Oxygenation

A client with a chest tube wishes to ambulate to the bathroom. What is the appropriate nursing response?

"I can assist you to the bathroom and back to bed." The client can move in bed, and ambulate while carrying the drainage system, as long as he or she has orders to do so. The nurse should supervise ambulation to the bathroom and back to bed while the client has the drain inserted to make sure it stays intact and to monitor for safety. Other answers are incorrect.

Partial Rebreather Mask

8-11 L/min = 50-75%

Venturi Mask

High flow 4-6 L/min = 24-40%

Respiratory rates

Infant: 20-40 bpm Toddler: 25-32 Child-Adult: 18-26 Older Adults: 16-24

Low Flow Nasal Cannula

Low flow 1-6L/min

Simple Mask

Low flow 5-8 L/min = 40-60% (5 L/min is minimum setting)

Atelectasis

abnormal breath sound heard over the lungs

The nurse is implementing an order for oxygen for a client with facial burns. Which delivery device will the nurse gather?

face tent A face tent is used without a mask; it is open and loose around the face and is often used for patients with facial trauma or burns. A simple mask or nasal cannula would irritate the facial skin. The client does not have a tracheostomy.

Bronchial sounds

those heard over the larynx and trachea are high-pitched, harsh "blowing" sounds, with sound on expiration being longer than inspiration

Room air %

Oxygen 21%

Pursed Lip Breathing

Patients who experience dyspnea and feelings of panic can often reduce these symptoms by using pursed-lip breathing. Exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration.

Where is the respiratory center located?

medulla

CBC Aftercare

• Reinforce information given by the patient's primary health care provider regarding further testing, treatment, or referral to another health care provider. • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of illness. • Evaluate test results in relation to the patient's symptoms, health care problems, and other tests performed.

The nurse is reviewing the chart of a client receiving oxygen therapy. The nurse would question which supplemental oxygen prescription if written by the health care practitioner?

8 L/min oxygen via nasal cannula The correct amount delivered FiO2 for a nonrebreather mask is 12 L/min; 8-11 L/min for partial rebreather mask; 4-10 L/min for Venturi mask; and 1-6 L/min for nasal cannula. However, per nasal cannula it may be no more than 2-3 L/min to for a client with chronic lung disease.

CK & isoenzymes Aftercare

• Recognize anxiety related to test results. Provide teaching and information regarding the implications of the test results. • Reinforce information given by the patient's primary health care provider regarding further testing, treatment, or referral to another health care provider. • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor the progression of illness. • Evaluate test results in relation to the patient's symptoms, health care problems, and other tests performed.

ABG Aftercare

• Record supplemental oxygen or respirator settings on specimen information. • The arterial specimen is immediately placed on ice and taken to the laboratory. • Apply pressure for 5-10 minutes and watch for evidence of bleeding. If the patient is taking anticoagulants, pressure must be applied for a longer interval.

High Flow Nasal Cannula

10-15 L/min Not recommended

Nonrebreather Mask

10-15 L/min = 80-95%

Procedure pages:

1523-1547

The pediatric nurse is caring for four clients. Which client will receive the greatest benefit from the use of an oxygen analyzer to assure that the client is receiving the prescribed amount of oxygen?

3-year old in croup tent An oxygen analyzer is used most commonly when caring for newborns in isolettes, children in croup tents, and clients who are mechanically ventilated. Other answers are incorrect.

The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation?

Arterial blood gas Arterial blood gases include the levels of oxygen, carbon dioxide, bicarbonate, and pH. Blood gases determine the adequacy of alveolar gas exchange and the ability of the lungs and kidneys to maintain the acid-base balance of body fluids.

A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen?

Instruct the client to inhale deeply and then cough. The client should be instructed to inhale deeply and cough; if this results in sputum, it should be collected in the container. The client should be placed in a semi-Fowler's position and instructed to clear the nose and throat and rinse the throat with water.

Administering Oxygen by Nasal Cannula Unexpected Situations/Interventions

Patient was fine on oxygen delivered by nasal cannula but now states she is short of breath, and the pulse oximeter reading is less than 93%: Check to see that the oxygen tubing is still connected to the flow meter and the flow meter is still on the previous setting. Someone may have stepped on the tubing, pulling it from the flow meter, or the oxygen may have accidentally been turned off. Assess lung sounds to note any changes. Report changes and assessment findings to primary care provider. Areas over ear or back of head are reddened: Ensure that areas are adequately padded and that tubing is not pulled too tight. If available, a skin care team may be able to offer some suggestions.

