Chapter:

Answers to Case Study, Chapter 21, Assessment of Respiratory FunctionObjective: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 patients 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 patients vital signs to determine hemodynamic stability. The nurse needs to further investigate the patients breathing pattern, which is suggestive of sleep apnea. The patients 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 patients 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 patients 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 patients 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 patients sudden decline in the respiratory status.

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 bodys compensatory mechanism of breathing faster, which is reflected in the baseline vital signs when the patients 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 patients tidal volume. The narcotic also depresses the patients respiratory center, which leads to a decreased respiratory rate.

The patients 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 patients 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 patients neck circumference is 21 inches, which supports excessive soft tissue related to obesity that may occlude the airway during sleep. The patients body mass index (BMI) of 36.2 also supports the risk for sleep apnea.