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NR305 Week 5 Topic 5 Discussion, Assessment of Respiratory Status
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NR305 Week 5 Topic 5 Discussion, Assessment of Respiratory Status
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NR305 Week 5 Topic 5 Discussion, Assessment of Respiratory StatusPlease review the video on the assignments page under the discussion section as it will provide you with an
opportunity to immerse yourself in the role of a nurse addressing tobacco use during routine patient care. In
doing so, reflect on what you have learned about tobacco use and the role that nurses and other
interdisciplinary team members play in helping to assist tobacco users with quitting. While viewing, it is also
important to keep in mind that tobacco users move through stages of change in the process of quitting. They
move from pre-contemplation to contemplation, contemplation to preparation; preparation to abstinence;
abstinence to maintenance. Every stage requires a different strategy by a nurse.
After watching the video, and reflecting on the information presented, address each of the following questions.
1. What are the common symptoms associated with an exacerbation of COPD?
2. What assessment techniques will you use to assess Mary?
3. Identify smoking strategies that would be appropriate for each of the encounters that Mary had with the
nurse throughout the video that could have been used to assist Mary in quitting smoking.
4. Find a resource in your community that could assist Mary. Start by searching the Internet for your local
health department's website. What services are available to Mary? Briefly describe the services that the
state quit line provides. Does it meet the 4 As? Is it accessible, acceptable, affordable, or available for
Mary?
5. What will you do to follow-up on Mary's smoking cessation process?
Class,
Smoking is very common in this society and you will find yourself doing a lot of smoking cessation teaching.
Please share what you have learned and experienced as a nurse to shed insight into this scenario.
Post
Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent and progressively
airflow obstruction. It’s attributable to inflammatory responses of the airways and lungs from noxious particle
or gas irritants and largely caused by exposure to cigarette smoking. Some of the common signs and
symptoms include dyspnea, fatigue, cough, and increased sputum production.
The risk of sensitized respiratory reactions is increased by traffic-related air pollution (Jarvis, 2015, p. 422). As
a result, subjective assessment of Mary would include inquiring about any history of occupational or
environmental exposure to respiratory irritants at home or the work environment. I would also assess
compliance of any medications and inquire of any family history of respiratory diseases since Mary indicated
that her parents were smokers. A psychosocial valuation may reveal her coping strategies for depression from
being unemployed. Objective assessment techniques consist of determining if Mary is able to sit upright
without any breathing difficulties and examining for a barrel chest appearance. Other observations include
assessing her respiratory features for shallow breathing, use of accessory muscles, and diminished breath and
dull chest sounds. I would also perform cardiovascular examination for tachycardia, dysrhythmias, edema, or
distant heart sounds due to her history of chest discomfort, heart attack, and diabetes. Undergoing diagnostic
exams such as arterial blood gas (ABGs) and chest X rays to validate the symptoms of COPD would be
recommended.
Each encounter with Mary would include specific interventions designed to identify smoking status, encourage
smoking cessation, determine willingness to quit, provide assistance for her to quit, and arrange for follow-up
to prevent potential relapses. Education using a motivational interviewing approach has been found to be
useful in encouraging patients with their COPD self-management and education (Engelke, 2016).
This consists of asking her if she still smokes and documenting the response. I would also provide advice on
reasons to quit along with examples of the hazards of continued smoking. Mary seems to indicate frustration
with the effects of smoking so assessing her readiness to quit would be constructive. I would then assist by
recommending counseling and medication programs to help gradually withdraw and treat associated
symptoms. Arranging a follow-up visit regarding her progress and would help provide continued supportive
communication.
New York State Smokers’ Quitline (NYSSQ) (http://www.nysmokefree.com) is a free and confidential service
that offers smoking cessations programs to its residents. Users can speak with a coach to develop a plan,
obtain free nicotine replacement therapy, receive peer support, and use available materials and videos for
education on smoking hazards and tips for staying smoke free.
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