Ventilation and V/Q
The movement of air into and out of the lungs.
Ventilation
A patient with asthma suddenly develops markedly diminished breath sounds, fatigue, and difficulty speaking. This finding indicates what dangerous condition?
Impending respiratory failure from critically reduced airflow
This postoperative intervention helps prevent alveolar collapse.
Incentive spirometry, deep breathing, coughing, and early ambulation
This short-acting beta₂ agonist is used as a rescue medication for acute bronchospasm.
Albuterol
A patient with SpO₂ 84% and severe dyspnea is unable to lie flat. What position should the nurse use first?
High-Fowler's position, while initiating oxygen and assessing respiratory status
A pulmonary embolism causes this V/Q problem because alveoli are ventilated but receive little or no blood flow.
High V/Q (dead space)
A patient with a tension pneumothorax has hypotension, absent breath sounds on one side, JVD, and tracheal deviation. What emergency treatment should be anticipated?
Immediate needle or finger decompression followed by chest tube placement
This childhood viral disorder commonly causes a barking cough and inspiratory stridor.
Croup
A patient uses inhaled fluticasone. What teaching helps prevent a common adverse effect?
Rinse the mouth after use to reduce oral candidiasis (thrush).
A patient with COPD receiving oxygen becomes increasingly somnolent. What assessment is especially important before simply increasing oxygen?
Respiratory rate, depth, mental status, and ventilation/CO₂ retention; prepare for ventilatory support if deterioration is present.
Pneumonia causes this V/Q problem when perfusion continues to alveoli with impaired ventilation
Low V/Q (shunt-like mismatch)
A child with drooling, tripod positioning, muffled voice, and inspiratory stridor is suspected of having epiglottitis. What should the nurse avoid?
Agitating the child, placing them supine, or examining the throat with a tongue blade
This condition involves thick mucus caused by defective chloride transport and is associated with recurrent Pseudomonas infections.
Cystic fibrosis
This medication is a leukotriene receptor antagonist used for chronic asthma control, not acute rescue.
Montelukast
A patient with suspected pulmonary embolism has sudden dyspnea, tachycardia, pleuritic chest pain, and SpO₂ 82%. What is the nurse's priority?
Support oxygenation, rapidly assess ABCs, activate urgent evaluation, and prepare for prescribed diagnostic and treatment measures.
A patient has a tidal volume of 500 mL and a respiratory rate of 20/min. Calculate the minute ventilation
10,000 mL/min, or 10 L/min
A patient with severe hypoxemia remains distressed despite supplemental oxygen. What escalation should the nurse anticipate?
Advanced respiratory support, such as noninvasive ventilation or intubation, depending on the patient's status
Differentiate neonatal respiratory distress syndrome from ARDS in terms of the primary underlying cause.
Neonatal RDS primarily results from surfactant deficiency in premature infants; ARDS results from systemic or direct injury to the alveolar-capillary membrane.
A patient taking theophylline develops nausea, tremors, tachycardia, and seizures. What should the nurse suspect?
Theophylline toxicity; it has a narrow therapeutic index.
A patient with severe asthma has a silent chest and can speak only one word at a time. Why is the absence of wheezing concerning?
Airflow may be so severely reduced that little air is moving to produce wheezing, indicating impending respiratory failure.
A patient with COPD is increasingly drowsy, has a respiratory rate of 8/min, PaCO₂ of 72 mm Hg, and pH of 7.28. Identify the primary problem and anticipated treatment.
Hypoventilation causing hypercapnic respiratory acidosis; prepare for ventilatory support, such as BiPAP or mechanical ventilation.
A postoperative patient develops sudden dyspnea, hypotension, absent unilateral breath sounds, and tracheal deviation. Explain how the condition causes decreased cardiac output.
Increased pleural pressure compresses great vessels, decreases venous return, reduces preload and cardiac output, and can cause obstructive shock
A patient with active pulmonary tuberculosis is admitted. Identify the required isolation precautions and the major medication-related toxicity that requires vision monitoring.
Airborne precautions; ethambutol can cause optic toxicity, including color-vision changes.
A patient with cystic fibrosis receives dornase alfa. Explain its therapeutic purpose
It breaks down extracellular DNA in respiratory secretions, reducing mucus viscosity and improving clearance.
A patient with respiratory distress becomes confused, cyanotic, and exhausted. Prioritize the nurse's actions using ABCs.
Immediately address airway and breathing, call for emergency assistance, provide oxygen and prepare for advanced airway/ventilatory support; do not delay escalation.