Don't Blow It!

​Situation: Thunder has the ability to increase her body's mass when she inhales large volumes of air. In this state she is near-immovable, almost completely invulnerable. Just by stomping the ground she can create massive shockwaves.

​

Thunder is complaining of shortness of breath and difficulty breathing. She has come to you to ask for help.​

​Identify findings

Thunder was fighting crime and a massive dust storm erupted about 3 days ago. She inhaled lots of dust, she is unable to take deep breaths, exhaling is insufficient, and is coughing "constantly."

​

Gather abnormal findings

Background

Assessment

T: 100.9 - P: 126 - RR: 28 - BP: 90/50 -

Room air saturation: 88%,

Pain: 7 out of 10

acceptable level of pain: 6​

Respiratory Rate: 28b/min Effort: Labored, coughing "constantly"

Rhythm: even Expectorated: green sputum, thick, scant, no odor

Chest expansion: symmetrical​. "I can't breathe all the way out!"

​Gather findings

Multiple Select

What is a normal respiratory assessment consist of?

• RR 10-20b/min

• Rhythm:

  Inspiratory time:

  1 sec

  expiratory time:

  2 sec

• symmetrical chest expansion and excursion

• effortless

• coughing while speaking

Multiple Select

Based on Thunder's assessment, what are the problems?

• She is not able to ventilate.

• She is in pain.

• Her lung receptors are attempting to compensate during this acute episode.

• RR is high, SpO2 is low.

• BP is too high

Match

Match the following.

• Irritant receptors

• Stretch receptors

• J-receptors

• Epithelial Irritants

C fibers that are sensitive to particles and causes bronchoconstriction and increased RR

C fibers that easily detect changes in lung volume and can control the cough reflex.

The autonomic nervous system controls these receptors. They can control airway diameter.

histamine, serotonin, prostaglandins, leukotrienes

• C fibers that are sensitive to particles and causes bronchoconstriction and increased RR

• C fibers that easily detect changes in lung volume and can control the cough reflex.

• The autonomic nervous system controls these receptors. They can control airway diameter.

• histamine, serotonin, prostaglandins, leukotrienes

Multiple Select

What do you think about Thunder's symptoms?

• Could be an infection.

• Could be COPD.

• Could be Asthma.

Multiple Select

What can we assess (with the MD's help) to figure out if Thunder is ventilating, perfusing, and oxygenating?

• Ask the MD if we can draw an arterial blood gas (ABG).

• We don't need no stinkin' doctor, just get an ABG.

• Ask the MD to auscultate her lungs sounds with you.

• Inquire if the MD would like a chest Xray.

The A:a Gradient is the DIFFERENCE between the Alveolar concentration of oxygen vs. the arterial concentration of oxygen.

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SHUNT VS. V/Q MISMATCH

Sit back, get the general concept of how gas diffusion works​, do not memorize contents of video.

​Hypoxemia

​

​​*V/Q mismatch

*Gas diffusion issues

*Shunting

Multiple Select

Think about Thunder's assessment findings.

a. The nurse must________

b. because the patient ___________

(select the 2 best choices)

• a. sit the pt up

  b. will not take deep breaths due to pain

• a. lay the patient down

  b. it will help clear zone 1

• a. stand patient up

  b. has an SBP of 90 and a low O2 sat

• a. encourage blood flow to zone 3

  b. administer pain medication ordered to encourage PEEP (increased pressure so alveoli exchange O2 for CO2)

Multiple Choice

How does gravity affect blood flow and gas exchange in different lung zones?

• Gravity has no effect on blood flow and gas exchange in the lung zones.

• Gravity causes increased blood flow and efficient gas exchange in zone one.

• Gravity leads to reduced blood flow and minimal gas exchange in zone three.

• Gravity affects blood flow and gas exchange differently in each lung zone.

Hotspot

Listen to the audio clip.

Click where Zone 1 (otherwise known as the bronchial area) is located in Thunder's lungs?

Hotspot

Listen to the audio clip.

Click where Zone 3 (otherwise known as the vesicular area) is located in Thunder's lungs?

Fill in the Blanks

Match

Match correctly.

• Chronic Obstructive Pulmonary Disease (COPD)

• Asthma

• Respiratory Infections

• VQ Mismatch

• Respiratory Compensation

Chronic cough and difficulty breathing

Triggered by genetics and allergens

Caused by viruses or bacteria

Helps to understand CO2 and blood flow

changes in normal respiratory function to support aerobic metabolism

• Chronic cough and difficulty breathing

• Triggered by genetics and allergens

• Caused by viruses or bacteria

• Helps to understand CO2 and blood flow

• changes in normal respiratory function to support aerobic metabolism

Dropdown

During an asthma attack, you may breathe in something you're allergic to.



Your body reacts by releasing chemicals that make it hard to breathe and trigger inflammation in your airways.



This can lead to symptoms like

Select answer

and ​

Select answer

.

Multiple Select

Select all that apply.

Inflammatory mediators cause early responses such as:

• vasodilation and capillary permeability

• mucosal edema and bronchospasm

• mucous secretion from goblet cells

• narrowing of airways

• weight gain

Multiple Choice

Back to Thunder's signs and symptoms.

The nurse must do X, because of Y and Z.

• X: call for help

  Y: there is fluid in zone 1

  Z: there should only be air

• X: assess patient's pain

  Y: it's a sympathomimetic

  Z: as evidenced by an SBP of 90mmHg

• X: turn the patient and place head of bed at zero degrees

  Y: she will faint

  Z: it will help with chest excursions

Please refer to your lecture notes and text to best prepare for your exam.

This lesson does not substitute for material covered in lecture.​

Points earned will not count toward your final grade.​​

Thank you for participating, your instructor will be reviewing all responses.​

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Poll

This lesson helped my learning.

• Yep.

• Meh.