Peak Expiratory Flow Rate

The maximum flow attained during the FVC

A nurse assessing a client's respiratory status gets a weak signal from the pulse oximeter. The client's other vital signs are within reference ranges. What is the nurse's best action?

Warm the client's hands and try again. Finding an absent or weak signal, the nurse should check vital signs and client condition. If satisfactory, warming the extremity may facilitate a stronger reading. This should be attempted prior to resorting to using the client's earlobe. Bright light can interfere with the operation of light sensors and cause an unreliable report. A blood pressure cuff will compromise venous blood flow to the site leading to inaccurate readings.

Which scenario describes how carbon dioxide levels determine the frequency and depth of ventilation?

When carbon dioxide levels in the blood increase, chemoreceptors are stimulated, causing deeper and more rapid breathing. Peripheral and central chemoreceptors in the aortic arch and carotid arteries and the medulla are sensitive to circulating blood levels of carbon dioxide and hydrogen ions. Increased carbon dioxide levels lead to more rapid and shallow breathing, whereas decreased carbon dioxide levels lead to slower and deeper respirations.

A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing:

a bronchospasm. When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways become edematous, mucus production increases, and inflammatory chemical mediators cause bronchospasm.

Wheezes

continuous, high-pitched squeak or musical sound made as air moves through narrowed or partially obstructed airway passages

Mr. Parks has chronic obstructive pulmonary disease (COPD). His nurse has taught him pursed-lip breathing, which helps him in which of the following ways?

decreases the amount of air trapping and resistance Exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration, which prevents air from being trapped in the alveoli and decreases resistance to exhalation. Increasing carbon dioxide levels to stimulate breathing is the natural stimulus for a person without COPD to breathe. Prolonging inspiration and shortening expiration does not assist the client because exhalation is difficult for the COPD client. Humidification and fluid intake help to liquefy secretions.

To drain the apical sections of the upper lobes of the lungs, the nurse should place the client in which position?

high-Fowler's position Postural drainage makes use of gravity to drain secretions from the lungs from smaller pulmonary branches into larger ones, where they can be removed by coughing. High-Fowler's position is used to drain the apical sections of the upper lobes of the lungs. Placing the client lying on the left side with a pillow under the chest wall helps to drain the right lobe of the lung. Placing the client in a side-lying position, half on the abdomen and half on the side, right and left, helps to drain the posterior sections of the upper lobes of the lungs. Trendelenburg position assists in draining the lower lobes of the lungs.

A nurse is caring for a client who has spontaneous respirations and needs to have oxygen administered at a FiO2 of 100%. Which oxygen delivery system should the nurse use?

nonrebreather mask A nonrebreather mask is the only device that can deliver an FiO2 of 100% to a client without a controlled airway. A Venturi mask delivers a maximum FiO2 of 55%. A nasal cannula delivers a maximum FiO2 of 44%. A simple mask delivers a maximum FiO2 of 60%.

Bronchovesicular breath sounds

normal breath sounds heard over the mainstem bronchus; they are moderate blowing sounds, with inspiration equal to expiration

Vesicular

normal sound of respirations heard on auscultation over peripheral lung areas

Cytologic Study Aftercare

• Advise the patient to inform the nurse when the specimen has been obtained. • Label and package the specimen and send it to the laboratory as soon as possible.

The nurse is assessing the vital signs of clients in a community health care facility. Which client respiratory results should the nurse report to the health care provider?

An infant with a respiratory rate of 20 bpm The infant's normal respiratory rate is 30 to 55 breaths per minute. The normal range for a child age 1 to 5 years is 20 to 40 breaths per minute. For a child 6 to 12 years of age the normal respiratory rate is 18 to 26 breaths per minute. The normal respiratory rate for an adult 65 years and older is 16 to 24 breaths per minute.

Upon entering a client's room, the nurse notes the client's pulse oximetry to be 86%. What is the priority nursing action?

Perform a respiratory assessment. As the nurse enters the room, he or she will immediately begin an assessment of respiratory efforts, vocalizations, chest symmetry or lack thereof, and auditory lung sounds. Other actions can take place subsequent to the assessment.

