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Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Lesson Plan Chapter 20, Assessment of Respiratory Function Goals of the Lesson: Learning Objectives: The lesson plan for each objective starts on the next page. 20.1 Describe the structures and functions of the upper and lower respiratory tracts. 20.2 Describe ventilation, diffusion, perfusion, and ventilation--perfusion imbalances. 20.3 Explain proper techniques utilized to perform a comprehensive respiratory assessment. 20.4 Discriminate between normal and abnormal assessment findings identified by inspection, palpation, percussion, and auscultation of the respiratory system. 20.5 Recognize and evaluate the major symptoms of respiratory dysfunction by applying concepts from the patient’s health history and physical assessment findings. 20.6 Identify the diagnostic tests used to evaluate respiratory function and related nursing implications.

20.1 Describe the structures and functions of the upper and lower respiratory tracts. Lecture Outline

Figures, Tables, and Features Content

 Describe the basic purpose of the respiratory system and the lungs.  Describe the structures of the upper respiratory system and explain the functions of each of these structures.  Describe the paranasal sinuses.  Describe the cross-section of the nasal cavity.  Describe the structures of the lower respiratory system.  Describe the alveoli.  Explain the structure and function of the alveolar capillary membrane in relation to the exchange of gases. Describe the types of alveolar cells. Explain the function of surfactant. 

Explain the functions of the five lobes and the bronchiole tree.

Text page(s) 480--483

Figures 20-1 Cross-section of nasal cavity, p. 481 20-2 The paranasal sinuses, p. 481 20-3 The respiratory system, p. 482 20-4 Anterior view of the lungs, p. 483

Instructor’s Notes

Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Chapter 20, Assessment of Respiratory Function

20.2 Describe ventilation, diffusion, perfusion, and ventilation–perfusion imbalances. Lecture Outline

Figures, Tables, and Features

Content  Explain the mechanism of ventilation, the movement of air in and out of the lungs.  Define and explain respiration. Note that respiration is not breathing, but refers to the exchange of gases even though we count “respirations” and assess “respirations.”  Define pulmonary perfusion, O2 and CO2 transport.  Define ventilation--perfusion (V/Q) ratio and explain the four types of V/Q states. Describe perfusion, shunting, and the relationship with pulmonary circulation. Explain the results of hypoxia and respiratory distress due to shunting or increased dead space.

Text page(s) 483-488

Figures 20-5 Changes occur in the partial pressure of gases during respiration, p. 487 Tables 20-1 Lung Volumes and Lung Capacities, p. 485 20-2 Age-Related Changes in the Respiratory System, p. 489 Features Chart 20-1 Causes of Increased Airway Resistance, p. 484 Chart 20-2 Ventilation–Perfusion Ratios, p. 486 Chart 20-3 Partial Pressure Abbreviations, p. 486 Chart 20-4 Oxyhemoglobin Dissociation Curve, p. 487

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Instruct or’s Notes

Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Chapter 20, Assessment of Respiratory Function

20.3 Explain proper techniques utilized to perform a comprehensive respiratory assessment. Lecture Outline

Figures, Tables, and Features Content

 Assessment findings.

Text page(s) 493--504

 Demonstrate or describe the auscultation of the lungs.  Explain the landmarks of the chest and the location and sequencing of auscultatory sites.  Note that auscultation at each site should be for a full inspiration and expiration and valid interpretation may require two full inspirations and expirations at a site.  Describe the normal and abnormal sounds.

Instructor’s Notes

Features Chart 20-5 Assessment: Assessing Psychosocial Factors Related to Respiratory Function and Disease, p. 491 20-6 Risk Factors: Respiratory Disease, p. 491 20-7 Genetics in Nursing Practice: Respiratory Disorders, p. 491 20-8 Disparities in Pulmonary Health Related to Socioeconomics, Race, and Ethnicity: A Snapshot, p. 492

20.4 Discriminate between normal and abnormal assessment findings identified by inspection, palpation, percussion, and auscultation of the respiratory system. Lecture Outline

Figures, Tables, and Features Content

 Discuss basic lung capacities and their relationship to the assessment and severity of pulmonary dysfunction.  Describe the assessment of tidal volume and peak expiratory flow with a spirometer.  Define and describe the assessment of inspiratory force.  Discuss the implications of TV, peak flow rate, and inspiratory force on patient care management. Page 3 of 6 Copyright © 2018 Wolters Kluwer • All Rights Reserved

