RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
1.
2.
3.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the client’s
situations.
Compare and contrast the normal
anatomy and physiology to the
pathophysiology of the disease
processes in the respiratory system
across the lifespan.
Analyze factors including the
assessment of the client experiencing
complex problems of the respiratory
system, including the developmental
and cultural considerations.
Content Outline
I. Application of terms
A. Bronchiolectasis
B. Carbon dioxide narcosis
C. Emphysema
D. Muscular dystrophy
E. Sleep Apnea
F. Sudden infant death syndrome (SIDS)
II. Anatomy & Physiology of the Respiratory System
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
B. Pathophysiology of respiratory system:
1. Alteration in Ventilation/Perfusion
a. Acidosis
b. Alkalosis
III. Respiratory Assessment
A. Interview
1. Chief complaint
2. Present illness
3. Prior medical history
4. Family/social/occupational history
5. Medication history
6. Prescription/non-prescription
7. Knowledge of health maintenance
8. Identify risk factors
B. Physical Exam
1. Vital signs
2. Level of consciousness
3. Breathing pattern (rate, depth, rhythm,
effort, symmetry)
4. Chest pain
5. Breath sounds
Clinical Objectives
Analyze client data to compare
expected and achieved
outcomes for client.
Learning opportunities
READ:
Lewis (2011)
Lehne (2010)
Implement cost effective care.
McKinney (2009)
Use current technology and
evidence-based information to
formulate and modify the
nursing plan of care.
Collaborate with other health
care providers with treatments
and procedures.
Select and carry out safe and
appropriate activities to assist
client to meet basic physiologic
needs, including: circulation,
nutrition, oxygenation, activity,
elimination, comfort, rest and
sleep.
Collaborate with others to
develop and modify
individualized teaching plans
based on developmental and
health care learning needs.
VIDEOS:
#M017 – Physical Assessment: The
Lungs
#1158 – Asthma, Emphysema and
Chronic Bronchitis
#M067 – Normal and Abnormal Breath
Sounds
#226 – Respiratory Alkalosis & Acidosis
#227 – Metabolic Alkalosis &
Acidosis
#M124 – Tuberculosis: Prevention and
Practices for Healthcare Workers
COMPUTER SIMULATIONS:
Laser 5033 – Physical Examination of the
Respiratory System
Individualize and implement
established teaching plans.
Laser 5017 – Promoting Oxygenation
Evaluate learning outcomes of
the client receiving instruction.
Laser 5045 – Critical Care Nursing –
Critical Thinking: Pulmonary Care
Modify teaching methods to
accommodate client differences.
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
4.
Differentiate between the etiology,
pathophysiology, and clinical
Content Outline
6. Breath odor
7. Tracheal position
8. Color (central & peripheral)
9. Cough
10. Sputum
11. Activity level
12. Capillary refill
C. Diagnostic Tests
1. Laboratory
a. Complete blood count (CBC)
b. Pulmonary function tests
c. Acid-fast bacillus
d. Sweat test
e. Coagulation study (PT/PTT/INR)
f. Culture & sensitivity
2. Radiology
a. Chest x-ray
b. Lung Scan
c. Bronchoscopy
3. Other
a. Arterial blood gases (ABG)
b. Pulse oximeter
c. Skin test
D. Cultural Influences
1. Hereditary
2. Environmental
E. Health beliefs/practices Developmental
1. Age specific assessment data
a. Vital signs
b. Breathing pattern
c. Capillary refill
d. Fluid/electrolyte nutritional needs
2. Behavioral/emotional response to health
care providers
IV. Complex Respiratory Problems
A. Arterial blood gases
Clinical Objectives
Adjust priorities for nursing
interventions in emergency
situations.
Learning opportunities
MEDCOM ONLINE FILMS:
VIDM238-T The Basics of Oxygen
Administration
Evaluate and communicate
quality and effectiveness of
therapeutic interventions.
VIDM240-T Assessment of Respiratory
Distress in the Pediatric Patient
VIDM199S-T Tuberculosis: New
Strategies for the Healthcare Worker
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
manifestations of selected complex
respiratory problems.
Content Outline
B. Croup syndrome/Respiratory syncytial virus
C. Mechanical ventilator
1) Tracheostomy Care
D. Chronic Obstructive Pulmonary Disease
(COPD)
1) Chronic bronchitis
2) Emphysema
E. Pneumo/hemothorax
F. Pleural effusion
G. Cystic fibrosis
H. Scoliosis
I. Myasthenia gravis
J. Pulmonary embolus/Deep vein thrombosis
K. Adult Respiratory Distress Syndrome (ARDS)
L. Tuberculosis
M. Guillain-Barre’
5.
