c. Course crackles a. Suction the tracheostomy. Changes in oxygen therapy or interventions should be avoided for 15 minutes before the specimen is drawn because these changes might alter blood gas values. 3.4 Activity Intolerance. See Table 25.8 for more thorough descriptions of these sounds and their possible etiologies and significance. No signs or symptoms of tuberculosis or allergies are evident. a. Study Resources . Sleep disturbance related to dyspnea or discomfort 6. 1. Nursing Diagnosis for Pleural Effusion Impaired Gas Exchange r/t decreased function of lung tissue Ineffective Breathing Pattern r/t compromised lung expansion Acute Pain r/t inflammatory process Anxiety r/t inability to take deep breaths Risk for infection r/t pooling of fluid in the lung space Nursing Care Plans for Pleural Effusion 4. 2. The nurse explains that usual treatment includes a. Carina It is important to assess the ability of the patient to do self-care ost especially if he or she is having respiratory symptoms. Pockets of pus may form inside the lungs or on their outer layers. Report significant findings. a. usually occur after aspiration of oral pharyngeal flora or gastric contents in persons whose resistance is altered or whose cough mechanism is impaired, Bacteria enter the lower respiratory tract via three routes. NurseTogether.com does not provide medical advice, diagnosis, or treatment. d. Dyspnea and severe sinus pain ineffective airway clearance related to pneumonia and copd impaired gas exchange related to acute and chronic lung. Activity intolerance 2. Turbinates warm and moisturize inhaled air. Basket stars are active at night. Fill fluid containers immediately before use (not well in advance). St. Louis, MO: Elsevier. What is included in the nursing care of the patient with a cuffed tracheostomy tube? Nursing management of pneumonia ppt is an acute inflammatory disorder of lung parenchyma that results in edema of lung tissues and. What is the best response by the nurse? d. Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube. Volume of air inhaled and exhaled with each breath a. Assess the patient for iodine allergy. d. Activity-exercise b. Palpation c. Ventilation-perfusion scan Discuss to him/her the different pros and cons of complying with the treatment regimen. A patient's initial purified protein derivative (PPD) skin test result is positive. c. A nasogastric tube with orders for tube feedings Encourage to always change position to facilitate mucous drainage in the lungs. b. Oral hygiene moisturizes dehydrated tissues and mucous membranes in patients with fluid deficit. 6) The patient is infectious from the beginning of the first stage Add heparin to the blood specimen. The assessment findings include a temperature of 98.4F (36.9C), BP 130/88 mm Hg, respirations 36 breaths/min, and an oxygen saturation reading of 91% on room air. Saunders comprehensive review for the NCLEX-RN examination. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Unless contraindicated, promote fluid intake (2.5 L/day or more). The tissue changes of TB and cancer of the lung may be diagnosed by chest x-ray or CT scan, MRI, or positron emission tomography (PET) scans. Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Learn how your comment data is processed. However, here are some potential NANDA nursing diagnoses that may be applicable: Impaired gas exchange related to decreased lung expansion and ventilation-perfusion imbalance; . Nursing Care Plan Patient's Name: Baby M Medical Diagnosis: Pediatric Community Acquired Pneumonia Nursing Diagnosis: Impaired gas exchange r/t collection of secretions affecting oxygen exchange across alveolar membrane. (n.d.). Bilateral ecchymosis of eyes (raccoon eyes) Assess the ability and effectiveness of cough.Pneumonia infection causes inflammation and increased sputum production. 4) Recent abdominal surgery. Volcanic eruptions and other natural events result in air pollution. c. There is equal but diminished movement of the 2 sides of the chest. During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include? When inflamed, the air sacs may produce fluid or pus which can cause productive cough and difficulty breathing. A) Increasing fluids to at least 6 to 10 glasses/day, unless. Report significant findings. If the patient is ambulatory, walking should be encouraged within the patients tolerance. e. FVC: (5) Amount of air that can be quickly and forcefully exhaled after maximum inspiration What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction? Allow patients to ask a question or clarify regarding their treatment. Document the results in the patient's record. Subjective Data: Pt family member tells you that the patient has been sleeping constantly for 2 weeks. . Lower Respiratory Tract Infections and Disord, Lewis Ch. Most commonly, P. jirovecii occurs in individuals with human immunodeficiency virus infection or in individuals who are therapeutically immunosuppressed after organ transplantation. Trend and rate of development of the hyperkalemia Cough suppressants. 