Introduction to Medical-Surgical Nursing, 6th ed.
31
Lesson Plans for
Acute Disorders of the Lower Respiratory Tract
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 31.1:
2. Identify the nursing implications of age-related changes in the respiratory system.
4. Explain nursing care of patients receiving therapeutic treatments for respiratory disorders.
Lesson 31.3:
6. Assist in developing a nursing care plan for the patient who has an acute respiratory disorder.
CHAPTER TEACHING FOCUS
• In this chapter, the student will have the opportunity to become familiar with the anatomy and
physiology of the respiratory system and to recognize the effects of age-related changes.
• The student will be shown how to assess patient respiratory health status by taking a health history and
performing a physical examination.
• The student will also be introduced to diagnostic tests and procedures—how they are performed and
what information they provide.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Oxygenation and Hemostasis
• Concept: Gas Exchange
• Exemplar: Pneumonia, p. 584
• Exemplar: Pulmonary Embolus, p. 593
THEME: Protection and Movement
• Concept: Infection
• Exemplar: Pneumonia, p. 584
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CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) A therapeutic measure that consists of percussion, vibration, and postural drainage is called
__________.
a) chest physiotherapy
b) suctioning
c) aerosol therapy
d) mechanical ventilation
2) Spirometry assesses __________.
a) slices or layers of the chest
b) concentrations of oxygen and carbon dioxide in the blood
c) ventilatory function of the lung
d) the bronchial tree structures
3) The most common complications of influenza are __________.
a) myocarditis and pericarditis
b) Reye syndrome and Guillain-Barré syndrome
c) seizures and confusion
d) bronchitis and viral or bacterial pneumonia
4) Accumulation of air in the pleural cavity that results in complete or partial lung collapse is called
__________.
a) hemothorax
b) pneumothorax
c) pleurisy
d) flail chest
5) Reexpansion of a collapsed lung may be accomplished by __________.
a) endotracheal suctioning
b) nasotracheal suctioning
c) a chest tube
d) IPPB
6) As part of cellular metabolic processes, one function of the respiratory system is to supply oxygen
and remove __________.
a) carbon monoxide
b) carbon dioxide
c) oxygen
d) nitrogen
7) A needle is inserted through the chest wall into the pleural space to remove fluid, blood, or air in a
procedure called __________.
a) thoracentesis
b) fiberoptic bronchoscopy
c) ventilation-perfusion
d) cytology
8) A potentially serious side effect of oxygen therapy for patients with a chronic respiratory condition is
__________.
a) respiratory compression
b) hypoventilation
c) respiratory depression
d) an allergic reaction
9) A possible dangerous consequence following treatment of an open chest wound is __________.
a) viral rhinitis
b) tension pneumothorax
c) pleurisy
d) acute bronchitis
10) One nursing diagnosis for a patient with pulmonary embolism includes Ineffective __________.
a) coping
b) stress response
c) infection control
d) tissue perfusion
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: Some signs of respiratory disorders are subtle and require noninvasive methods to detect.
What are signs that might lead a nurse to suspect a respiratory disorder?
Answer: Many signs of respiratory disorders, either rapid or slow breathing, can be a sign of hypoxia.
Flaring of the nares is a common sign of air hunger. A nurse’s inspection of the lips, tip of the nose, top of
Question: How would you explain the statement “Respiration is monitored and controlled by the brain”?
4 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.1
Textbook Objectives Covered
1. Identify data to be collected in the nursing assessment of the patient with a respiratory disorder.
3. Describe diagnostic tests or procedures for respiratory disorders and nursing interventions.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying acute respiratory disorders, including:
• Anatomy and physiology of the respiratory system
• Diagnostic tests and procedures
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• atelectasis (p. 561)
• crackles (p. 561)
• dyspnea (p. 558)
• rhonchus (pl. rhonchi) (p.
