UNIT 11 BUILDING CLINICAL COMPETENCEResponses to Altered Respiratory FunctionFUNCTIONAL HEALTH PATTERN: Activity-Exercise

Think about clients with respiratory disorders and altered patterns of activity and exercise forwhom you have cared in your clinical experiences.

■ What were the clients’ major medical diagnoses affecting the respiratory system (e.g.,upper respiratory infection, laryngeal cancer, pneumonia, tuberculosis, asthma, pleuraleffusion, pneumothorax, chronic obstructive pulmonary disease, respiratory failure)?

■ What manifestations did each of these clients have? Were these manifestations similar ordifferent?

■ How did the clients’ health status interfere with their activity and exercise? Was theirbreathing difficult or painful? Did the clients experience shortness of breath with activity orat rest? How many pillows did they use to sleep? Did your clients have a dry orproductive cough? What color, odor, and consistency was the sputum? Did they smoke?Had they been exposed to environmental smoke or pollution? Did your clients have ahistory of respiratory disorders? Were they taking any medications or using oxygen? Hadthey had a chest x-ray and a tuberculosis skin test?

The Activity-Exercise Pattern describes the client’s usual patterns of exercise and activity. Disor-ders that affect physiologic energy production affect the Activity-Exercise Health Pattern. The res-piratory system provides oxygen to support cellular metabolism and eliminates carbon dioxide(a metabolic waste product) with each breath. This occurs through ventilation, the movementof air into and out of the lungs, and respiration, the exchange of oxygen and carbon dioxide be-tween air and blood that occurs in the alveoli, respiratory bronchioles, and tissues.

The upper respiratory system cleans, humidifies, and warms air entering the lungs. Upperrespiratory disorders affect breathing, communication, and body image.

Lower respiratory system disorders affect air movement (ventilation) and gas exchangeacross the alveolar-capillary membrane (respiration).

■ Rhinorrhea (antigen [a viral pathogen or allergen] � inflammation and release ofchemical mediators � mucosal vasodilation and release of WBCs and fluid fromcapillaries � mucosal edema and watery discharge from the nose)

■ Cough (irritants or excess secretions in respiratory tract � stimulation of cough receptors intracheobronchial wall � impulses transmitted to medullary center � rapid inhalation of largevolume of air � closure of glottis and rapid contraction of abdominal and expiratory muscles� increased intrathoracic pressure � sudden opening of glottis and explosive air expulsion)

■ Dyspnea (discrepancy between respiratory muscle strength, stretch; bronchial smoothmuscle contraction; decreased lung compliance or inspiratory capacity � stimulation ofreceptors in lungs, thorax, or cerebral cortex � dyspnea, a subjective perception ofdifficulty breathing)

■ Cyanosis (decreased oxygen tension in alveoli � decreased diffusion of oxygen intocapillaries � decreased blood oxygen tension � increased amount of deoxygenatedhemoglobin � gray to blue or purple color of skin and mucous membranes)

■ Wheezing (bronchoconstriction, airway inflammation or obstruction � turbulent airflowthrough narrowed airway � high- or low-pitched musical breath sounds).

Priority nursing diagnoses within the Activity-Exercise Pattern that may be appropriate for clientswith respiratory disorders include:

■ Ineffective Breathing Pattern as evidenced by shortness of breath, dyspnea, orthopnea,retractions, nasal flaring, altered chest excursion

■ Ineffective Airway Clearance as evidenced by ineffective cough, diminished or abnormalbreath sounds, cyanosis, restlessness

■ Impaired Gas Exchange as evidenced by cyanosis, abnormal respiratory rate and rhythm,nasal flaring, tachycardia, diaphoresis, confusion

■ Impaired Spontaneous Ventilation as evidenced by dyspnea, use of accessory muscles,tachycardia, apprehension.

Two nursing diagnoses from other functional health patterns often are of high priority for theclient with altered respiratory function:

■ Disturbed Sleep Pattern (Sleep-Rest)■ Anxiety (Self-Perception-Self-Concept)

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