3. I have a list of nursing diagnoses like acute pain r/t surgery, ineffective peripheral tissue perfusion r/t immobility or abdominal surgery, anxiety r/t change in health, impaired gas exchange r/t decreased functional lung tissue, ineffective airway clearance r/t inflammation and presence of secretion, i also have risk for infection - invasive Stop feeding when the patient is lying flat. Those at higher risk, such as the very young or old, patients with compromised immune systems, or who already have a respiratory comorbidity, may require inpatient care and treatment. 1) SpO2 of 85% 2) PaCO2 of 65 mm Hg 3) Thick yellow mucus expectorant 4) Respiratory rate of 24 breaths/minute 5) Dullness to percussion over the affected area Click the card to flip Empyema is a collection of pus in the thoracic cavity. 2. c. Wheezing The nurse can also teach him or her to use the bedside table with a pillow and lean on it. e. Suction the tracheostomy tube when there is a moist cough or a decreased arterial oxygen saturation by pulse oximetry (SpO2). Reporting complications of hyperinflation therapy to the health care provider. 25: Assessment: Respiratory System / CH. a. It can be obtained by coughing, aspiration, transtracheal aspiration, bronchoscopy or open lung biopsy. Shetty, K., & Brusch, J. L. (2021, April 15). Obtain a sputum sample for culture.If the patient can cough, have them expectorate sputum for testing. Nursing diagnosis: Deficient knowledge about the disease process and treatment of pneumonia related to lack of information as evidenced by failure to comply with treatment. is a 28-year-old male patient who sustained bilateral fractures of the nose, 3 rib fractures, and a comminuted fracture of the tibia in an automobile crash 5 days ago. Individuals with depressed level of consciousness, advanced age, dysphagia, or a nasogastric (NG) or enteral tube are at increased risk for aspiration, which predisposes them to pneumonia. 3. The nurse can also teach coughing and deep breathing exercises. Pleurisy Administer analgesics 1/2 hour prior to deep breathing exercises. Pneumonia is an infection of the lungs that can be caused by bacteria, fungi, or viruses. a. treatment with antibiotics. d. a total laryngectomy to prevent development of second primary cancers. Lack of lung expansion caused by kyphosis of the spine results in shallow breathing with decreased chest expansion. Patient's temperature d. Oxygen saturation by pulse oximetry Early small airway closure contributes to decreased PaO2. a. Thoracentesis They will further understand the topic since they already have an idea of what is it about. Bacterial Pneumonia. Oxygen is administered when O2 saturation or ABG results show hypoxemia. c. Explain the test before the patient signs the informed consent form. c. Terminal structures of the respiratory tract b. These symptoms are very crucial and the patient must be given immediate care and intervention to avoid hypoxia. Gravity and hydrostatic pressure in this position promote perfusion and ventilation matching. b. Cuff pressure monitoring is not required. Impaired gas exchange occurs due to alveolar-capillary membrane changes, such as fluid shifts and fluid collection into interstitial space and alveoli. A patient with pneumonia shows inflammation in their lung parenchyma causing it to have. Mixed venous blood gases are used when patients are hemodynamically unstable to evaluate the amount of oxygen delivered to the tissue and the amount of oxygen consumed by the tissues. This can be due to a compromised respiratory system or due to lung disease. Arrange the tasks of the patient when providing care to him/her. c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid. The nurse will gather the supplies as soon as the order to do a thoracentesis is given. Teach the patient to use the incentive spirometer as advised by their attending physician. Recognize the risk factors for infection in patients with tracheostomy and take the following actions: Risk factors include the presence of underlying pulmonary disease or other serious illness, increased colonization of the oropharynx or trachea by aerobic gram-negative bacteria, increased bacterial access to the lower airway, and cross-contamination from manipulation of the tracheostomy tube. This can lead to hypoxia (lack of oxygen), and possibly tissue damage. Consider sources of infection.Any inserted lines such as IVs, urinary catheters, feedings tubes, suction tubing, or ventilation tubes are potential sources of infection. Types of Nursing Diagnoses There are 4 types of nursing diagnoses. 