561)
• tachypnea (p. 575)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.1
Assignments 2 hours
1
READ – Textbook (pp. 557-561)
REVIEW
• Figure 31-1: Structure of the respiratory system and the bronchioles, alveoli, and capillaries
(p. 558)
• Figure 31-2: Normal inspiration (A) and expiration (B) (p. 559)
• Figure 31-3: Sequence for percussion and auscultation of the lungs (p. 562)
• Figure 31-4: Finger clubbing (p. 562)
• Table 31-1: Types of Breathing Patterns (p. 559)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 3 (p. 596)
ANSWER – Study Guide
• Part IA: 1-14 (p. 187)
• Part IB: 1-3 (p. 188)
• Part IE: 1-12 (p. 189)
• Part IH: A-E (p. 190)
• Part II I: 6, 17 (pp. 190-191)
2
READ – Textbook (pp. 558-560)
ANSWER – Text
ANSWER – Study Guide
• Part IC: 1, 2 (p. 188)
3
READ – Textbook (pp. 561-569)
REVIEW
• Figure 31-5: Normal functioning alveolus and pulmonary capillary blood flow (p. 566)
• Figure 31-6: The Allen test (p. 568)
ANSWER – Study Guide
• Part ID: 1-11 (p. 188)
SIMCHART
• Simulation: Scenario 1 – Wallace Peterson: Pneumonia with Hypoxia, Oxygen Delivery
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LESSON 31.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 31
Acute Disorders of the Lower Respiratory Tract
1
Slide 2
Nose
• External nose
• The part that is seen on the face
• Made of bones and cartilage covered with skin
• Lining: thick mucous membranes and small hairs
• Nasal cavity
• Lies over the roof of the mouth
• Lined with mucous membranes along with the cilia (small hairlike projections)
TALKING POINTS:
• What purpose do the mucous membranes serve?
Pharynx
• A 5-inch tube extending from the back of the mouth to the esophagus
Slide 4
Pharynx (cont.)
• A passage for the respiratory and digestive systems
• Functions in the formation of sounds, especially vowel sounds
• Tonsils located in the pharynx; may interfere with breathing, particularly nasal breathing, if
they become enlarged
Slide 5
Larynx
• The air passage between the pharynx and the trachea
• Contains vocal cords and several types of cartilage, including the thyroid cartilage and the
epiglottis
• During swallowing, the epiglottis acts like a lid to help prevent aspiration of food into the
trachea
TALKING POINTS:
• What is another name for the larynx?
Trachea
• A 4- to 5-inch tube descending from the larynx into the bronchi
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LESSON 31.1
Slide 7
Bronchi
• Passageway for air to and from the lungs
• Two primary bronchi split to the right and left from the trachea
• Right bronchus is shorter and wider and runs straighter up and down than the left
bronchus
TALKING POINTS:
• Which bronchus do foreign bodies from the trachea usually enter?
Slide 8
Bronchi (cont.)
• Larger bronchi divide into smaller, or secondary, bronchi; divide again into smaller tertiary
bronchi
• Tertiary bronchi divide into smaller bronchioles, which lead into tiny air sacs called alveoli
in the lungs
• Through the walls of the alveoli, exchange of oxygen and carbon dioxide takes place
Slide 9
• Each lung covered by membrane: the pleura
Lungs
• Located in right and left sides of the thoracic cavity within the chest wall
• Thoracic cavity is separated from the abdominal cavity by the diaphragm, a large sheet of
muscle
• Three lobes on the right and two on the left
Slide 10
Physiology of the Respiratory System
• Mechanism of breathing
• Inspiration: air entering the lungs
• Active contraction of the muscles and diaphragm and can be noted by an
enlargement of the chest cavity
• Expiration: air leaving the lungs
TALKING POINTS:
• The terms inhalation and exhalation are used interchangeably with inspiration and
expiration.
• What muscles are used to accomplish the movement required for inspiration and
expiration?
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LESSON 31.1
Slide 11
Physiology of the Respiratory System (cont.)
• Respiratory center
• Located in medulla; controls breathing
• Stimulated by changing levels of carbon dioxide and oxygen in arterial blood
• Chemoreceptors in the aorta and carotid artery monitor the pH and amount of carbon
TALKING POINTS:
• Where is the medulla located?
