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HCC Acute Resp

HCC Acute Respiratory

Compensatory Mechanisms When alternative body organs take over in an attempt to compensate. Early sign(clues) something is wrong.
Keeping a happy heart beat Normal pH, balanced electrolytes, oxygen, glucose for ATP formation.
Right Bronchus Wider, shorter, steeper, more vertical
Left Bronchus Narrower, longer, more horizontal
Intubation Tubing should stop 1 inch above bifurcation
Causes of Hypoxia Failure to exchange oxygen in the lungs, deliver enough oxygen, in the transport system, in the cells ability to uptake oxygen.
Hypoxia Manifestations Confused, restless, agitated, combative. NEVER SEDATE! You must prove hypoxia is not the cause b4 you sedate. Kills in seconds to minutes. Lack of O2 = increased lactic acid.
S/sx of Inadequate Oxygenation CNS Unexplained apprehension, restlessness or irritability, or new-onset confusion, combativeness, coma(late finding).
S/sx of Inadequate Oxygenation Respiratory Tachypnea, dyspnea on exertion, dyspnea at rest, orthopnea, use of accessory muscles, retraction of interspaces on inspiration, nasal flaring, pause for breath between sentences or words.
S/sx of Inadequate Oxygenation Cardio Tachycardia, unexplained fatigue, mild HTN, dysrhythmias, hypotension, cyanosis, cool clammy skin/diaphoresis.
CO2 Narcosis Total opposite of hypoxia, sedative effect, kills in hours. Lethargic/sleeping.
Nasal Cannula 1-6 L/min. 24-44% oxygen. >4 L = need for humidifier. Ease for talking, eating, and hygiene.
Simple Face Mask 6-12 L/min. 35-50% oxygen. May be uncomfortable due to seal and must be removed to eat and drink. Must fit snugly. At least 5 L/min flow to prevent accumulation of expired air in the mask.
Partial Rebreather 6-10 L/min. 40-60%. Reservoir bag must be 3/4 filled.
Non-rebreather 60-90%. Valve prevents expired air from flowing back into bag.
Venturi Cone-shaped device is fitted to face. Available to deliver 24, 28, 31, 35, 40, and 50% oxygen.
Face Tent Ideal for moderate-to-high-density aerosol.
Oxygen Toxicity Symptoms Nonproductive cough, substernal chest pain, GI upset, dyspnea, crackles and hypoxemia, pulmonary edema, hemorrhage.
Goal of Oxygen Therapy Use the lowest amount of oxygen for an acceptable blood oxygen level without causing harmful side effects.
Bronchoscopy NPO, informed consent, TJC Patient Safety Goals, in OR or ICU at bedside, potential complication.
Thoracentesis Informed consent/verification of patient and procedure, stinging/pressure, MOTIONLESS(very easy to to puncture the lung), goggles and mask, potential complication.
Respiratory Nursing Interventions TCDB, Pursed-lip breathing, positioning, fluid intake, percussion and postural drainage, maintain good nutrition, airway suctioning.
Facial Trauma ALWAYS ASSESS AIRWAY! anticipate and prepare for intubation, Breathing, Circulation, control hemorrhage, watch CSF, suction equipment.
Epistaxis Trauma, foreign bodies, nasal spray abuse, street drug use, tumors, meds that effect clotting times.
Anterior Bleed Epistaxis Pressure to nares.
Posterior Bleed Epistaxis Posterior Packing.
Tonsillectomy Pre-op teaching, post-op care, control of pain, HEMORRHAGE.
Upper Airway Obstruction Life-threatening emergency, unable to speak, cyanotic, collapses, DIE WITHIN 4 MINUTES.
RSV Respiratory Syncytial Virus(bronchiolitis), occurs in winter & early spring, bronchiole mucosa swells, URI/ear & eye infections, Low Resp involved(coughing, wheezing, tachypnea, retractions), severe resp distress(crackles, cyanosis, poor air exchange).