3.2 Impaired Gas Exchange. Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures secondary to CHF as evidenced by shortness of breath, Report weight changes of 1-1.5 kg/day. d. Pulmonary embolism. 8. The available treatments of pneumonia can give a good prognosis to the patient for as long as he or she complies with it. COPD ND3: Impaired gas exchange. Patient who is anesthetized b. Filtration of air She found a passion in the ER and has stayed in this department for 30 years. Avoid environmental irritants inside the patients room. Save my name, email, and website in this browser for the next time I comment. Nursing Diagnosis: Impaired Gas Exchange related to decreased lung compliance and altered level of consciousness as evidence by dyspnea on exertion, decreased oxygen content, decreased oxygen saturation, and increased PCO2. To detect presence of hypernatremia, hyperglycemia, and/or dehydration. Touching an infected object and then touching your nose or mouth can also transfer the germs. 1. d. Use over-the-counter antihistamines and decongestants during an acute attack. Guillain-Barr syndrome, illicit drug use, and recent abdominal surgery do not put the patient at an increased risk for aspiration pneumonia. The greatest chance for a pneumothorax occurs with a thoracentesis because of the possibility of lung tissue injury during this procedure. Amount of air that can be quickly and forcefully exhaled after maximum inspiration d. treatment with medication only if the pharyngitis does not resolve in 3 to 4 days. Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention. Symptoms of an abscess caused by aerobic bacteria develop more acutely and resemble bacterial pneumonia. For best yield, blood cultures should be obtained before antibiotics are administered. Expresses concern about his facial appearance 26: Upper Respiratory Problems / CH. Educating him/her to use the incentive spirometer will encourage him/her to exercise deep inspiration that will help get more oxygen in the lungs and prevent hypoxia. The syringe used to obtain the specimen is rinsed with heparin before the specimen is taken and pressure is applied to the arterial puncture site for 5 minutes after obtaining the specimen. Hospital-Acquired Pneumonia. 2. What keeps alveoli from collapsing? 3) Sleep alone. d. The patient cannot fully expand the lungs because of kyphosis of the spine. Monitor oximetry values; report O2 saturation of 92% or less. Provide factual information about the disease process in a written or verbal form. Promote fluid intake (at least 2.5 L/day in unrestricted patients). e. Decreased functional immunoglobulin A (IgA). What is a primary nursing responsibility after obtaining a blood specimen for ABGs? Tylenol) administered. Patients who are weak or fatigued with an ineffective cough can be taught how to suction themselves. Use a sterile catheter for each suctioning procedure. Always wear gloves on both hands for suctioning. Breath sounds in all lobes are verified to be sure that there was no damage to the lung. Select all that apply. Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in arterial oxygen saturation by pulse oximetry (SpO2) from 95% to 85% over several hours. b. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). c. Empyema Palpation identifies tracheal deviation, limited chest expansion, and increased tactile fremitus. Which instructions does the nurse provide for the patient? d. Contain dead air that is not available for gas exchange. "You should get the inactivated influenza vaccine that is injected every year." (Symptoms) Reports of feeling short of breath Alveolar sacs are terminal structures of the respiratory tract, where gas exchange takes place. Fever reducers and pain relievers. Hospital associated Nosocomial pneumonias, Pneumonia in the immunocompromised individual, Risk for Infection (nosocomial pneumonia), Impaired Gas Exchange due to pneumonic condition, 5 Nursing care plans for anemia | Anemia nursing interventions, 5 Nursing diagnosis of pneumonia and care plans, Nursing Care Plans Stroke with Nursing Diagnosis. d. Comparison of patient's current vital signs with normal vital signs Outcomes Interventions Rationale with reference Eval of goal/outcomes Gas r/t alveolar- membrane AEB Positive for strep Bi-pap to maintain rhonchi diminished breath bilaterally. An initial negative skin test should be repeated in 1 to 3 weeks and if the second test is negative, the individual can be considered uninfected. Assess the patients knowledge about Pneumonia. 