2 L of oxygen even though she is still sometimes short of breath? 5. You enter Mrs. Johnson's room one evening and find her with increased dyspnea. You check her oxygen and find it is on at 2 L per minute as ordered. What questions can you ask to further assess the severity of her problem? 6. You decide to check her oxygen saturation and find it is 85% on 2 L of oxygen. What do you do? 7. You page the physician. While you are waiting for his call, you sit with Mrs. Johnson and try to calm her. What are some techniques that may help? What position will be most effective for her? Williams & Hopper, Understanding Medical Surgical Nursing. 5 Edition Copyright 2015 F. A. Davis Company 29-4

Answer 1

1. Respiratory assessment includes : an initial assessment, history taking, inspection, palpation, percussion, auscultation and investigation .

Routine data to be collected are :-

Airway - any stridor , exertion etc

Behaviour and feeding - normal ,or talks in sentence

Respiratory rate - assess RR

Accessory muscle use - yes or no

Oxygen is required or not

2. Normal lung chages associated with age :-

Alveolar surface area decreases.

Diffusion capacity decreases.

Elastic recoil decreases.

Bronchioles and alveolar ducts dilate.

Ability to cough decreases.

Airways close early.

Residual volume increases.

Vital capacity decreases.

Efficiency of oxygen and carbon dioxide exchange decreases.

Elasticity decreases.

3. Barrel chest - Barrel chest has horizontal ribs and costal angle >90 degrees. Not equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.

4. Mrs. Johnson is on 2L of oxygen because of Hypoxic drive

The backup trigger to breath. It is triggered by falling levels of oxygen rather than rising levels of carbon dioxide.