NUR 501 Exam II

Digestion begins with mastication.

Peristalsis moves food into the stomach.

Stores food; mixes food,liquid, and digestive juices;moves food into small intestines

Duodenum, jejunum, and ileum

• The primary organ of bowel elimination.
• Some absorpt. of H20 and electrolytes

Expels feces and flatus from the rectum

• Normal GI tract function
• Sensory awareness of rectal distention and rectal contents
• Voluntary sphincter control
• Adequate rectal capacity
• Compliance

• Age Diet
• Fluid intake
• Physical activity
• Psychological factors
• Personal habits
• Position during defecation
• Pain
• Pregnancy
• Surgery and anesthesia
• Medications, laxatives,and cathartics
• Diagnostic tests

suppresses peristalsis and decreases gastric emptying

slow peristalsis and segmental contractions often results in constipation

inhibit gastric acid secretion and depress gastrointestinal motility

(Although helpful in treating hyperactive bowel disorders- cam cause constipation)

produce diarrhea by disrupting the normal bacterial flora in the GI tract

cause GI irritation that increases the incidence of bleeding with serious consequences to older adults; rectal bleed is often observed w/ GI irritation

prostaglandin inhibitor; interferes w/ the formation and production of protective mucus and causes GI bleeding

suppress the secretion of hydrochloric acid and interfere with the digestion of some foods

causes discoloration in the stool (black), nausea, vomiting, constipation (dia. is less commonly reported), and abdom. cramps

Decreased salivation and mastication

Decreased motility

Decreased nutrient absorption - make sure they are getting nutrient rich foods

• Increase in intestinal wall pouches
• Constipation
• Missed defecation signal

Decreased size

Decreased acid secretions, motor activity & mucosal thickness

1100-1400 mL daily

• Constipation 
• Impaction
• Diarrhea
• Incontinence
• Flatulence
• Hemorrhoids

A symptom, not a disease;infrequent stool and/or hard, dry,small stools that are difficult to eliminate

Results from unrelieved constipation; a collection of hardened feces wedged in the rectum that a person cannot expel

an increase in the number of stools and the passage of liquid, unformed feces

Inability to control passage offeces and gas to the anus

Accumulation of gas in the intestines causing the walls to stretch

Dilated, engorged veins in the lining of the rectum

Temporary or permanent artificial opening in the abdominal wall

Surgical opening in the ileum or colon

stoma.

• Loop colostomy
• End colostomy
• Double-barrel colostomy

This is temporary in the transverse colon.

Proximal end forms stoma, and distal end is removed or sewn closed.

Bowel is surgically cut, and both ends are brought through the abdomen.

• Usual elimination pattern
• Patient description of stool characteristics
• Routines to promote normal elimination
• Use of artificial aids at home
• Presence & status of bowel diversions
• Changes in appetite 
• Diet history
• Daily fluid intake
• Surgery/illness affecting GI tract
• Medication history
• Emotional state
• History of exercise
• History pain/discomfort
• Social history
• Mobility & dexterity

• Mouth,
• abdomen, and
• rectum

• Fecal characteristics
• Fecal specimens

• Radiologic imaging, with or without contrast
• Endoscopy
• Ultrasound
• Computed tomography (CT) or
• magnetic resonance imaging(MRI)

• Proper Fluid and Food Intake
• Regular exercise
• Maintenance of Skin Integrity

• Goal – normal elimination
• Assess defecation frequency, feces character andproblem foods

Ambulate as soon as possible in acute care

High risk for skin breakdown with fecal incontinence or diarrhea

No urine produced

Bacteria in the urine that leads to the spread of organisms into the kidneys and possible leads to bactereima or urosepsis (bacteria in the bloodstream)

bacteria in the bloodstream

Inflammation of the bladder.

Presence of large proteins in the urine. (Kidneys do not filter large proteins. Normally insulin will break down but if insufficient will lead to proteinuria)

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.(Kidney diseases=decreased production=anemia)

Urination; the act of voiding

increase in nitrogeneous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions

Awakening to void one or more times at night.

Decreased urine output.

