Help with breathing pattern case study

  1. 1
    Hi, I'm a fairly new nursing student struggling with a few questions on a case study on breathing patterns.
    Here's the study:
    Josh Haskell, a nine-year-old boy, is brought to the Health Center by his mother because he is experiencing dyspnea and a cough.
    The nurse assesses Josh's vital signs. His respirations are rapid and shallow.

    What is the best technique for the nurse to use to assess Josh's respirations accurately?
    A) Observe chest expansion for fifteen seconds and multiply by four.
    B) Encourage Josh to breathe as deeply and slowly as possible.
    C) Watch for nasal flaring and count the air exchanges with each movement.
    D) Place a hand on Josh's chest and count the hand motion.
    I think the answer is C, but not sure?

    To determine the need for the application of a nasal cannula, which assessment is most important for the nurse to perform?
    A) Measure oxygen saturation.
    B) Auscultate breath sounds.
    C) Measure capillary refill.
    D) Observe chest excursion.

    In assessing Josh's breath sounds, the nurse should ask him to perform which action?
    A) Hold his breath for fifteen seconds.
    B) Repeat the phrase, "Ninety-nine."
    C) Cough deeply after each breath.
    D) Breathe deeply through the mouth.

    To measure capillary refill, the nurse must first perform which action?
    A) Count Josh's radial pulse.
    B) Compress Josh's nailbed.
    C) Obtain a healthcare provider's prescription.
    D) Elevate the extremity to be assessed.

    Any help on any of these questions would be much appreciated!!
    dcam likes this.
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  3. 7 Comments so far...

  4. 1
    1)D is the best answer,(w/ dyspnea and rapid breathing the pt will use his accessory muscles, I have yet to encounter one who doesnít) therefore putting a hand on Josh's chest will give better visualization
    2)A- low 02 saturation(hypoxia) is indicative for O2 theraphy
    3)D- all I know is you have to ask the pt. to breathe deeply, for each and every auscultation site and itís the closest one
    4)C-must be elevated at about the level of the right atrium

    im just a 3rd year student btw(although for the last 2 years ive been frequently assigned to pulmonary/contagious units)...
    so take this w/ a pinch of salt
    lucky3773 likes this.
  5. 0
    Lucky3773,

    I think you need to take some time and read in your books or google and do some reading for the answers. I think you were Lucky to have someone just out right give you answers. I am not in nursing class yet, but just read these questions carefully and the answers are there.

    Number 3- You have been to the dr. I am sure in your lifetime and they assess your breathing....have you ever been asked to repeat the phrase 99 or to hold your breath....no, they ask you to take deep breaths through your mouth and they say again, good, again as they move the stethoscope around.

    Does it make sense to check capillary refill and based on that give someone oxygen or observe chest excursion etc. You need to determine what is nasal cannula and if you don't know then look it up as it is to deliver supplemental oxygen for someone in need of respiratory help.

    IMO, and I am not there yet, you need to spend some time so you really understand why it is the answer it is.
  6. 0
    Racquetmom,
    I have actually spent days researching/reading to find the answers to these questions. There are 30 questions in the case study and these are the only ones that I have not been able to find the answers for even after a lot of frustrating hours researching them.
    On #3, you're right, it's obvious that you wouldn't have the pt. hold his breath but from my reading, having the pt. say "ninety-nine" can help you determine if there are fine crackles or other abnormalities in the lungs. I assumed this wouldn't be the correct answer, but with breathing difficulty, I couldn't be 100% positive that you wouldn't want to auscultate for respiratory crackles or other problems that may be contributing to the problem.
    I am aware of what a nasal cannula is. I knew that the nurse would want to measure the oxygen saturation level before administering oxygen, but it also seems logical to me that you would want to check capillary refill since my instructed has said that is also a quick way to help determine if the client is in need of oxygen due to poor blood flow.
    Most of these questions I had narrowed down to 2 options, so I was looking for a second opinion and someone was kind enough to take the time to give it to me.
    Thanks for your concern for my stupidity on questions that may seem common sense to you, but as a new nursing student, I'm just not confident enough to make guesses on questions that I haven't been able to find the answers to without asking for a little help from someone more experienced. I'm sure this confidence will come with time and more experience.
  7. 0
    Actually those were the first 4 questions of the case study!
  8. 0
    So the school is using case studies from 2010....interesting.

