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Maryville NURS 612 Exam 2 verified and passed latest solution Update
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Maryville NURS 612 Exam 2 verified andpassed latest solution update
inspect the chest - without clothes on; 1st assess shape and size; 2nd check
for symmetry; 3rd thoracic landmarks; 4th color of skin; 5th check for
supernumerary nipples; 6th superficial venous patterns; and 7th observe for
rib prominence
thoracic landmarks - midline trachea, costal angle, angle of ribs, intercostal
spaces, suprasternal notch
symmetry of chest - thoracic expansion at costal angle, w/o use of accessory
muscles
hx questions for cc of resp issue - What is the nature of your cough?; Do you
produce any sputum?; Is your cough related to activity?; What position are
you most comfortable in?; How many pillows do you sleep with at night?; Is
your SOB related to activity?
normal respirations - rate between 12 to 20/min; ratio of resp to heart
beats= 1:4; pt should breathe easily, regularly w/o apparent distress;
pattern should be even, not too shallow or too deep
hypopnea - term for abnormally shallow respirations
tachypnea - term for resp rate greater than 20, but consistent and may
occur during hyperventilation; often a symptom of pain
bradypnea - term for resp rate less than 12; may indicate neurologic or
electrolyte disturbances, infection, or conscious response to protect against
the pain of pleurisy or other irritative pneumonia. Can also be 2/2 level of
cardio fitness
hyperventilation - term for fast and deep, heavy respirations, can be
caused by exercise, anxiety, and CNS and metabolic diseases
hyperpnea - term for abnormally deep respirations
kussmaul respirations - deep and mostly rapid respirations, used to describe
resp effort of metabolic acidosis
cheyne stokes respirations - regular breathing with intervals of apnea by
crescendo decrescendo breathing; can be seen in sleeping pts, but mostly
pts who are very ill, esp with brain damage
, biot respirations - irregular breathing that varies in depth and is interrupted
irregularly by intervals of apnea; associated with severe and persistent
increased intracranial
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