The nurse is caring for a client with a chronic lung disorder who has been prescribed portable oxygen, 2L/min. What delivery device will the nurse select that is most appropriate for this client?

nasal cannula A nasal cannula is ideal for administering low concentrations of oxygen to clients who are not extremely hypoxic or have chronic lung disease. A tracheostomy collar is contraindicated because this client does not have a tracheostomy. A simple mask is used to administer higher levels of oxygen than a cannula. A face tent is used without a mask; it is open and loose around the face and is often used for patients with facial trauma or burns.

When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing

Poor tissue perfusion Chronically poor perfusion may result in hair loss in the affected area, discolored skin, thickened nails, and shiny, dry skin indicative of inadequate tissue nutrition.

When caring for a client with a tracheostomy, the nurse would perform which recommended action?

Suction the tracheostomy tube using sterile technique. Sterile technique is required when suctioning a tracheostomy in order to prevent introduction of microorganisms into the respiratory tract. The area around a new tracheostomy may need to be assessed and cleaned every 1 to 2 hours. Gauze dressings that are not filled with cotton must be used to prevent aspiration of lint or cotton fibers into the trachea.

Which guideline describes the proper method for measuring the appropriate length to use when inserting a nasopharyngeal airway?

When holding the airway on the side of the client's face, it should reach from the tragus of the ear to the tip of the nostril. The nasopharyngeal airway length is measured by holding the airway on the side of the client's face. The airway should reach from the tragus of the ear to the tip of the nostril. The diameter should be slightly smaller than the diameter of the nostril. For an oropharyngeal airway, when holding the airway on the side of the client's face, it should reach from the opening of the mouth to the back angle of the jaw.

An older adult client is visibly pale with a respiratory rate of 30 breaths per minute. Upon questioning, the client states to the nurse, "I can't seem to catch my breath." The nurse has responded by repositioning the client and measuring the client's oxygen saturation using pulse oximetry, yielding a reading of 90%. The nurse should interpret this oxygen saturation reading in light of the client's:

hemoglobin level. Pulse oximetry readings are reflective of the number of available oxygen receptors on hemoglobin molecules. Consequently, an acceptable reading in a client with low hemoglobin can be artificially inflated. Age, blood pH, and electrolyte levels do not have a direct bearing on the accuracy and clinical application of pulse oximetry.

The nurse must obtain a blood specimen for blood gas analysis. What is the most important thing for the nurse to do immediately after the needle has been removed?

Apply steady, firm pressure on the puncture site for 5 to 15 minutes. Because the artery has been punctured, there is an increased risk for puncture site bleeding compared to venous blood draws. The nurse should apply steady, firm pressure on the puncture site for 5 to 15 minutes or until bleeding has completely stopped. An adhesive bandage should not be placed before bleeding is stopped. The blood specimen should be properly labeled; however, the priority for the nurse would be to ensure bleeding from the puncture site has stopped. Pressure should be applied prior to any extremity elevation.

A nurse is assessing the breath sounds of a newborn. Which sound is an expected finding for this developmental level?

Crackles Normal breath sounds of an infant are harsh crackles at the end of deep inspiration. Wheezing is a whistling sound made while breathing. Clear sounds are usually not heard in an infant. A bruit is an audible vascular sound and not a pulmonary sound associated with turbulent blood flow.

Spirometry

measures the volume of air in liters exhaled or inhaled by a patient over time. It evaluates lung function and airway obstruction through respiratory mechanics. Spirometry can be used to measure the degree of airway obstruction and evaluates response to inhaled medications.

Which medication is administered in the home or the hospital to relieve inflammation in the lung tissue?

Corticosteroids In many cases, bronchodilators and corticosteroids are required to open airways and ease breathing. Corticosteroids relieve inflammation.

A nurse is delivering 3 L/min oxygen to a client via nasal cannula. What percentage of delivered oxygen is the client receiving?

32% A nasal cannula is used to deliver from 1 L/minute to 6 L/minute of oxygen. 1 L/minute = 24%, 2 L/minute = 28%, 3 L/minute = 32%, 4 L/minute = 36%, 5 L/minute = 40%, and 6 L/minute = 44%

Pulse Ox Unexpected Situations/Interventions

Absent or weak signal: Check vital signs and patient condition. If satisfactory, check connections and circulation to site. Hypotension makes an accurate recording difficult. Equipment such as a restraint or blood pressure cuff may compromise circulation to site and cause venous blood to pulsate, giving an inaccurate reading. If extremity is cold, cover with a warm blanket and/or use another site. Potentially inaccurate reading: Check prescribed medications and history of circulatory disorders. Try the device on a healthy person to see if the problem is equipment related or patient related. Drugs that cause vasoconstriction interfere with accurate recording of oxygen saturation. A bright light (sunlight or fluorescent light) is suspected of causing equipment malfunction: Turn off light or cover the probe with a dry washcloth. Bright light can interfere with operation of light sensors and cause an unreliable report.

