263 2. Identify the equipment illustrated below by placing your answer on the line provided. MATCHING EXERCISES Match the definition in Part B with the tern IIsted in Part A. PART A a. Ventilation b. Inspiration c. Fixpiration d. Lung compliance e. Airway resistance f. Diffusion g. Perfusion h. Hypoventllation I. Atelectasls j. Hyperventilation k. Hypoxia PART B 1. Movement of muscles and thotax to bring air into the lungs 2. Movement of oxygen and carbon dioxide between the air and the blood 3. Incomplete lung expansion ot lung collapse 4. An inadequate amount of oxygen in the cells 5. Movement of air in and out of the lungs 6. Any impediment or obstruction that air meets as it moves through the airway 7. Stretchablilty of the lungs or the ease whth which the lungs can be inflated 8. Process by which the oxygenated capillary blood passes through tissue 9. A decreased rate of air movement into the lungs 10. An increased rate and depth of ventilation above the body's normal metabolic requitrements Match the type of oxysen dellvery system tisted in Part A with its descriptlon listed in Part B. PART A a. Nasal cannula b. Nasopharyngeal catheter c. Slmple facernask d. Partial rebteather mask c. Noniebreather mask f. Venturl mask 9. Oxygen tent h. Transtracheal oxygen dellvery PART B 11. Connects to oxygen tubing, a humidlfier, and flow meter and uses a delivery flow rate greater than ; it should be comfortably snug over face but not tight; it has wents in sides to allow room air to leak in at many places, diluting the source oxygen. 12. Produces the highest concentration of oxygen with a mask contains two oneway valves that prevent conservation of exhaled alt, which escapes through slde vents. 13. Thls mask delivers the most precise concentration of oxygen and has a large tube with an oxygen inlet. As the tube natrows, pressure drops, causing air to be sucked in through the side potts. 14. Probably the most commonly used respiratory ald, this consists of a disposable, plastic derice with two protruding prongs for insertion into the nostrils; it is connected to an oxygen source with a humldifier and a flow meter. 15. A sasall catheter is inserted into the trachea under local anesthesia and the catheter is attached to the oxygen source.
264 16. This mask is equlpjed with a reservoli bag for the collection of the fisst part of the patient's exhaled ait. The alr is mlxed with oxygen for the next intralation. SHOWT ANSWER 1. List three factors on which normal respira. fory functioning depends. a. b. c. 2. Briefly describe the functions of the upper and lower alrways, listing their maln components. a. Upper airway. b. Lowet alrway: 3. List foar factors that influence the diffusion of gas in the lungs. a. b. c. d. 4. Deseribe the two ways that oxygen is cartied in the body. a. b. 5. Briefly describe the variations in respiration experienced by the following age groaps. a. Infant: b. Preschool- and schooleged child: c. Older adult: 6. Describe nursing responsibilities before, dering, and after a thoracentesis. 7. How would you describe the effects of smoking on the lungs to a patient who smokes a pack of clgarettes a day? 8. Balefly detalbe the following techniques deslgned to promote proper breathing. a. Decp breathing b. Incentive spirometry: c. Pursed lip breathing: d. Diaphragmatic breathing: e. Volantary coughing: 9. You are the visiting nurse for a patient with emplyysema who is recelving oxygen therapy. List five precautions you would take to prevent fre and infury to this patient. a. b. c. d. e. 10. Briefly describe the following types of alrways and their uses. a. Oropharyageal/nasopharyngeal airway: b. Endotracheal tube:
11. What is the nurse's responsibility when managing a patient's chest tube? 12. Describe seven comfort measures for patients with impaired respiratory functioning. a. b. c. d. REFUECTIVE PRACTICE: CUUIVATNG QSEN COMPETENCIES e. Use the following expandind sconario from Chapter 39 in your textbook to answer the f. questions below. 9. Scenaribr Joan Mclintyie, age 72 , is in the 13. Describe the nuese's role in providing trachemedlical intensive care unit, diagnosed wish ostomy care for a patient. severe COPD. Unable to betathe on her own, she has a tracheostony and is recelving mechandcal ventlation. Diforts are being made to wean her from the ventilatoc, but she has been unable to bseathe on her own for any length of time. She has written notes asking the staff to "let me the next time she falis to be weaned. Her only daughter is by her side and asks that all measures to ave her mother's Hife be initiated. 14. Brielly describe the following components in the procedure for administering cardiopulmonary resusctiation (CPR): a. Chest compression: 1. How might the narse sespond to Mr. Mclntyre's b. Alrway: request for a DNR otder, whille taking into consideration the wishes of her daughter? c. Breathing: d. Defibrillation: 2. What would be a successful outcome for this patient?
Sensory Functioning ASSESSING YOUR UNDERSTANDING FILL. IN THE BLANKS 1. is the process of recelving data about the internal or external environment through the senses. 2. refers to awaresess of positioning of body parts and body movement. 3. is the sense that percelves the solidity of objects and their slize, shape, and texture. 4. The state in which a person cannot remember bits of information or behavior skills is known as and is attributed to pathophysiologic or situational causes that are either temporary or permanent. 5. Impaired or absent functioning in one or more senses is termed MATCHING EXERCISES Match the senses in Part A with thatr defluition in Part B. PART A a. Visual b. Auditory c. Olfactory d. Gustatory e. Tactile f. Kinesthesia 9. Visceral h. Stereognosis PART B 1. The sense that perceives the solidity of oblects and their size, shape, and texture 2. The sense of taste 3. The sense of sight 4. The sense of smell 5. The sense of hearing 6. The awareness of positioning of body parts and body movement 7. The sense of touch Match the aamples in Part B with the appropriate stimulation listed in Part A. Some answers may be ased more than once. PART A a. Visual stimulation b. Auditory stimulation c. Gustatory/olfactory stimulation d. Tactile stimulation PART B 8. A nurse wears a brightly colored top when caring for patients confined to bed. 2. A nurse collaborates with the hospital nutritionist to prepare meals with varied seasonings and textures. 10. A patient confined to bed is given dally massages. 11. Soft music is played in the room of a patient who has eye patches following his surgery.