1) Increase the intake of foods that are high in vitamin C. c. Tracheal deviation c. Patient in hypovolemic shock 2018.03.29 NMNEC Leadership Council. Priority Decision: When F.N. d. Testing causes a 10-mm red, indurated area at the injection site. Ventilation is impaired in spite of adequate perfusion in the lungs. Objective Data: >Tachypnea RR: 33 breaths per min >Dyspnea >Peripehral Cyanosis Rationale An infection triggers alveolar inflammation and edema. The alcohol intake of the patient is within normal limits, so it is not correct to say that alcohol may have damaged the liver. e. Sleep-rest Atelectasis Surfactant is a lipoprotein that lowers the surface tension in the alveoli. If he or she cannot do it alone, make sure to place suction secretions at the bedside to use anytime. 3. 1# Priority Nursing Diagnosis. Outcomes are influenced by the age of the patient, the extent of the disease process, the underlying disease, and the pathogen involved. Administer antibiotics.A diagnosis of pneumonia will warrant antibiotic treatment. Hospital acquired pneumonia may be due to an infected. Line the lung pleura Hopefully the family will have some time to discuss this before they are instructed to leave the room, unless it is an emergency. Assist with respiratory devices and techniques.Flutter valves mobilize secretions facilitating airway clearance while incentive spirometers expand the lungs. Cleveland Clinic. The turbinates in the nose warm and moisturize inhaled air. d. A tracheostomy tube and mechanical ventilation, What should the nurse include in discharge teaching for the patient with a total laryngectomy? To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. d. Pulmonary embolism Fine crackles at the base of the lungs are likely to disappear with deep breathing. 2. The patient needs to be able to effectively remove these secretions to maintain a patent airway. The pH is also decreased in mixed venous blood gases because of the higher partial pressure of carbon dioxide in venous blood (PvCO2). Partial obstruction of trachea or larynx d. Dyspnea and severe sinus pain. Ciliary action impaired by smoking and increased mucus production may be caused by the irritants in tobacco smoke, leading to impairment of the mucociliary clearance system. Frequent suctioning increases risk of trauma and cross-contamination. Assist the patient when they are doing their activities of daily living. Nursing Diagnosis: Impaired gas exchange related to alveolar-capillary membrane changes secondary to COPD as evidenced by oxygen saturation 79%, heart rate 112 bpm, and patient reports of dyspnea. Help the patient get into a comfortable position, usually the half-Fowler position. Increase heat and humidity if patient has persistent secretions. Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively. a. Normal venous blood gas values reflect the normal uptake of oxygen from arterial blood and the release of carbon dioxide from cells into the blood, resulting in a much lower PaO2 and an increased PaCO2. Retrieved February 9, 2022, from, Testing for Sepsis. Medications such as paracetamol, ibuprofen, and. Observing for hypoxia is done to keep the HCP informed. b. CO2 causes an increase in the amount of hydrogen ions available in the body. Findings may show hypoxemia (PaO2 less than 80 mm Hg) and hypocarbia (PaCO2 less than 32-35 mm Hg) with resultant respiratory alkalosis (pH greater than 7.45) in the absence of underlying pulmonary disease. Dont forget to include some emergency contact numbers just in case there is an emergency. The patient will also be able to demonstrate and verbalize understanding about the desired therapeutic regimen. A less severe form of bacterial pneumonia is called walking or atypical pneumonia, in which the symptoms are very mild and the infected person can do his/her activities of daily living as normal. c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid. Monitor patient's behavior and mental status for the onset of restlessness, agitation, confusion, and (in the late stages) extreme lethargy. d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen status. To avoid the formation of a mucus plug, suction it as needed. When planning care for a patient with pneumonia, the nurse recognizes that which is a high-priority intervention? Pinch the soft part of the nose. Immunosuppression and neutropenia are predisposing factors for the development of nosocomial pneumonia caused by common and uncommon pathogens. Fever and vomiting are not