Excessive urine output

Irreversible damage to the kidney tissue

Reversible; Sudden loss of function; Overdose, meds, posioning, excessive blood loss can progress to chronic renal failure

An accumulation of urine due to the inability of the bladder to empty. Void small amounts 2-3 times per hour. Bladder distension/fullness

Involuntary leakage of urine

Pain or burning during urination. (Associated with lower UTIs as urine flows over inflamed tissues)

Blood-tinged urine

Kidney infection

• Kegels
• Surgical intervent.
• biofeedback
• electrical stimulations
• absorbent products

Loss of urine w/ increased intraabdominal pressure (coughing, laughing, sneezing, or lifting w/ full bladder.)

Involuntary leakage of urin during increased abdominal pressure in the absence of bladder muscles contraction

Cant get to the bathroom on time (temporary); External reasons; Intact nervous system; Schedule toileting

Involuntary; passage of urine after a strong sense of urgency to void

Ureters brought to the abdominal surface. Two collection bags. Transureterostomy where the two ureters are connected into one

Tube placed directly into the renal pelvis

The weight or degree of concentration of a substance compared with an equal volume of water. Normal Range 1.010-1.030

• Production of erythropoietin is essential to maintaining a normal red blood cell (RBC) volume.
• Production of renin, prostaglandin E2, and prostacyclin affects blood pressure.
• Kidneys affect calcium and phosphate regulation

• Remove waste from the blood to form urine
• fluid and electrolyte balance

influence bladder function.

Bladder contraction + Urethral sphincterand pelvic floor muscle relaxation

• 1. Stretching of bladder wall signals the micturition center in the sacral spinal cord.
• 2. Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control.
• 3. When a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract, and the bladder empties.

• Disease conditions
• Medications and medical procedures
• Surgical procedures
• Diagnostic examination of urinary system
• Sociocultural factors (need for privacy)
• Psychological factors (anxiety, stress, privacy)
• Fluid balance ( Nocturia, polyuria, oliguria, anuria)
• Diuresis
• Fever
• Growth & Development

Muscle tone

Restriction of fluid intake lowers urine output. Stress causes fluid retention.

• Restriction of fluid intake lowers urine output
• Direct visualization causes localized trauma and edema;patients may have difficulty voiding.

• Some cause urinary retention and/or overflow incontinence.
• Some cause urgency and incontinence.
• Some change the color of urine.

• Prerenal, renal, postrenal classification
• Conditions of the lower urinary tract
• Diabetes mellitus and neuromuscular diseases such asmultiple sclerosis
• Benign prostatic hyperplasia
• Cognitive impairments (e.g., Alzheimer’s)
• Diseases that slow or hinder physical activity
• Conditions that make it difficult to reach and use toiletfacilities
• End-stage renal disease, uremic syndrom

• Urinary retention
• Urinary tract infection
• Urinary incontinence
• Urinary diversion

• patient’s urination pattern and symptom
• factors affecting urination
• identify urinary alterations

• Nursing History
• Physical assessment
• Assess urine
• Assess the patient’s perception of urinary problems as it affects self-concept and sexuality.
• Gather relevant laboratory and diagnostic test data.

• Skin and mucosal membranes
• Kidneys & bladder
• Urinary meatus

• Intake and output
• Urine characteristics (color, clarity, odor)

4.6-8.0

none- 8mg/100mL

None

None

None

1.0053-1.030

• Maintaining elimination habits
• Medications
• Catheterization

• Relieving discomfort of bladder distention, providing decompression
• obtaining sterile urine specimen, when clean catch is unavail.
• Assessing residual urine after urination
• managing pts w/ spinal cord inj., neuromusclar degeneration, or incompetent bladder long term

• obstruction to urine outflow
• surgical repair of bladder, urethra and surrounding struct.
• prevention of urethral obstruction from blood clots after genitourinary surgery
• measurement of urinary output in crit. ill pts
• continuous or intermittent bladder irrigations

• severe urinary retention w/ recurrent episodes of uti
• skin rash, ulcers, or wounds irritated by with urine
• terminal illness when bed linen changes are painful for pts

• Pelvic floor strengthening
• Bladder retraining
• Habit training
• Self – catheterization
• Maintaining skin integrity
• Promotion of comfort

• Provide frequent opportunities to void. Older adults have a smaller bladder capacity than younger adults.
• Encourage older adults to empty the bladder completely before and after meals and at bedtime.
• Encourage patients to increase fluid intake to at least six to eight glasses a day unless medically contraindicated.

legally and ethically

all unauthorized readers.

HIPAA; the minimum necessary.