Tests to Check Cardiopulmonary Function

Arterial Blood Gas & pH Cardiac biomarkers: creatine kinase and isoenzymes Complete Blood Count Cytologic Study

Upon auscultation of the client's lungs, the nurse hears loud, high-pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound?

Bronchial Bronchial breath sounds are loud, high-pitched sounds heard primarily over the trachea and larynx. Vesicular breath sounds are low-pitched, soft sounds heard over the peripheral lung fields. Bronchovesicular breath sounds are medium-pitched blowing sounds heard over the major bronchi. Vesicular, bronchial, and bronchovesicular breath sounds are normal breath sounds. Adventitious breath sounds are abnormal lung sounds.

A nurse using a pulse oximeter to measure a client's SpO2 obtains a reading of 95%. What is the nurse's most appropriate action?

Document this expected assessment finding. A range of 95% to 100% is considered normal oxygen saturation. As such, there is no need to change the client's position, encourage deep-breathing exercises and coughing, or to review the client's medication history.

Diaphragmatic breathing

Many people with COPD breathe in a shallow, rapid, and exhausting pattern. Teach the patient with COPD to change this type of upper chest breathing to another form, diaphragmatic breathing. Diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration

Vital Capacity

Maximum amount of air exhaled after maximum inspiration

Forced Vital Capacity

Maximum amount of air that can be forcefully exhaled after a full inspiration

A nurse is overseeing the care of a client who is receiving oxygen via nasal cannula. Which aspects of the client's care can the nurse safely delegate to unlicensed assistive personnel (UAP)? Select all that apply.

Measuring the client's respiratory rate Inserting the client's nasal cannula after it has become dislodged Reapplying the client's nasal cannula after a bath Reapplication of the nasal cannula during nursing care activities, such as during bathing, may be performed by UAP. UAP may measure a client's respiratory rate in the context of measuring the client's vital signs. Chest auscultation and changes to oxygen delivery are beyond the scope of UAP.

Which is a sign of dyspnea specific to infants?

Nasal flaring In the infant, flaring of the nostrils and retractions of the ribs during inspiration are notable signs of air hunger and extraordinary work of breathing.

The nurse is obtaining a pulse oximetry reading for a client admitted with exacerbation of chronic obstructive pulmonary disease (COPD). When observing a reading of 89%, what action should the nurse perform?

No action is required, because this may be normal for the client For clients with chronic lung disease, a level of 88%-92% may be considered within normal limits and there is no further action for the nurse to take. There is no indication that intubation is needed. Administering oxygen at levels too high may diminish the client's stimulus to breathe, because a higher CO2 level is tolerated. Breathing into a paper bag would elevate the level of carbon dioxide and would be dangerous for this client.

Providing Care of a Tracheostomy Tube Unexpected Situations/Interventions

Patient coughs hard enough to dislodge tracheostomy: Keep a spare tracheostomy and obturator at bedside. Insert obturator into the new tracheostomy and insert tracheostomy into stoma. Remove obturator. Secure ties and auscultate lung sounds. Palpate for any subcutaneous emphysema. Tracheostomy becomes dislodged and is not easily replaced: Notify the primary care provider immediately. This is an emergency situation. Cover the tracheostomy stoma. Assess the patient's respiratory status. Anticipate the possible need for maintaining ventilation using a manual resuscitation device and mask, and for possible oro- or nasotracheal intubation. On palpating around the insertion site, you note a moderate amount of subcutaneous emphysema in tissue: Assess for dislodgement of the tracheostomy tube. If the tube has become displaced, a buildup of air in the subcutaneous portion of the skin is likely. Notify the primary care provider if the subcutaneous emphysema is a change in the status of the tracheostomy.