RSV Treatment High humidity, O2 by hood or tent, adequate fluid intake, rest, anti-viral medication(ribavirin), isolation precautions.
Status Asthmaticus Severe acute episode of airway obstruction, intensifies once it begins, does not respond to common therapy, severely diminished breath sounds are an ominous sign for both the child and adult with asthma.
Lung Cancer Leading cause of cancer deaths, majority caused by cigarette smoking.
Interventions for Lung Cancer Lobectomy, pneumonectomy(removal of the lung), segmentectomy(wedge resection), all will require a chest tube. Radiation. Chemotherapy. TEACH WARNING SIGNS OF LUNG CANCER.
Palliative Care for Lung Cancer Oxygen, drugs, thoracentesis/pleurodesis, dyspnea. Morphine is gold standard for lung cancer pain.
Antihistamines, Diphenhydramine(Benadryl), Loratadine(Claritin non-sedating) Block histamine decrease allergic response, reduce secretions and itching. SE's drowsieness, sedation, dry mouth, photosensitivity. Monitor effectiveness and for SE's, encourage fluid intake.
Antitussives, Dextromethorphan(non-opioid), Codeine/hydrodone(opioid) Inhibit cough center in medulla. SE's dizziness, headache, drowsiness, hallucinations(high doses), addiction c opioids, respiratory depression.
Decongestants, Pseudophedrine(sudafed) Relieve nasal stuffiness by shrinking swollen nasal mucous membranes. SE's insomnia, palpitations, tremors. Antihypertensives can have decreased effect.
Expectorants, Guaifenesin(Robitussin) Increases respiratory tract fluid and decreases viscosity of secretions for removal. SE's Dizziness, headache, N&V.
Mucolytics, Acetylcysteine(Mucomyst) Inhaled. Oral is antidote for Tylenol overdose, also protects kidneys from contrast dye. SE's Sore throat, N&V, headache, bronchospasm. DO NOT USE WITH ASTHMA.
Beta2 Adrenergic Agents Stim beta2-receptors cause smooth muscle of lungs to relax. Relaxes bronchospasms. Decrease airway reaction to allergens, facilitate expectoration of secretions.
Albuterol(short acting) DRUG OF CHOICE WITH ACUTE ASTHMA ATTACK Stim beta2-receptors cause smooth muscle of lungs to relax. Relaxes bronchospasms. Decrease airway reaction to allergens, facilitate expectoration of secretions.
Salmeterol(long acting) DO NOT GIVE IN ACUTE ASTHMA ATTACKS Stim beta2-receptors cause smooth muscle of lungs to relax. Relaxes bronchospasms. Decrease airway reaction to allergens, facilitate expectoration of secretions.
Anticholinergic(atrovent) DO NOT GIVE IN ACUTE ASTHMA ATTACK Anticholinergics cause bronchodilation. Stim beta2-receptors cause smooth muscle of lungs to relax. Relaxes bronchospasms. Decrease airway reaction to allergens, facilitate expectoration of secretions.
Nursing Interventions for Bronchodilators Monitor VS's, auscultate lung sounds before and after Tx. Monitor BG in diabetics, beta2 may increase BG.
Methylxanthines(Theophylline) Prevent & Tx wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. SE's headache, anxiety, tachycardia dysrhythmias palpitations, N&V, Insomnia/seizures.
Methylxanthines(Theophylline) Nursing Interventions Monitor VS's, serum levels, and for signs of toxicity such as restlessness.
Anti-inflammatory(systemic-prednisone, solumedrol) (inhaled-pulmicort, flovent) Prevent & Tx of inflammation of airways and decrease bronchoconstriction.
Inhaled Nonsteroidals (Cromolyn, Nedocromil) Prevention of asthma. SE's headache, cough, unpleasant taste, dry mouth. Assess repiratory function to monitor effect.
Leukotriene Modifiers(Singulair) Prevent difficulty breathing, chest tightness, wheezing and coughing caused by asthma. SE's increased liver enzymes, fatigue, headache. Assess respiratory for effectiveness.
Created by: mande747