Physical, psychosocial, environmental, self-care, patient education, knowledge level, and discharge planning needs

• Communication
• Legal documentation
• Reimbursement
• Education
• Research
• Auditing/monitoring

• Correct all errors promptly, using the correct method.
•  Record all facts; do not enter personal opinions.
• Do not leave blank spaces in nurses’ notes.
• Write legibly in permanent blank ink.
• If an order was questioned, record that clarification was sought.
• Chart only for yourself, not for others.
•  Avoid generalizations.
• Begin each entry with the date/time and end with your signature and title.
•  Keep your computer password secure.

• Factual
• Accurate
• Complete
• Current
• Organized

• Subjective,
• objective,
• assessment,
• plan

• Subjective,
• objective,
• assessment,
• plan,
• intervention,
• evaluation

• Problem,
• intervention,
• evaluation

• Data,
• action,
• response

• Source records: A separate section for each discipline
• Charting by exception (CBE):Focuses on documenting deviations
• Case management plan and critical pathways:Incorporate a multidisciplinary approach to care- Variances

• Medicare has specific guidelines for establishing eligibility for home care.
• Medicare guidelines for establishing a patient’s home care cost reimbursement serve as the basis for documentation by home care nurses.
• Documentation is the quality control and justification for reimbursement from Medicare, Medicaid, or private insurance.
• Nurses need to document all their services for payment.

• Occurs with transfer of patient care
• Provides continuity and individualized care
• Reports are quick and efficient.

• Situation-background-assessment-recommendation(SBAR)
• Document every call
• Read back

• Used to document any event that is not consistent with the routine operation of a health care unit or the routine care of a patient
• Follow agency policy

• Application of computer and information science for managing health-related data
• Focus on the patient and the process of care
• Goal is to enhance the quality and efficiency of care provided.
• Driven by the Health Information Technology forEconomic and Clinical Health Act (HITECH)

Nursing Information Systems

• Increased time to spend with patients
• Better access to information
• Enhanced quality of documentation
• Reduced errors of omission
• Reduced hospital costs
• Increased nurse job satisfaction
• Compliance with accrediting agencies
• Common clinical database development

• Clinical Information Systems  (CISs) and
• administrative information systems.

• Monitoring systems,
• order entry, and
• laboratory,
• radiology, and
• pharmacy systems

• Improves accuracy
• Speeds implementation
• Improves productivity
• Saves money

• A continuous process characterized by open-­
• mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant
• Recognizing that an issue exists, analyzing information, evaluating information, and making conclusions

• I. Specific knowledge base in nursing
• II. Experience
• III. Critical thinking competencies
• IV. Attitudes for critical thinking
• V. Standards for critical thinking
• A. Intellectual standards
• B. Professional standards

• Interpretation
• Analysis
• Inference
• Evaluation
• Explanation
• Self-­‐regulation

• Truth seeking
• Open-­‐mindedness
• Analytic approach
• Systematic approach
• Self-­‐confidence
• Inquisitiveness
• Maturity

• Scientific method
• Problem solving
• Decision making
• Diagnostic reasoning and inference
• Clinical decision making
• Nursing process as a competency

• Confidence
• Independence
• Fairness
• Responsibility
• Risk taking
• Discipline
• Perseverance
• Creativity
• Curiosity
• Integrity
• Humility

A tool used to clarify concepts throughreflection by thinking back or recallingsituations

A visual representation of patient problems andinterventions that illustrates an interrelationship

• Identify the nursing diagnoses and collaborative problems of each patient. 
• Decide which are most urgent. 
• Consider the time it will take to care for those patients. 
• Consider the resources that you have to manage each problem. 
• Consider how to involve the patients as participants in care. 
• Decide how to combine activities. 
• Decide which nursing care procedures to delegate. 
• Discuss complex cases with the health care team.

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

• Collection of information from primary and secondary sources 
• Interpretation and validation of data to ensure a completedatabase

• establish database about patient’s perceived needs, health problems, and responses to problems
• Data may also reveal related experiences, health practices, goals, values & expectations about health care

• Patient (interview, observation, physicalexamination)—the best source of information 
• Family and significant others (obtain patient’sagreement first) 
• Health care team 
• Medical and other records 
• Scientific literature 
• Nurse’s experience

• Collect data. 
• Cluster cues, make inferences, and identifypatterns and problem areas. 
• Critically anticipate. 
• Be sure to have supporting cues before making an inference. 
• Knowing how to probe and frame questions is askill that grows with experience.