manifestations of a lung abscess. To help clear thick phlegm that the patient is unable to expectorate. a. Consider using a closed suction system; replace closed suction system according to agency guidelines. c. Percussion 1. Impaired gas exchange is a nursing diagnosis for a patient suffering current or future problems with oxygen/carbon dioxide balance (unknown, 2012). Signs and symptoms of respiratory distress include agitation, anxiety, mental status changes, shortness of breath, tachypnea, and use of accessory respiratory muscles. Assess for mental status changes. Nursing care plan pneumonia - Nursing care plan: Pneumonia Pneumonia is an inflammation of the lung - Studocu care plan pneumonia nursing care plan: pneumonia pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that impair Skip to document Ask an Expert Sign inRegister Sign inRegister Home The patient is infectious from the beginning of the first stage through the third week after onset of symptoms or until five days after antibiotic therapy has been started. On inspection, the throat is reddened and edematous with patchy yellow exudates. They are as follows: Ineffective Airway Clearance Impaired Gas Exchange Ineffective Breathing Pattern Risk for Infection Acute Pain Decreased Activity Tolerance Hyperthermia Risk for Deficient Fluid Volume Risk for Imbalanced Nutrition: Less Than Body Requirements c. Comparison of patient's SpO2 values with the normal values a. a. Maegan Wagner is a registered nurse with over 10 years of healthcare experience. A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. To care for the tracheostomy appropriately, what should the nurse do? Productive cough (viral pneumonia may present as dry cough at first). Always change the suction system between patients. d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). A) Sit the patient up in bed as tolerated and apply What is the first action the nurse should take? a. Weight changes of 1-1.5 kg/day may occur with fluid excess or deficit. a. d. Comparison of patient's current vital signs with normal vital signs. What covers the larynx during swallowing? These interventions help ensure that the patient has the appropriate knowledge and is able to perform these activities. d. Testing causes a 10-mm red, indurated area at the injection site. (2022, January 26). Place the patient in a comfortable position. Community-acquired pneumonia occurs outside of the hospital or facility setting. If sepsis is suspected, a blood culture can be obtained. Bacterial infections are indications for antibiotic therapy, but unless symptoms of complications are present, injudicious administration of antibiotics may produce resistant organisms. Auscultate breath sounds at least every 2 to 4 hours or as the patients condition dictates. If he or she can not do it, then provide a suction machine always at the bedside. Impaired Gas Exchange Thisnursing diagnosis for asthma relates to the decreased amount of air that is exchanged during inspiration and expiration. Physical examination of the lungs indicates dullness to percussion and decreased breath sounds on auscultation over the involved segment of the lung. To help alleviate cough and allow the patient to rest, cough suppressants may be given at low doses. b. Page . a. Assess the patient for iodine allergy. b. a. Try to use words that can be understood by normal people. Other antibiotics that may be used for pneumonia include doxycycline, levofloxacin, and combination of macrolide and beta-lactam (amoxicillin or amoxicillin/clavulanate known as Augmentin). If the patient is having increased mucous production, encourage him or her to clear the airway. d. VC The palms are placed against the chest wall to assess tactile fremitus. Most of the cases of poor prognosis of pneumonia are undertreatment or not being able to be assessed earlier. Which symptoms indicate to the nurse that the patient has a partial airway obstruction (select all that apply)? Buy on Amazon. This work is the product of the Warm and moisturize inhaled air Impaired Gas Exchange; May be related to. b. A tracheostomy is safer to perform in an emergency. 2. of . g. Position the patient sitting upright with the elbows on an over-the-bed table. Normal mixed venous blood gases also have much lower partial pressure of oxygen in venous blood (PvO2) and venous oxygen saturation (SvO2) than ABGs. Use 1 for the first action and 7 for the last action. Level of the patient's pain Discussion Questions nursing diagnosis based on the assessment data the major nursing diagnoses for meconium aspiration syndrome are hyperthermia related to inflammatory process hypermetabolic state as evidenced by an increase in body temperature warm skin and tachycardia fluid volume . 