2
Slide 12
Age-Related Changes
• Muscle atrophy of pharynx and larynx, slackening vocal cords, less elasticity of laryngeal
muscles and cartilages
• May result in a gravelly, softer voice with a rise in pitch
• Deviation of trachea if scoliosis of upper spinal column
• Loss of lung elasticity, enlargement of the bronchioles, and a decreased number of
functioning alveoli
TALKING POINTS:
• Older adults who are hard of hearing may have a difficult time communicating with one
Slide 13
Chief Complaint and History of Present Illness
• Cough
• Onset, duration, frequency, type (wet or dry), severity, related symptoms (sputum
production, and pain)
• Dyspnea
• Onset, duration, severity, and precipitating events
• Pain
TALKING POINTS:
• What characteristics should be documented related to sputum production?
• Record the patient’s effort to treat the cough with measures such as medication,
vaporizers, and humidifiers, as well as the response to the treatments.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.1
Slide 14
Past Medical History and Family History
• Allergies, colds, pneumonia, tuberculosis, chronic bronchitis, emphysema, asthma, cancer
of the respiratory tract, cystic fibrosis, sinus infections, ear infections, diabetes mellitus,
and heart disease
• Conditions that suppress the immune response
Slide 15
Review of Systems
• Assess for fatigue, weakness, fever, chills, night sweats, earaches, nasal obstructions,
sinus pain, sore throat, hoarseness, edema, dyspnea, and orthopnea
• Ask about the usual diet and fluid intake
Functional Assessment
• Patient’s occupational history, including exposure to pathogens or substances that might
irritate or harm the respiratory tract
TALKING POINTS:
• Document exposure to any fumes, toxins, coal dust, silica, or sawdust.
• How are pack-years calculated for a smoker?
Physical Examination
• Head and neck
• Inspect the nose for symmetry and for deformity and gently palpate for tenderness
TALKING POINTS:
• How can the patency of each naris be assessed?
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LESSON 31.1
Slide 18
Physical Examination (cont.)
• Thorax
• Inspect chest for deformities and lesions and observe the breathing pattern and effort
• Palpate thorax for tenderness and lumps
TALKING POINTS:
• What is the purpose of percussion in examining the thorax?
• Listen for the normal movement of air in and out of the lungs and for abnormal breath
sounds: wheezes, rhonchi, and crackles.
3
Slide 19
Diagnostic Tests and Procedures
• Radiologic studies
• Chest radiography, fluoroscopy, ventilation-perfusion scan
• Imaging procedures
Slide 20
Question 1
• Breathing is controlled by the respiratory center, which is located in the _________.
A. arachnoid
B. cerebellum
C. cerebrum
D. medulla
TALKING POINTS:
Slide 21
Question 2
• Which of the following is not a reason why older persons may experience difficulty with
respiration?
A. Loss of lung elasticity
B. Enlargement of the bronchioles
C. Increase in ciliary function
D. Decreased number of functioning alveoli
TALKING POINTS:
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LESSON 31.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Divide the class into small groups. Have half
the groups describe the path of an oxygen
molecule as it moves from the external nose
to the blood and draw the path on the board.
Have the other groups describe the path of a
carbon dioxide molecule as it moves from
the blood in the tissues to the external nose
PRACTICE
• Have pairs of students demonstrate to each
other the breathing patterns described in
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
structures of the respiratory system and
describe the functions of each part.
• Post the following discussion topic online
and have students comment. Discuss the
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.1
2
PRACTICE
• Divide the class into small groups and ask
each group to identify ways in which the
age-related changes listed below might
affect other common respiratory disorders
such as pneumonia, the common cold, or
acute bronchitis. Next, have each group
identify several nursing interventions for
each and share their results with the class.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
changes that occur to the respiratory system
as a person gets older.
3
DISCUSS
• Present the scenarios below to the class.
For each scenario, ask how the nurse
should intervene along with the rationale for
each intervention.
• A patient who has had a ventilation-
perfusion scan an hour ago drops his
urinal and urine has soaked the bed
linens.
• A patient who recently had a
thoracentesis has a respiratory rate of
PRACTICE
• Divide the class into pairs. Each student
should write the names of a diagnostic
respiratory test on the front of index cards.
Partners should exchange cards and then
write a patient preparation, procedure care,
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
various tests and procedures used to
diagnose respiratory disorders.
• Post the following discussion topic online
and have students comment. Discuss
patient preparation and postprocedure care
for respiratory diagnostic procedures.