• To conduct an accurate and complete assessment, you need to consider a patient’s cultural background. 
• When cultural differences exist between you and a patient, respect the unfamiliar and be sensitive to a patient’s uniqueness. 
• If you are unsure about what a patient is saying, ask for clarification to prevent making the wrong diagnostic conclusion.

• Biographical information
• Patient expectations
• Reason for seeking health care
• Present illness or health concerns
• Health history
• Family history
• Environmental history
• Psychosocial history
• Spiritual health
• Review of systems
• Documentation of findings

• The last component of a complete assessment
• Legal and professional responsibility
• Requires accurate and approved terminology and abbreviations

Identification of a diseasecondition based on specificevaluation of signs and symptoms

Clinical judgment about the patient in response to an actual or potential health problem

Actual or potential physiological complication that nurses monitor to detect a change in patient status

• Provides a precise definition of a patient’s problem that gives nurses and other members of the health care team a common language for understanding patients’ needs 
• Allows nurses to communicate what they do among themselves and with other health care professionals and the public 
• Distinguishes the nurse’s role from that of the physician or other health care provider 
• Helps nurses focus on the scope of nursing practice

• Assessment of patient’s health status:
•    • Patient, family, and health care resources constitute database.
•    • Nurse clarifies inconsistent or unclear information.
•    • Critical thinking guides and directs line of questioning and examination to reveal detailed and relevant database.
• Validate data with other sources.
• Are additional data needed? If so, reassess.If not, continue...
• Interpret and analyze meaning of data
• Data clustering
•    • Group signs and symptoms.
•    • Classify and organize.
• Look for defining characteristics and related factors.
• Identify patient needs. 
• Formulate nursing diagnoses and collaborative problems.

• a set of signs or symptoms gathered during assessment that you group together in a logical way.
• Data clusters are patterns of data that contain defining characteristics—clinical criteria that are observable and verifiable.

an objective orsubjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion.

• a condition, historical factor, or causative event that gives a context for the defining characteristics and shows a type of relationship with the nursing diagnosis. 
• A related factor allows you to individualize a nursing diagnosis for a specific patient.

Describes human responses to health conditions or life processes

Describes human responses to health conditions/life processes that may develop

A clinical judgment of motivation, desire, and readiness to enhance well-­‐being and actualize human health potential

• Diagnostic label
• Related factors (etiology)
• Defining characteristics

• Name of ND as approved by NANDA 
• All have a definition which describes the characteristics of the human response identified (definition helps you ID the correct ND)

• Identified from patient assessment data; reason patientis displaying the ND 
• Four categories – pathophysiological, treatment-­‐related, situational, and maturational

• Symptoms patient is manifesting
• Used only with 3 part ND statements

• • Data Collecting
• • Data Clustering
• • Interpreting/Analyzing
• • Diagnostic statement (Labeling)

• 1. Identify the patient’s response, not themedical diagnosis.
• 2. Identify a NANDA-­‐I diagnostic statement ratherthan the symptom.
• 3. Identify a treatable cause or risk factor rather thana clinical sign or chronic problem that is nottreatable through nursing intervention.
• 4. Identify the problem caused by the treatment ordiagnostic study rather than the treatment or study itself.
• 5. Identify the patient response to the equipment rather than the equipment itself.
• 6. Identify the patient’s problems rather than your problems with nursing care.
• 7. Identify the patient problem rather than the nursing intervention.
• 8. Identify the patient problem rather than the goal of care.
• 9. Make professional rather than prejudicial judgments.
• 10. Avoid legally inadvisable statements.
• 11. Identify the problem and its cause to avoid a circular statement.
• 12. Identify only one patient problem in the diagnostic statement.

• Ordering of nursing diagnoses or patient problems uses determinations of urgency and/or importance to establish a preferential order for nursing actions. 
• Helps nurses anticipate and sequence nursing interventions
• The order of priorities changes as a patient’s condition changes. 
• Priority setting begins at a holistic level when you identify and prioritize a patient’s main diagnoses or problems. 
• Patient-centered care requires you to know a patient’s preferences, values, and expressed needs. 
• Ethical care is a part of priority setting.

