Answers to Case Study, Chapter 21, Assessment of Respiratory Function
Objective:
4
Which assessment parameters are appropriate to determine the characteristics and
severity of the symptoms that the patient is exhibiting?
The nurse needs to assess the patient’s lungs anteriorly and posteriorly to assess for
adequacy of ventilation. Pulse oximetry is also needed to assess for oxygenation. The
nurse needs to assess the patient’s vital signs to determine hemodynamic stability. The
nurse needs to further investigate the patient’s breathing pattern, which is suggestive of
sleep apnea. The patient’s symptoms of lethargy and somnolence are suggestive of
retaining carbon dioxide (CO2).
Which nursing interventions should the nurse institute? Which intervention must be
provided immediately?
The nurse needs to place the head of the bed up immediately to a level where the
patient’s lungs may fully expand to help the patient to breathe. The nurse will need to
perform an assessment to determine the underlying causes for the patient’s sudden
change in maintaining airway and breathing. The nurse will need to contact the surgeon
with the assessment findings. The nurse should call for the rapid response team to help
assess the patient’s situation and to provide emergent standing orders to maintain airway
and breathing. The nurse anticipates that the patient will need oxygen, and naloxone
(Narcan) to reverse the respiratory depression caused by the narcotic, and further
investigation and follow-up treatment of sleep apnea.
Explain the possible reasons for the patient’s sudden decline in the respiratory
status.
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A patient who is obese has limited chest expansion because of the large abdomen
interfering with proper expansion, leading to hypoventilation and atelectasis, and
the retention of CO2. The retention of CO2 leads to the body’s compensatory
mechanism of breathing faster, which is reflected in the baseline vital signs when
the patient’s respiratory rate was 26 breaths per minute.
The patient is lying supine and chest expansion is limited by obesity leading to
shallow breaths and the development of atelectasis. The narcotic provides
sedation, which further decreases the patient’s tidal volume. The narcotic also
depresses the patient’s respiratory center, which leads to a decreased respiratory
rate.
The patient’s sedation leads to sleep, and the patient may have sleep apnea as
reflected by the observation of having a period of apnea followed by a snorting
gasp. As the patient’s CO2 level increases, the body starts to increase the
respiratory rate and the airway in sleep apnea may be blocked by excessive soft
tissue so the patient snorts to open the airway and then gasps for air and begins
breathing. The patient’s neck circumference is 21 inches, which supports
excessive soft tissue related to obesity that may occlude the airway during sleep.
The patient’s body mass index (BMI) of 36.2 also supports the risk for sleep
apnea.