    Just for giggles......two of those "answered" are wrong.

    The answer for #1 is C.
    Nasal flaring is seen mostly in infants and younger children.
    Any condition that causes the infant to work harder to breathe can cause nasal flaring. While many causes of nasal flaring are not serious, some can be life threatening.
    Nasal flaring

    The answer for #2 is C and D. The O2 desatuation inchildren is a LATE sign that the child needs O2. Childre willcompensate for extended peroids of time....once they desat you are in CRITICAL trouble. How hard the child is breathing is you FIRST indicator the child needs O2. If they continue to be SOB the cap refill will begin to increase


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  9. 0
    Quote from lucky3773
    Hi, I'm a fairly new nursing student struggling with a few questions on a case study on breathing patterns.
    Here's the study:
    Josh Haskell, a nine-year-old boy, is brought to the Health Center by his mother because he is experiencing dyspnea and a cough.
    The nurse assesses Josh's vital signs. His respirations are rapid and shallow.

    What is the best technique for the nurse to use to assess Josh's respirations accurately?
    A) Observe chest expansion for fifteen seconds and multiply by four.
    B) Encourage Josh to breathe as deeply and slowly as possible.
    C) Watch for nasal flaring and count the air exchanges with each movement.
    D) Place a hand on Josh's chest and count the hand motion.
    I think the answer is C, but not sure?

    To determine the need for the application of a nasal cannula, which assessment is most important for the nurse to perform?
    A) Measure oxygen saturation.
    B) Auscultate breath sounds.
    C) Measure capillary refill.
    D) Observe chest excursion.

    In assessing Josh's breath sounds, the nurse should ask him to perform which action?
    A) Hold his breath for fifteen seconds.
    B) Repeat the phrase, "Ninety-nine."
    C) Cough deeply after each breath.
    D) Breathe deeply through the mouth.

    To measure capillary refill, the nurse must first perform which action?
    A) Count Josh's radial pulse.
    B) Compress Josh's nailbed.
    C) Obtain a healthcare provider's prescription.
    D) Elevate the extremity to be assessed.

    Any help on any of these questions would be much appreciated!!
    I'm sure the original author has long since completed this, but if anyone else out there is looking for help on this case study, definitely do your own research! I can tell you some or all responses from every contributor who posted answers to this are incorrect according to Evolve.
    I'm not bashing or trying to argue with anyone's knowledge or experience. I'm just informing other students that the some of the responses provided are NOT what Evolve will count as correct. I am doing this case study right now and I am very glad I second guessed and looked them up.
  10. 0
    to measure capillary refill, the nurse must first perform which action?
    a) count josh's radial pulse.
    b) compress josh's nailbed.
    c) obtain a healthcare provider's prescription.
    d) elevate the extremity to be assessed.

    capillary refill is an indicator of local blood flow, not oxygenation. ok, so if you have poor blood flow in one area you have poor oxygenation in that area, but it tells you nothing about systemic oxygenation. radial pulse rate tells you nothing about this. you do not need any prescription to do this basic assessment.

    to recap: to check capillary refill, compress the area until it blanches (turns white, from the french, blanche, white). release and count in seconds how long it takes to turn pink again. normal capillary refill is <3 seconds (count to yourself, "one mississippi, two mississippi, three mississippi"), and for most people a fingertip will pink right up as soon as you release pressure. more than that suggests arterial disease or occlusion, or drastically low blood pressure (which you would take with a bp cuff or arterial line anyway). chart your findings as something like, "capillary refill <3 seconds right great toe, >6 seconds left great toe,"
    or "prompt (or brisk) all extremities." (do not write "extremity blanches normally." some people who don't realize what "blanching" means think that saying that indicates normal capillary fill. they are wrong.)

    elevating the extremity decreases local arterial blood pressure and in some people will artificially prolong capillary refill. wrong answer.


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