A specific and measurable behavior or response that reflects a patient’s highest possible level of wellness and independence in function

An objective behavior or response expected within hours to a week

An objective behavior or response expected within days, weeks, or months

• Always partner with patients when setting their individualized goals.
• For patients to participate in goal setting, they need to be alert and must have some degree of independence in completing activities of daily living, problem solving, and decision making.
• Patients need to understand and see the value of nursing therapies, even though they are often totally dependent on you as the nurse.

• Patient centered
• Singular goal or outcome
• Observable
• Measurable
• Time limited
• Mutual factors
• Realistic

• An objective criterion for goal achievement 
• A specific, measurable change in a patient’s status that you expect in response to nursing care 
• Direct nursing care 
• Determine when a specific, patient-­‐centered goal has been met 
• Are written sequentially, with time frames 
• Usually, several are developed for each nursing diagnosis and goal.

• Know the scientific rationale for the intervention
• Possess the necessary psychomotor andinterpersonal skills 
• Be able to function within a setting to use health care resources effectively

• Nurse initiated: Independent—Actions that a nurse initiates
• Physician initiated: Dependent—Require an order from a physician or other health care professional
• Collaborative: Interdependent—Require combined knowledge, skill, and expertise of multiple health care professionals

• When preparing for physician-initiated or collaborative interventions, do not automatically implement the therapy, but determine whether it is appropriate for the patient. 
• The ability to recognize incorrect therapies is particularly important when administering medications or implementing procedures.

• Characteristics of nursing diagnosis
• Goals and expected outcomes
• Evidence base for interventions
• Feasibility of the interventions
• Acceptability to the patient
• Nurse’s competency

• Nursing care plan  
• Interdisciplinary care plan

• Nursing diagnoses, goals andexpected outcomes, and nursing interventions, anda section for evaluation findings so any nurse isable to quickly identify a patient’s clinical needsand situation
• Reduces the risk for incomplete, incorrect, orinaccurate care
• Changes as the patient’s problems and status change

Contributions from all disciplines involved in patient care.

A critical time, when nurses collaborate and share important information that ensures the continuity of care for a patient and prevents errors or delays in providing nursing interventions

• Communicates information from off going to on coming patient care personnel= “Nurse handoff” 
• Focus your reports on the nursing care, treatments, and expected outcomes documented in the care plans.

• Critical pathways are patient care plans that provide the multidisciplinary health care team with activities and tasks to be put into practice sequentially. 
• The main purpose of critical pathways is to deliver timely care at each phase of the care process for a specific type of patient.

• Provide a visually graphic way to show the relationship between patients’ nursing diagnoses and interventions 
• Group and categorize nursing concepts to give you a holistic view of your patient’s health care needs and help you make better clinical decisions in planning care 
• Help you learn the interrelationships among nursing diagnoses to create a unique meaning and organization of information

• any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes. 
• Interventions include direct and indirect care measures aimed at individuals, families, and/or the community.

Treatments performed through interactions with patients

• -­‐Medication administration
• -­‐Insertion of anintravenous (IV) infusion
• -­‐Counseling during a time of grief
• Activities of DailyLiving(ADLs)
• Instrumental Activities of Daily Living (IADLs)
• Physical care techniques
• Lifesaving measures

Treatments performed away from the patient but on behalf of the patient or group of patients

• -­‐Managing the patient’s environment (e.g., safety and infection control)
• -­‐Documentation
• -­‐Interdisciplinary collaboration
• Communicating nursing interventions: Written or oral
• Delegating, supervising, and evaluating the work of other health care team members

Systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations

A preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems

• Evaluation is an ongoing process.
• If outcomes are met, patient goals are met. 
• Positive evaluations occur when nurses meet desired outcomes. 
• Positive evaluations lead nurses to conclude that interventions were successful.

• Resolve actual health problems
• Prevent potential problems
• Maintain a healthy state

Defines standards

• Being systematic
• Using criterion-­‐based evaluation
• Collaborating
• Using ongoing assessment data to revise care plan
• Communicating results

• Collaborate with the patient and family. 
• Use evaluative measures.
• Interpret and summarize findings. 
• Document results. 
• Revise care plan.

• 1. Examine the outcome criteria.
• 2. Evaluate the patient’s actual response.
• 3. Compare the established outcome criteria withthe actual response.
• 4. Judge the degree of agreement between the outcome criteria and the response.
• 5. If no or only partial agreement, what are the barriers?

• Has the goal been met?
• Does the patient agree?
• Document the discontinued plan.

