Walkthrough: Physiological Adaptation Q9 – NCLEX-RN®

00:01 Wow. This question is short and to the point, but this is a really fun kind of a format for a question.

00:07 So let's take a look, which client is the priority for the nurse to evaluate rapidly for respiratory distress? There's more in that question than it seems; this means I'm going to see more than one patient, you'll see four patients, and they're asking you who should you see first or who is our top priority? Now, what is the other criteria for respiratory distress? Okay. Now we're going to bring these patients on.

00:37 When the answer choices come on, I want you to read through each one of these clients slowly.

00:44 Keep focusing your mind, is this patient at a high risk for respiratory distress? So answer number 1, yes or no? If you say no, go on to the next one.

00:57 Let's compare the second answer to number 1.

01:01 Which of these clients is a higher risk for respiratory distress? So make your choice between 1 and 2.

01:08 Then, compare answer choice 3 to your selection, see which one is at higher risk for respiratory distress, then pick answer, compare 4 to the answer that you selected.

01:21 That's how you tell who you should see first, because above all questions, when they're asking you who's the priority? Who do you see first? You need to make sure you pick one of these four clients that seems to have the highest priority or highest risk for respiratory distress.

01:40 Ready? Push the pause, do the work, I'll see you back in a little while.

01:52 Okay, ready? Let's do this.

01:56 Number 1. A client diagnosed with diabetes, has a blood glucose of 250 after running out of insulin yesterday, and is breathing quickly. Okay, diabetes. So, is that respiratory distress? Not necessarily. Blood glucose that's 250, too high, is that respiratory? Not necessarily. They run out of insulin yesterday and are breathing quickly.

02:26 Okay, I'm going to keep an eye on this. Now blood sugar 250 is not that high, but they could be on their way to going into DKA but let's keep an eye on them.

02:37 Number 2. I'm going to compare number 2 to number 1.

02:42 I see that number 1 is breathing quickly, but they didn't actually gave me a rate, 250 is not that high, so let's compare it to number 2. A client with a respiratory rate of 28.

02:53 Hello. Anytime, you see a number that's high, low, or normal; but 28 is outside of the normal range for an adult and it's considered high.

03:03 Now 28 breathes a minute who takes shallow breathe, that's not normal, and complains of chest pain, that's not normal, after an auto accident, uh, oh, that deploy the air bags.

03:19 Okay. If I'm sitting in the car and the air bags are deployed, where am I likely to get hit? Right here in the chest, so number 2 is in worse shape respiratory distress wise compare to number 1.

03:33 The respirations are fast, the respirations are shallow, that's never a good thing. Remember that means breathing like this, instead of taking a long breath.

03:46 They're having chest pain and we know they've been in an auto accident that deployed the air bag so they've taken a hit right to their chest wall, so definitely, 2 has more severe respiratory problems than number 1. But we're not done.

04:01 We need to compare option 3 to number 2.

04:05 So number 3. A client with chronic obstructive pulmonary disease, right, that's COPD.

04:12 Well, they don't usually do well respiratory, but they are using pursed lip breathing, like that, so they're doing that. Again, not a great sign. Has an oxygen saturation of 93% on room air.

04:29 Hey, that's normal than I would like, but they are chronic obstructive pulmonary disease, so that may just be their normal, and 93 is on the edge.

04:40 Now, I know that who do I see first is all based on who the other clients are.

04:46 Well, I see number three, I sure will, but they're not in worse shape that number 2.

04:52 Number 2 is still a priority over number 1 and number 3.

04:58 Alright, number 4, let's see if you can top number 2.

05:02 A client who just had a stroke, ooh, that's a big deal, receives oxygen at 2 L via nasal cannula, has an oxygen saturation of 96%, that's within normal, and demonstrates dysarthria when trying to speak.

05:20 Okay, stroke is really a big deal and I know that you need to take care of them in chronic, but what is the topic of the question? Who do I evaluate rapidly for respiratory distress? Well, number 4 deserves to be seen, but let's see if the risk for respiratory distress is higher than number 2.

05:44 Just had a stroke, but they're getting oxygen at 2 L nasal cannula, that's not that much, but they're still not on room air, but they have an oxygen saturation that is normal of 96%.

05:58 Now, they do have dysarthria when trying to speak, so they have difficulty with that.

06:03 Does that indicate respiratory distress? No, it does not.

06:09 So, going back to number 2, that's our winner. That client is the priority to evaluate.

06:16 Remember, they're breathing fast already, they're breathing shallow, telling you they're kind of getting in distress, they have chest paid, and they took a direct hit to their chest wall, that's the client you're going to see first.

06:28 Okay, let's reflect. How did you do on this question? Did you get it right? Did you get it wrong? Did you get it close? Did you do what people always say, I get it down to the last two answers, and I always pick the wrong one. Stop saying that. You don't always pick the wrong ones.

06:46 Those are just the questions you remember.

06:48 You get some questions right, so stop saying that to yourself.

06:52 That's an automatic negative thought, saying, I always get it down to the last two answers and I always pick wrong, not true.

07:01 But what drew your attention away? What made you think if you didn't pick 2, what did you think was worse about your selection than number 2? Now that we've talk through it, do you feel differently about that? Yeah, go ahead, reflect on that. Write some notes in your notebook.

07:21 Is there anything you want to remember? Do you want to think about, oh, consider chest wall contusions, if someone has had the air bags deployed.

07:29 Keep in mind what you're looking for that you can take from this question and use on other questions.

07:37 Alright, see you for the next question.