2. The arterial oxygen saturation by pulse oximetry (SpO2) compared with normal values will not be helpful in this older patient or in a patient with respiratory disease as the patient's expected normal will not be the same as standard normal values. Decreased functional cilia and decreased force of cough from declining muscle strength cause decreased secretion clearance. Impaired gas exchange is caused by conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), or asthma. c. "An annual vaccination is not necessary because previous immunity will protect you for several years." 2. Before other measures are taken, the nurse should check the probe site. Goal/Desired Outcome Short-term goal: The patient will remain free from signs of respiratory distress and her oxygen saturation will remain higher than 96% for the duration of the shift. Assess the patients vital signs and characteristics of respirations at least every 4 hours. Pulse oximetry may not be a reliable indicator of oxygen saturation in which patient? Immunotherapy may be indicated if specific allergens are identified and cannot be avoided. When admitting a female patient with a diagnosis of pulmonary embolism (PE), the nurse assesses for which risk factors? It is important to let the patient know the pros of taking an accurate dosage and the right timing of medication for fast recovery. The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? Please follow your facilities guidelines, policies, and procedures. c. Turbinates a. Thoracentesis Priority: Sleep management A patient with pneumonia is at high risk of getting fatigued and overexertion because of the increased need for oxygen demands in the body. If they cannot, sputum can be obtained via suctioning. As an Amazon Associate I earn from qualifying purchases. Nursing Diagnosis Impaired Gas Exchange related to to altered alveolarcapillary membrane changes due to pneumonia disease process. Take an initial assessment of the patients respiratory rate and blood oxygen saturation using a pulse oximeter. Give health teachings about the importance of taking prescribed medication on time and with the right dose. associated with increased fluid loss in the presence of tachypnea, fever, or diaphoresis Desired outcome: at least 24 hours before hospital discharge, the patient is normovolemic, i.e., has a urine output of 30 mL/h or greater, stable weight, heart rate less than 100 bpm, blood pressure greater than 90 mm Hg, fluid intake equal to fluid excretion, moist mucous membranes, and normal skin turgor. Pulmonary function test Nursing Diagnosis 1: Risk for fluid volume deficit related to increased fluid losses secondary to diarrhea and decreased fluid intake; Nursing Diagnosis 2: Impaired gas exchange related to pneumonia and decreased oxygen saturation levels; 2. Expected outcomes Aspiration is one of the two leading causes of nosocomial pneumonia. Impaired gas exchange is the state wherein there is either excess or decrease in the oxygenation of an individual. The nurse should assess the patient's cardiopulmonary status with careful monitoring of vital signs, cardiac rhythm, pulse oximetry, arterial blood gases (ABGs), and lung sounds. 3. Avoid instillation of saline during suctioning. What testing is indicated? Normal or low leukocyte counts (less than 4000/mm3) may occur in viral or mycoplasma pneumonia. b. a hemilaryngectomy that prevents the need for a tracheostomy. Etiology The most common cause for this condition is poor oxygen levels. Macrolide antibiotics such as azithromycin and clarithromycin are commonly used as first-line drugs for pneumonia. A patient develops epistaxis after removal of a nasogastric tube. Adjust the room temperature. The patient must understand the importance of seeing an attending physician and not rely on what they see or hear on the internet. The immunity will not protect for several years, as new strains of influenza may develop each year. Order stat ABGs to confirm the SpO2 with a SaO2. a. 5) Corticosteroids and bronchodilators are helpful in reducing d. "Antiviral drugs, such as zanamivir (Relenza), eliminate the need for vaccine except in the older adult.". Homes should be well ventilated, especially the areas where the infected person spends a lot of time. a. Base to apex She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. h. FRC The 150 mL of air is dead space in the trachea and bronchi. Impaired gas exchange 5. Bronchophony occurs with pneumonia but is a spoken or whispered word that is more distinct than normal on auscultation. There is an induration of only 5 mm at the injection site.