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.1
Critical Thinking Question
The assessment of a patient’s respiratory function should include a review of age-related
anatomy and physiology, lifestyle, conditions that affect other areas of the body, and
cultural attitudes. When collecting data from a patient with a respiratory disorder, what
information should a nurse obtain about the patient’s current health and lifestyle?
Discussion Guidelines: The respiratory system changes naturally as a result of the aging process.
Older individuals may have muscle atrophy that affects the larynx, pharynx, and position of the
Instructor Notes/Student Feedback
14 Chapter 31Acute Disorders of the Lower Respiratory Tract _________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.2
Instructor Preparation
Textbook Objectives Covered
4. Explain nursing care of patients receiving therapeutic treatments for respiratory disorders.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying acute respiratory disorders, including:
• Anatomy and physiology of the respiratory system
Materials and Supplies
• computer and PowerPoint
projector
• water source
Key Terms
• atelectasis (p. 561)
• crackles (p. 561)
• rhonchus (pl. rhonchi) (p.
561)
Assignments 2 hours
4
READ – Textbook (pp. 569-581)
REVIEW
• Figure 31-7: (A) The patient is positioned for a thoracentesis, (B) The needle is inserted into
the pleural space (p. 569)
• Figure 31-8: Incentive spirometry (p. 570)
• Figure 31-9: (A) Percussion, (B) Vibration (p. 571)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 5 (p. 596)
ANSWER – Study Guide
• Part IF: 1-4 (p. 189)
• Part IG: 1-7 (p. 189)
• Part II I: 4, 7-16 (pp. 190-191)
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
Slide 22
Common Therapeutic Measures
• Thoracentesis
• Breathing exercises
• Deep-breathing and coughing exercises
• Pursed-lip breathing
• Sustained maximal inspiration
• Chest physiotherapy
TALKING POINTS:
• A thoracentesis is the insertion of a large-bore needle through the chest wall into the
pleural space.
• Why may a thoracentesis be performed?
Slide 23
• Intermittent positive-pressure breathing (IPPB) treatments are used to achieve maximal
Common Therapeutic Measures (cont.)
• Oxygen therapy
• Intermittent positive-pressure breathing (IPPB) treatments
• Artificial airways
• Oral airway
• Nasal airway
TALKING POINTS:
• In the presence of cardiopulmonary disease or injury, it may be necessary to provide a
patient with supplemental oxygen; that is, to enrich the atmospheric air with higher
concentrations than the patient normally breathes.
• What percentage of oxygen does air in the atmosphere normally contain?
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LESSON 31.2
Slide 24
Routine Preoperative Nursing Care
• Emphasize postoperative breathing exercises
• If insertion of a chest tube is anticipated, explain the procedure to the patient
Slide 25
Assessment
• Monitor vital signs, lung sounds, mental status, dressings, and chest tube function and
drainage
Slide 26
Interventions
• Impaired gas exchange
• Ineffective breathing pattern
• Ineffective airway clearance
TALKING POINTS:
• After a thoracotomy, the patient is at risk for pneumonia and atelectasis because of the
Slide 27
Video Thoracoscopy
• Inserting an endoscope through small thoracic incision
• Procedures that can be done with this instrument include resection of pulmonary and
mediastinal lesions, biopsy, drainage of effusions, sympathectomy, vagotomy, and
thymectomy
TALKING POINTS:
• What are potential complications of a thoracoscopy?
________________________________________ Chapter 31Acute Disorders of the Lower Respiratory Tract 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 31.2
Activities
Classroom Choose from below to make 30 minutes
Online
4
DISCUSS
• Divide the class into three groups. Assign
one of the scenarios below to each group
and have them discuss a nursing care plan
specific to the patient who has undergone a
thoracotomy. Then, ask each group to
present its plan to the class and invite
feedback.
• A patient with cancer, who recently had
a right pneumonectomy, now has left
• A patient who had a thoracotomy after a
motor vehicle accident has a closed
• Break the class into three groups. Assign
one of the following scenarios to each group
and have them discuss how the nurse
should respond and why.
• A patient with hypertension tells the
nurse that he has been taking over-the-
counter decongestants to treat a cold.
POST & COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
role of various drug therapies, including side
effects and nursing interventions, which may
be involved in treating acute respiratory
disorders.
• Post the following discussion topic online
and have students comment. Discuss the
various types of thoracic surgery.