Case Study, Chapter 20, Assessment of Respiratory

Function
1. John April, 24 years of age, is a male patient who was admitted to the
surgical unit after a successful repair of an inguinal hernia. He is 5 feet 10
inches tall and weighs 120 kg. He has a neck circumference of 21 inches. The
patient has a morphine PCA. He has no known drug allergies. His vital signs
are as follows: blood pressure, 122/70 mm Hg; respiratory rate, 26
breaths/min; heart rate, 88 bpm; and temperature, 98.6°F. The patient
complains of incision pain and rates it on the pain scale as 7 of 10. His family
is visiting at the bedside. The nurse administers a bolus dose of morphine.
Fifteen minutes after administering the pain medication, a family member
enters the hallway and yells, “We need help in here! John is not breathing.”
The nurse finds John having periods of apnea lasting a few seconds followed
by a short snorting gasp and then he begins breathing at a rate of 12
breaths/min. His lips are bluish in coloration and so are his nail beds. The
patient is lying supine in the bed. He awakens as the nurse enters, but is
very lethargic and somnolent. (Learning Objectives 4 and 5)

a. Which assessment parameters are appropriate to determine the

characteristics and severity of the symptoms that the patient is
exhibiting?

b. Which nursing interventions should the nurse institute? Which

intervention must be provided immediately?

c. Explain the possible reasons for the patient’s sudden decline in the
respiratory status.

2. Mr. Williams, a 72-year-old man, is scheduled for a bronchoscopy, due to

changes noted on a recent chest x-ray. A retired factory worker, Mr. Williams
recently was notified that the buildings that he had worked in for over 25
years were destroyed due to asbestos. Additionally, the number of
employees from this company with respiratory diseases or allergies is
significantly above the national averages. (Learning Objective 6)

a. What is the rationale for the bronchoscopy in Mr. Williams?

b. List preprocedure nursing interventions.

c. What is the rationale for the administration of atropine preprocedure?

d. For what postprocedure complications should the nurse assess Mr.

Williams?