The nurse is concerned that a patient with traumatic chest injures is developing respiratory distress. What assessment findings led the nurse to come to this conclusion?
Select all that apply.
1. combative behavior
2. absent breath sounds in left lower lobe
3. pedal and popliteal pulses weak and irregular
4. temperature raised 2 degrees over the last 4 hours
5. oxygen saturation 86% on 40% oxygen face mask
Correct Answer: 1, 2, 5
An early sign of an ineffective airway is a change in the patient's behavior. If the patient becomes combative, the nurse immediately assesses the effectiveness of the airway. Absent breath sounds can indicate airway obstruction. Oxygen saturation is a measurement of airway effectiveness. Oxygen flow should be adjusted to keep saturation level between 94% and 100%. Changes in lower extremity pulses indicate an alteration in perfusion. Changes in body temperature indicate an infectious process.
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After teaching a group of community health nursing students about urban sprawl and its effects, the instructor determines that additional teaching is needed when the students identify which of the following as an effect?
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