Text page(s) 484, 485, 501--503

Figures 20-6 Clubbed finger, p. 492 20-7 Technique for palpating the frontal sinuses at left and the maxillary sinuses at right, p. 493 20-8 At left, the nurse positions the light source for transillumination of

Instructor’s Notes

Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Chapter 20, Assessment of Respiratory Function

Lecture Outline

Figures, Tables, and Features Content

 Briefly discuss arterial blood gases. This material is covered in another chapter.  Describe pulse oximetry. Explain the method by which this works and state the normal values.  Explain factors which may interfere with the reliability of pulse oximetry readings.

Text page(s) the frontal sinus. At right, the nurse shields the patient’s brow and shines the light, p. 493 20-9 Method for assessing posterior respiratory excursion, p. 497 20-10 Palpation sequence for tactile fremitus, p. 497

Tables 20-3 Tools for Measuring Dyspnea, p. 25 20-4 Rates and Depths of Respiration, p. 37 20-5 Characteristics of Percussion Sounds, p. 40 20-7 Abnormal (Adventitious) Breath Sounds, p. 499 20-8 Assessment Findings in Common Respiratory Disorders, p. 500 Features Chart 20-9 Locating Thoracic Landmarks, p. 493

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Instructor’s Notes

Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Chapter 20, Assessment of Respiratory Function

20.5 Recognize and evaluate the major symptoms of respiratory dysfunction by applying concepts from the patient’s health history and physical assessment findings. Lecture Outline

Content  Discuss the importance of taking the health history and medication history.

Text page(s) 488--492, 500

 Describe the elements of physical assessment.  The physical findings for the most common respiratory diseases are summarized in Table 20-8.

Figures, Tables, and Features

Resources and In-Class Activities

Outside Assignmen ts/ Evaluation

Tables 20-8 Assessment Findings in Common Respiratory Disorders, p. 500

Pre/post-Lecture Quizzes Discussion Topics An elderly patient is scheduled for a thoracentesis. The nurse needs to recognize and evaluate the major symptoms of respiratory dysfunction by applying concepts from the patient’s health history and physical assessment findings.  Why is it important to obtain a chest x-ray before and after the procedure?  After a thoracentesis, for what potential complications should the nurse assess the patient? Case Study Mr. W is a 72-year-old patient scheduled for a bronchoscopy due to changes noted on a recent chest x-ray. A retired factory worker, Mr. W recently was notified that the buildings that he had worked in for over 25 years were destroyed due to asbestos.  What is the rationale for the bronchoscopy in Mr. W?  List preprocedure nursing interventions.

Clinical Assignmen ts Identify the major symptoms of respiratory dysfunction.

Features Chart 20-10 Risk Factors: Hypoventilati on, p. 501

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Instru ctor’s Notes

Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition Chapter 20, Assessment of Respiratory Function

Lecture Outline

Content

Figures, Tables, and Features

Resources and In-Class Activities

Outside Assignmen ts/ Evaluation

Instru ctor’s Notes

Text page(s) 



What is the rationale for the administration of atropine preprocedure? For what postprocedure complications should the nurse assess Mr. W?

20.6 Identify the diagnostic tests used to evaluate respiratory function and related nursing implications. Lecture Outline

Content

 List the procedures used in the diagnosis of respiratory function.  Describe each of these procedures and discuss the nursing implications for care.

Text page( s) 502-508

 Include specific nursing interventions related to each of the procedures in this discussion.

Link :

Easy Auscultation

Page 6 of 6 Copyright © 2018 Wolters Kluwer • All Rights Reserved

Figures, Tables, and Features

Resources and InClass Activities

Outside Assignments/ Evaluation

Figures 20-12 Measuring blood oxygenation with pulse oximetry.p. 503 20-13 Endoscopic bronchoscopy permits visualization of bronchial structures, p. 506 20-14 Endoscopic thoracoscopy, p. 507 Tables 20-9 Pulmonary Function Tests, p. 502

Pre/post-Lecture Quiz Fill-in-the-Blank  An oxygen saturation value of less than _____%, using pulse oximetry, indicates that tissues are not receiving enough oxygen.

Web Assignments Research diagnostic tests and related nursing implications used to evaluate respiratory function.

Instruct or’s Notes...