Total Lung Capacity

The amount of air contained within the lungs at maximum inspiration

Forced Expiratory Volume

The amount of air exhaled at a specific time interval; for example, in the first, second, and third seconds after a full inspiration

Residual Volume

The amount of air left in the lungs at maximal expiration

The nurse sets up an oxygen tent for a client. Which client is the best candidate for this oxygen delivery system?

a child who has pneumonia An oxygen tent is commonly used with children who need a cool and highly humidified airflow. It is also more effective for children because they often do not like to keep oxygen administration devices in place. Since the tent does not allow the maintenance of a satisfactory or precise oxygen concentration, is difficult to maintain a consistent level of oxygen. The oxygen tent does not adequately deliver oxygen at a rate higher than 30% to 50%; thus, it is rarely used with other clients.

The nurse is performing a check with an oxygen analyzer. Which oxygen analyzer assessment finding indicates that the device is working properly?

reads 0.21 when checking oxygen in room air An oxygen analyzer should read 0.21 when checking oxygen in room air if there is a normal mixture of oxygen and other gases in the environment. When the analyzer is positioned near or within the device used to prescribe oxygen, it should register at the prescribed amount (>0.21).

Peak expiratory flow rate

refers to the point of highest flow during forced expiration. PEFR reflects changes in the size of pulmonary airways and is measured using a peak flow meter. It is routinely used for patients with moderate or severe asthma to measure the severity of the disease and degree of disease control.

The nurse educator is presenting a lecture on the respiratory and cardiovascular systems. Which response given by the nursing staff would indicate to the educator that they have an understanding of cardiac output?

"If the client's stroke volume is 50 mL and heart rate is 50 beats per minute, then the cardiac output is 2.5 L/minute." The following formula is used to determine cardiac output: Cardiac Output = Stroke Volume x Heart Rate. A client with a stroke volume of 50 mL and heart rate of 50 beats per minute has a cardiac output of 2.5 L/minute. If stroke volume is 70 and heart rate is 70 beats per minute, then the cardiac output is 4.9 L/minute. If stroke volume is 80 and heart rate is 80 beats per minute, then the cardiac output is 6.4 L/minute.

A nurse is conducting a physical assessment of a client who is being treated for pleural effusion at a health care facility. The nurse needs the client to exhale additional air, which will allow the nurse to check the quality of the client's oxygenation. What instruction should the nurse give the client?

Contract the abdominal muscles. The nurse should instruct the client to contract the abdominal muscles to exhale additional air. A person can forcibly exhale additional air by contracting abdominal muscles such as the rectus abdominis, transverse abdominis, and external and internal obliques. The client elevates the ribs and sternum and expands the thoracic cavity during inspiration. The client relaxes the respiratory muscles during normal expiration.

The client has an increased anteroposterior chest diameter, dyspnea, and nasal flaring. The most appropriate nursing diagnosis is:

Ineffective Breathing Pattern related to hyperventilation related to increased anteroposterior diameter. Ineffective breathing pattern is the state in which a person's inspiration and/or expiration pattern does not provide adequate ventilation.

Which teaching about the oxygen analyzer is important for the nurse to provide to a client using oxygen?

It determines whether the client is getting enough oxygen. The oxygen analyzer measures the percentage of delivered oxygen to determine whether the client is receiving the prescribed amount. The flowmeter is a gauge used to regulate the amount of oxygen that a client receives. The provider prescribes concentration. The humidifier produces small water droplets that are delivered during oxygen administration to decrease dry mucous membranes.

The nurse is suctioning a client's tracheostomy when the tracheostomy becomes dislodged and the nurse is unable to replace it easily. What is the nurse's most appropriate response?

Maintain the client's oxygenation and alert the health care provider immediately. If the tracheostomy becomes dislodged and is not easily replaced, the nurse should notify the primary care provider immediately, cover the tracheostomy stoma, and assess client's respiratory status.

Suctioning a Tracheostomy: Open System Unexpected Situations/Interventions

Patient coughs hard enough to dislodge tracheostomy: Keep a spare tracheostomy and obturator at the bedside. Insert obturator into tracheostomy tube and reinsert tracheostomy into stoma. Remove obturator. Secure ties and auscultate lung sounds. Palpate for any subcutaneous emphysema. Tracheostomy becomes dislodged and is not easily replaced: Notify the primary care provider immediately. This is an emergency situation. Cover the tracheostomy stoma. Assess the patient's respiratory status. Anticipate the possible need for maintaining ventilation using a manual resuscitation device and mask, and for possible oro- or nasotracheal intubation. Lung sounds do not improve greatly and oxygen saturation remains low after three suctioning attempts: Allow the patient time to recover from previous suctioning. If needed, hyperoxygenate again. Suction the patient again and assess whether the oxygen saturation increases, lung sounds improve, and secretion amount decreases.

