Sherpath - Acute Respiratory Failure

The adult health nurse is assessing a patient admitted with acute respiratory failure (ARF). Which information is most important to obtain from the patient's history?

-Diagnosed with asthma at age 9 -Smokes 2 packs of cigarettes a day for the last 12 years

A patient presents with shortness of breath and chest pain. The provider suspects that the patient has a pulmonary embolus. Which diagnostic tests might the provider order?

-Ventilation/perfusion (V/Q) scan -Chest computed tomography (CT) scan

The nurse is caring for several patients. Which patient's vital signs and diagnostic information indicate the need for immediate evaluation by the nurse?

A 28-year-old patient with cystic fibrosis experiencing dizziness, restlessness, and fatigue whose arterial blood gas values indicate a decreased pH of 7.30.

A patient with a chronic obstructive pulmonary disease (COPD) exacerbation is being treated with supplemental oxygen via nasal cannula and intravenous (IV) corticosteroids. The nurse notes the patient gets short of breath with activity. How should the nurse proceed?

Allow the patient to have periods of rest between treatments.

A nurse is caring for a bed-bound patient with emphysema. In the morning the patient complains of chest tightness, difficulty breathing, and feeling warm. The patient has a white blood cell (WBC) count of 18 and a fever. The nurse should contact the physician for an order for which type of medication?

Antibiotic

A patient with bilateral pneumonia presents with crackles in both lung bases, a temperature of 103.6° F, heart rate of 98 beats/min, blood pressure of 167/98 mm Hg, functional oxygen saturation of 84%, and respiratory rate of 32 breath/min.Which action would the nurse take first?

Apply oxygen.

Mrs. Ham rings the call bell complaining of pain in her left calf and has become increasingly restless with increasing tachypnea. The nurse notices increased ecchymosis and warmth on the affected leg. Which additional action is most important for the nurse to perform?

Call the physician to obtain an order for a ventilation/perfusion (V/Q) scan.

A nurse is caring for a patient with acute respiratory failure (ARF). The patient is receiving 0.9% normal saline solution at 120 mL/hr. Which new assessment finding indicates that treatment has not been effective?

Crackles auscultated bilaterally

A patient is admitted to the medical-surgical unit with a diagnosis of pneumonia. Arterial blood gas (ABG) results reveal a pH of 7.38, partial arterial oxygen tension (PaO2) of 53 mm Hg, partial pressure of carbon dioxide in arterial blood (Paco2) of 44 mm Hg, and a bicarbonate level of 24. Which type of acute respiratory failure (ARF) would the nurse suspect?

Hypoxemic normocapnia

A patient with bilateral pneumonia presents with crackles in both lungs and a deep nonproductive cough. Which action should the nurse take first to help relieve this patient's symptoms?

Initiate nasotracheal suctioning.

CASE STUDY

Mrs. Ham is a 60-year-old interior decorator who sustained a stable fracture of the pelvis in an automobile accident 4 days ago. Her medical history is positive for osteopenia and hypothyroidism. Mrs. Ham has multiple areas of soft tissue trauma to her legs, as evidenced by large hematomas over the entire left leg and right thigh. She also has several facial fractures from hitting the steering wheel during the accident. She is being treated by immobilization with bed rest. Her medication orders include enoxaparin, 40 mg, subcutaneously daily; oral levothyroxine, 100 µg daily; oral alendronate, 70 mg weekly; oxycodone/acetaminophen, 2 tablets every 4 hours as needed; and psyllium, 2 tsp twice a day. The morning assessment findings include the following: blood pressure 128/82 mm Hg, heart rate 92 beats/min, respiratory rate 19 breaths/min, and temperature 99.2° F (36.8° C). The patient is oriented to person, place, time and situation; however, she is a little agitated and restless. Swelling and ecchymoses are noted on the right side of her face; lung sounds are clear but decreased in lower lobes bilaterally. S1 and S2 heart sounds are normal; bowel sounds are active in all four quadrants. She moves her lower extremities with difficulty; denies acute pain but says her legs are very sore. Pedal pulses are 2+ bilaterally; she has 1+ edema around both ankles; legs are warm and ecchymotic. The previous evening's ABG values revealed PaO2 of 52, PaCO2 of 45, HCO3 of 25, and pH of 7.35. Mrs. Ham is on a regular diet but appears to be disinterested in eating and drinking. Her latest activated partial thromboplastin time (aPTT), determined this morning, was 42 seconds.

The nurse is caring for a patient with metastatic lung cancer and worsening anxiety. The nurse notes that the patient has become increasingly restless. The nurse anticipates which order form the health care provider?

Oxygen via nasal cannula at 3 L/min

The nurse is performing a respiratory assessment on a patient being treated for acute respiratory failure (ARF). The nurse determines that the patient's respiratory status is severely worsening if which occurs?

Paradoxical diaphragmatic movements

A student nurse is caring for a patient who has Guillen-Barré syndrome. The nurse reminds the student to check which laboratory value that, if abnormal, can suggest the ventilatory compromise seen in acute respiratory failure (ARF)?

Partial pressure of carbon dioxide in arterial blood (PaCO2)

The nurse is caring for a patient with a pulmonary embolus who complains of severe dyspnea, anxiety, and chest pain. The nurse notes increased respiratory effort, functional oxygen saturation of 82%, and lethargy. Which provider order would the nurse implement first?

Prepare the patient for intubation.

The nurse is caring for a female patient with acute respiratory failure (ARF). The nurse can hear audible crackles, and when the nurse instructs the patient to cough, the patient states, "I'm too weak to do it." Which action should the nurse take?

Push both hands into the patient's abdomen during expiration to facilitate a cough.

A patient using pursed-lip breathing with a rapid, shallow breathing pattern is lying down and complaining of the inability to breathe. Which action would the nurse take first?

Reposition patient.

The nurse is assessing a patient with dyspnea who has asthma. The nurse will recognize that this patient may be beginning to experience type II acute respiratory failure (ARF) if which finding is noted?

Respiratory rate of 24 breaths/min and a PaCO2 of 48 mm Hg

A new nurse is caring for a patient with acute respiratory failure (ARF). Which action by the new nurse, if noted by the registered nurse, indicates a need for further teaching?

The new nurse encourages the patient to maintain a low-protein, high-calorie diet.