Discuss analysis, planning,
implementation and evaluation for
the nursing management of clients
with complex respiratory problems
and associated technology.
V. Selected nursing diagnoses/nursing
implementation/evaluation.
A. Impaired gas exchange:
Ventilation/perfusion inequality.
1. Independent interventions
a. Respiratory status
b. Pulmonary toilet
c. Positioning for maximum
ventilation
d. Energy conservation
e. Fluid volume balance
f. Nutritional support
g. Breathing techniques
h. Monitoring pertinent diagnostic
tests
i. Maintain asepsis
2. Collaborative interventions
a. Oxygen support
b. Mechanical ventilation
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
Content Outline
Collaborate with Respiratory
Therapy
d. Administer medications and
monitor for desired effects/adverse
effects/side effects
(1) Steroids
(2) Antibiotics
(3) Analgesics
(4) Mucolytics
(5) Expectorants
(6) Anticoagulant
(7) Antituberculosis
(8) Antipyretics
(9) Cough suppressants
(10) Nebulized epinephrine
(Racemic epi)
(11) Bronchodilators
(12) Pancreatic enzymes
(13) Leukotriene Modifiers
e. Surgical modalities
(1) Chest tubes
(2) Thoracentesis
(3) Bronchoscopy
(4) Lung biopsy
(5) Vena-cava ligation umbrella
(6) Rod instrumentation
(7) Pleurodesis
(8) Tracheostomy
f. Nutritional support
(1) High carbohydrate, high salt
Recognition of complications
a. Mediastinal shift
b. Airway obstruction
c. Respiratory failure
d. Infection
e. Hemorrhaging
f. Crepitus(subcutaneous emphysema)
c.
3.
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
Content Outline
g. Flail chest
h. Spontaneous pneumothorax
i. Ventilatory dependence
j. Tracheal erosion
k. Vocal cord trauma
l. Nutritional problems (anorexia)
m. Reproductive problems
n. Febrile seizures
o. Rectal prolapse
4.
The client will exhibit improved gas
exchange as evidenced by:
a. Breathing pattern
b. Level of consciousness
c. Vital signs
d. Color
e. Cough/sputum
f. Decreased pain
g. Activity level
h. Arterial blood gases & pulse
oximeter
B. Altered health maintenance: Knowledge
deficit.
1. Client teaching
a. Assess readiness to learn, ability,
knowledge/educational level
b. Avoid aggravating
factors/alleviating factors
c. Breathing techniques
d. Reportable signs/symptoms
e. Medication teaching
f. Rest/activity
g. Relaxation technique
h. Nutritional
i. Milwaukee brace
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
Content Outline
2.
Community resources
a. Cystic Fibrosis foundation
b. American Lung Association
c. Sudden Infant Death Syndrome
Association
d. Empty Cradle
e. Home Health
f. Department of Public Health
g. Long term care facility for
ventilator dependent client
h. Pulmonary rehabilitation program
i. Genetic counseling
3. The client will have improved health
maintenance as evidenced by:
a. Identifying aggravating and
alleviating factors
b. Identifying reportable signs and
symptoms
c. Describing the purpose, correct
administration and side effects of
meds
d. Ability to discuss diagnosis
surgical procedure, and post care
e. Demonstrates osmotic care
f. Increasing activity as tolerated
g. Achieves optimum level of nutrition
through prescribed diet
h. Utilizing community resources
C. Ineffective coping: Anxiety, fear,
powerlessness, dependence
1. Establish trust and rapport
2. Therapeutic communication techniques
3. Diversional activity
4. Parenting skills
5. Involve in decision making
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit III - Care of the Client Experiencing Respiratory Problems
Behavioral Objectives
6.
7.
8.
n:soph\fall\Unit III Respiratory
Content Outline
Counseling (vocational, spiritual,
psychosocial, grief)
Age specific coping strategies
The client will have effective coping as
evidenced by:
a. Verbalization of different
methods/techniques to cope
effectively
b. Seeking appropriate counseling
when necessary
c. Engaging in activities appropriate
for age, interest, condition, and
cognitive level
d. Demonstrating a willingness and
ability to resume self care/role
responsibility
Clinical Objectives
Learning opportunities
Revised 04/10
Reviewed 07/11