Administering Oxygen by Mask Unexpected Situations/Interventions

Patient was previously fine but is now short of breath, and the pulse oximeter reading is less than 93%: Check to see that the oxygen tubing is still connected to the flow meter and the flow meter is still on the previous setting. Someone may have stepped on the tubing, pulling it from the flow meter, or the oxygen may have accidentally been turned off. Assess lung sounds for any changes. Report changes and assessment findings to primary care provider. Areas over ear or back of head are reddened: Ensure that areas are adequately padded and that tubing is not pulled too tight. If available, a skin care team may be able to offer some suggestions.

Suctioning of Oro/nasopharyngeal Situations/Interventions

The catheter or sterile glove touches an unsterile surface: Stop the procedure. If the gloved hand is still sterile, call for assistance and have someone open another catheter or remove the gloves and restart the procedure. Patient vomits during suctioning: If the patient gags or becomes nauseated, remove the catheter; it has probably entered the esophagus inadvertently. If the patient needs to be suctioned again, change catheters, because it is probably contaminated. Turn the patient to the side and elevate the head of the bed to prevent aspiration. Epistaxis (bleeding) is noted with continued suctioning: Notify the primary care provider and anticipate the need for a nasal trumpet. (See Skill Variation in Skill 14-6: Inserting a Nasopharyngeal Airway.) The nasal trumpet will protect the nasal mucosa from further trauma related to suctioning.

When inspecting a client's chest to assess respiratory status, the nurse should be aware of which normal finding?

The chest should be slightly convex with no sternal depression. The adult chest contour is slightly convex, with no sternal depression. The skin of the thorax should be warm and dry, and the anteroposterior diameter of the chest should be less than the transverse diameter. The contour of the intercostal spaces should be flat or depressed.

Tidal Volume

Total amount of air inhaled and exhaled with one breath

Crackles

fine, crackling sounds made as air moves through wet secretions in the lungs

Capnography

is a method to monitor ventilation and, indirectly, blood flow through the lungs. Exhaled air passes through a sensor that measures the amount of carbon dioxide (CO2) exhaled with each breath. The reported results also provide information about the respiratory rate and depth, the presence of apnea, and efficiency of gas exchange.

While examining a client, the nurse palpates the client's chest and back. What would the nurse expect to identify with this technique?

pattern of thoracic expansion The nurse can assess patterns of thoracic expansion through palpation. Fluid-filled and consolidated portions of lungs can be assessed through percussion, not through palpation. Presence of pleural rub can be assessed through auscultation.

A nurse is assigned to care for a client admitted to the health care facility with the diagnosis of atelectasis. When interviewing the client, the nurse would anticipate a history of:

pneumonia. Pneumonia, which causes the lungs to swell and stiffen, can lead to atelectasis. Stiffer lungs tend to collapse, and their alveoli also collapse. Consequently, the amount of space available for gas exchange in the lungs decreases. Croup, asthma, and alcohol use do not lead to atelectasis. Croup, which is common young children, is a condition that obstructs upper airways by swelling the throat tissues. Asthma causes the small airways to become inflamed and narrowed. Alcohol use depresses the central respiratory center.

What structural changes to the respiratory system should a nurse observe when caring for older adults?

respiratory muscles become weaker One of the structural changes affecting the respiratory system that a nurse should observe in an older adult is respiratory muscles becoming weaker. The nurse should also observe other structural changes: the chest wall becomes stiffer as a result of calcification of the intercostals cartilage, kyphoscoliosis, and arthritic changes to costovertebral joints; the ribs and vertebrae lose calcium; the lungs become smaller and less elastic; alveoli enlarge; and alveolar walls become thinner. Diminished coughing and gag reflexes, increased use of accessory muscles for breathing, and increased mouth breathing and snoring are functional changes to the respiratory system in older adults.

A nurse suctioning a client through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur?

trauma to the tracheal mucosa Occluding the Y-port on the suction tubing is what creates the suction. While suctioning would be difficult but possible, suctioning while advancing the tube would damage the tracheal mucosa and remove excessive amounts of oxygen, not carbon dioxide, from the respiratory tract. Suctioning during insertion of the catheter would not compromise sterility.