Author Question: Which patient assessment indicates the most severe respiratory distress? a. Nasal flaring, ... (Read 61 times)

strangeaffliction · **on:** Jul 11, 2018

Which patient assessment indicates the most severe respiratory distress?

a. Nasal flaring, symmetrical chest wall expansion, SaO2 88
b. Abdominal breathing, SaO2 97
c. Substernal retraction, SaO2 84
d. Substernal retraction, SaO2 90

Question 2

Which preoperative teaching should a nurse include for a person scheduled for a partial laryngectomy? (Select all that apply.)

a. Tracheal suction will be frequent
b. The presence of a temporary tracheotomy
c. That isolation will be required for 24 hours
d. The surgery involves removal of a diseased vocal cord
e. Some speech will be retained
f.
The sense of smell and taste will be lost

Leostella20 · **Reply #1 on:** Jul 11, 2018

Answer to Question 1

ANS: C
Observe the patient's facial expressions and signs of respiratory distress, such as flaring nostrils, substernal or clavicular retractions, asymmetrical chest wall expansion, and abdominal breathing. The lower the SaO2, the more severe the respiratory distress.

Answer to Question 2

ANS: A, B, D, E
A partial laryngectomy involves the removal of the diseased cord and possible thyroid cartilage. There will be a temporary tracheostomy that will be closed once edema is under control. Tracheal suctioning will be done frequently. There will be some vocal ability retained. Isolation is not required. Sense of smell and taste are lost with a total laryngectomy.