• Reassessment
• Redefining diagnoses
• Goals and expected outcomes

• Appropriateness of the intervention: Based on the standard of care
• Correct application of the intervention
• A patient’s nursing diagnoses, priorities, and interventions sometimes change as a result of evaluation.

repeat the entire nursing process sequence for that nursing diagnosis to identify necessary changes to the plan.

• Environment
• Develop. needs
• Drug-Nutrient Interactions

• Breastfeeding,
• formula,
• solid foods

• Increased energy needs
• Eating disorders

• Pregnancy and lactation
• Eating disorders

• Decreased energy need
• Financial concerns (food insecurity)
• Illness related dietary needs

• Dietary intake and food preferences
• Unpleasant symptoms
• Allergies
• Taste, chewing, and swallowing
• Appetite and weight
• Use of medications

• Risk for aspiration
• Deficient knowledge
• Diarrhea
• Imbalanced nutrition: less than body requirements
• Imbalanced nutrition: more than body requirements
• Feeding self-care deficit
• Impaired swallowing
• Readiness for enhanced nutrition

• Interruptions
• Advancing diets
• Promoting appetite
• Assisting with oral feeding
• Enteral nutrition
• Parenteral nutrition

• Dietary education
• Meal planning
• Weight loss support
• Food safety

difficulty swallowing

• Myogenic- musclar (MD)
• Neurogenic- MS/Stroke
• Obstructive
• Misc.

• Cough when eating
• Voice tone/quality change after swallowing
• Abnormal movements of mouth, tongue or lips
• Slow, weak, imprecise,uncoordinated speech
• Abnormal gag
• Delayed swallowing
• Incomplete oral clearance (pocketing)
• Regurgitation
• Pharyngeal pooling
• Delayed/absent trigger to swallow
• Inability to speak

• Physiological factors
• Conditions affecting chest wall movementChronic disease

• Decreased oxygen-carrying capacity
• Hypovolemia
• Decreased inspired oxygen concentration Increased metabolic rate

• Pregnancy
• Musculoskeletal abnormalities
• Trauma
• Neuromuscular diseases
• CNS alterations

– rapid respirations, sighing breaths, numbness &tingling of hands/feet, light-headedness, and loss ofconsciousness

CO2 removed faster than produced by cellularmetabolism

Inadequate alveolar ventilation

– mental status change, dysrhythmia, potentialcardiac arrest…..convulsions, unconsciousness, death

• Inadequate tissue oxygenation at cellular level
• Life-threatening

– apprehension, restlessness, inability to concentrate, dizziness, behavioral changes, fatigued & agitated, cannot lay flat, increased pulse rate, increased rate/depth respirations…may see increased BP early

• – respiratory rate declines, cyanosis
• Central cyanosis versus peripheral cyanosis

• Nutrition
• Exercise
• Smoking
• Substance abuse
• Stress

• Nature of cardiopulmonary problem
• Signs and symptoms
• Onset and duration
• Severity
• Predisposing factors
• Effect of symptoms on patient

• Pain
• Fatigue
• Dyspnea
• Cough
• Wheezing
• Environmental or geographical exposures
• Smoking
• Respiratory infections
• Allergies
• Health risks
• Medications

• Inspection
• Palpation
• Percussion
• Auscultation
• Diagnostic tests

• Muscle contraction
• Blood flow
• Conduction system
• Arterial vesselcompliance

• Mechanics of breathing
• Oxygenation
• Breathing control/pattern
• Lung defenses
• Sleep and breathing

• Xanthelasma
• Corneal arcus
• Pale conjunctiva
• Cyanotic conjunctiva
• Petechiae on conjunctiva
• Cyanotic mucus membranes
• Pursed-lip breathing
• Neck vein distention
• Nasal flaring
• Retractions
• Chest asymmetry
• Skin cyanosis –peripheral vs. central
• Decreased skin turgor
• Dependent edema
• Periorbital edema
• Clubbing
• Splinter hemorrhages
• Nail bed cyanosis

• Vaccinations
• Lifestyle considerations
• Pollutants
• Teaching strategies

• Interventions for dyspnea
• Airway maintenance
• Secretions
• Hydration
• Humidification
• Nebulization
• Oxygen
• Breathing exercises
• Coughing and deep breathing
• Chest physiotherapy
• Postural drainage
• Suctioning
• Airways
• Promoting airway expansion

PaO2 < 55mmHgO2 saturation < 88% on room air