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Nursing Chs 29-33

Important info.

Question
Assessment of Resp. Hx
-Smoking Hx
-Childhood illnesses (asthma, pneumonia, comm. diseases, hay fever, allergies, eczema, frequent colds, croup, and cystic fibrosis)
-Adult Illnesses (Pneumonia, sinusitis, TB, HIV/AIDS, Lung disease emphysema and sarcoidosis, diabetes, hypertension, and heart disease
-Influenza, pneumococcal, and BCG vaccines
-Surgeries of U or L resp system
-Injuries to U or L resp system
-Hospitalizations
-Date of chest x-ray, pulmonary function test, TB test, other diagnostic tests
-Recent weight loss
-Night sweats
-Sleep disturbances
-Lung disease/condition of fam.
-Geographical areas of recent travel
-Occupation/leisure activities
Percussion
-Resonance: Low pitch, moderate-loud, hollow, long duration, characteristic of normal lung tissue.
-Hyperresonance:Higher pitch than resonance, very loud, booming, longer than res., indicates presence of trapped air, commonly heard over emphysematous or asthmatic lung, occasionally over pneumothorax
-Flatness:High pitch, soft, extreme dullness, , short, example is sternum. Over lung fields may indicate massive pleural effusion
-Dullness:Medium pitch, medium, thudlike, medium duration, example is over liver and kidneys. Can be percussed over atelectatic lung or consolidated lung
-Tympany:High pitch, loud, musical/drumlike, short, examples are chest filled w/ air and abdomen distended w/ air. Over lung, usually indicates a large pneumothorax
Features of Adventitious Breath Sounds
-Discontinuous
*Fine crackles, fine rales, and high-pitched rales: In early or late inspiration. Popping, discontinuous sounds caused by air moving into previously deflated airways; sounds like hair being rolled between fingers near the ear. "Velcro" sounds late in in i
*Coarse crackles and low-pitched crackles: Common on expiration, may be present early in inspiration. Lower-pitched, coarse, discontinuous rattling sounds caused by fluid/secretions in large airways; likely to change w/ coughing or suctioning. Associated
-Continuous
*Wheeze: Audible during either inspiration, expiration, or both. Squeaky, musical continuous sounds associated w/ air rushing through narrowed airways; may be heard w/out stethoscope. Arise from small airways. Usually do not clear w/ coughing. Associated
*Rhonchus (rhonchi):Audible during both inspiration and expiration, commonly more prominent on expiration. Lower-pitched, coarse, continuous snoring sounds. Arise from large airways. Associated w/: Thick and tenacious secretions, sputum production, obstru
-Pleural Friction Rub: Heard during inspiration and expiration, generally at end of inspiration and beginning of expiration. Loud, rough, grating, scratching sounds caused by inflamed surfaces of pleura rubbing together; often associated w/ pain on deep
inspirations. Heard in lateral lung fields. Associated w/: Pleurisy, TB, pulmonary infarction, pneumonia, and lung cancer
-O2 therapy intervention for pt w/ resp. problems *Clear oral, nasal and tracheal secretions *Maintain airway patency *Set up O2 equipment and administer through a heated, humidified system *Monitor O2 liter flow *Monitor position of O2 delivery devi
*Periodically check O2 delivery device to ensure prescribed concentration is being delivered *Monitor effectiveness of O2 therapy (pulse ox, ABGs) *Ensure replacement of mask or cannula when device is removed *Observe for signs of O2-induced
hypoventilation *Monitor for signs of O2 toxicity and absorption atelectasis *Monitor O2 equipment to make sure it does not interfere w/ pt's attempts to breathe *Monitor pt's anxiety r/t need for O2 therapy *Monitor for skin breakdown from friction o
device *Provide for O2 when pt is transported *Instruct pt/fam about O2 use at home *Arrange for use of O2 devices that facilitates mobility, teach pt
-Safety for pt receiving O2 therapy *Check Dr.'s prescription w/ type of delivery system and liter flow or % of O2 actually in use *Obtain prescription for humidification if O2 is delivered at 4L/min or more *Be sure
Created by: evangelineh86