12. In a long-term care facility, a nurse checks a patient for properly fitting dentures. 13. A nurse hugs a depressed patient who has made the effort to bathe and dress herself. 14. A nurse explains a procedure to a comatose patient. 15. A nurse arranges a patient's cards in a heart shape on her wall. SHORT ANSWER 1. List four conditions that must be present for a person to receive data necessary to experience the world. a. b. c. d. 2. Give an example of how the following factors may place a patient at high risk for sensory deprivation. a. Environment: b. Impalred ability to recelve envitonmental stimull: c. Inability to process environmental stimull: 3. Briefly describe the following effects of sensory deprivation: a. Perceptual responses: b. Cognitlve responses: c. Pmotional responses: 4. List three examples of sensory overload you have observed when caring for patients on your nursing unit. a. b. c. c.
10. Give two suggestions for increasing environmental stimulation and role model approptiate interactional behaviors for children in the following areas. a. Visual: b. Auditory: c. Olfactory: d. Gustatory: e. Tactile: 11. Give an example of how each of the following factors may influence the amount and quality of stimuli needed to maintain cortical arousal. a. Developmental considerations: b. Culture and lifestyle: c. Personality: d. Stress: e. Illness and medication: 12. Explain how you might assess a patient for the following sensory experlences. a. Stimulation: b. Reception: c. Transmission-perception-reaction: 13. Give three examples of how a nurse might communicate with the following patients. a. Visually impaired patients: b. Hearing-Impalred patients: c. Unconscious patients: APPLYING YOUR KNOWLEDGE CRITICAL THINIKING QUESTIONS 1. Test your friends' senses by trying out these tactile, gustatory, and olfactory exercises. a. Gather several ttems from your home/work area and place them in a paper bag. These Items could include things such as a key, a cotton ball, a toothpick, a tongue depressor, etc. Have your friends take turns feeling the objects in the bag and guessing what they are without looking at them. As an item is identified, remove it from the bag. Discuss the importance of tactile experiences to the vision-impaired patient. b. Gather several foods for your friends to taste and identify. You could use pudding, gelatin, mints, chocolate, etc. Blindfold your friends and give them a taste of each food. See how many they can identify correctly. c. Gather items with a pungent odor for your friends to smell and identify. You could use alcohol, lemon juice, pickle juice, cinnamon, mint, etc. See how many odors they can identify correctly. Reflect on the role different senses play. Do you believe using only one sense at a time helghtens the awareness of that sense? Relate the exercises above to the special needs of hearing-impaired and vision-impaired patients. 2. Walk down a busy street in a city and try to plck out individual noises. How many noises were you able to identify? How many notses became indistinct due to sensory overload? Relate this experience to a patient in a critical care unit. 1
REFLECTIVE PRACTICE: CULTIVATING QSEN COMPETENCIES Use the following expanded scenario from Chapter 44 in your textbook to answer the questions below. Scenario: Dolores Mrolla, age 74, comes to the older adult clinic with her 77 -year-old husband who was diagnosed with macular degeneration and progresslve viston loss. She says, "Now l've noticed he's also having difficulty hearing me. I'm worrled because he doesn't want to leave the bouse. We hardly see any of our friends anymore. We used to go out to the movles or dinner at least once a week, and lately if we get out once a month, that's a lott" Mrs, Pirolla also expresses concerns about ber husband's safety when moving about the house and neighborhood. 1. What nursing interventions might be appropriate for Mr. Pirolla? 2. What would be a successful outcome for this patient? 3. What Intellectual, technical, interpersonal, and/or ethlcal/legal competencles are mos: likely to bring about the desired outcome? 4. What resources might be helpful for Mr. Pirolla? PATIENT CARE STUDY Read the following patlent care study and use your marsing process skills to answer the questions below. Scenarla: George Gibson, an 81-year-old, married, African-American man, reluctantly reports, after much prodding from his wife, that he is not hearing as well as he used to be. "I don't know what the trouble is," he tells you. "I'm in perfect health, always have been. More and mote, people just seem to be numbling instead of talking." You notice he is seated on the edge of his chair and bends toward you when you speak to him. His wlfe reports that he has stopped going out and pretty much stays in his room whenever people come to visit because he is embarrassed by his inability to hear. "This is really a shame, because George was always the life of the party," she says, You ask Mr. Gibson If he has ever had bis hearing evaluated, and be tells you no, until now, he's been trying to convince bimself that nothing's wrong with hls hearing. 1. Identify pertinent patient data by placing a single underline bencath the objective data in the patient care study and a double underline beneath the subjective data. 2. Complete the Nursing Process Worksheet on page 310 to develop a three-part diagnostic statement and related plan of care for this patient. 3. Write down the patient and personal nursing strengths you hope to draw on as you assist this patient to better health. Patient strengths: Personal strengths: 4. Pretend that you are performing a nursing assessment of this patient after the plan of care is implemented. Document your findlings.