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Respiration ch 21

QuestionAnswer
In bronchitis what happens to the lower respiratory tract? It has compromised function
What happens when you leave your bronchitis untreated? Respiratory failure; chronic respiratory disease
When you have inflammation and infection in the alveoli and bronchioles what is the outcome? Impaired gas exchange
What is acute bronchitis? Inflammation of the mucous membranes
What is tracheobronchitis? Inflammatory process involving the trachea
What could cause bronchitis? Viral infection (URI) secondary to bacterial or funagal infection
Where are gases exchanged in bronchitis? Lower respiratory tract
What could cause bronchitis? Chemical reaction
What is a better term for pus? purulent
Assessment findings of bronchitis are? Initially dry cough, fever, chills, malaise, HA
Assessment findings later in bronchitis are? blood streaked sputum, mucopurulent sputum (yellow/green), paroxysmal coughing attacks/possibly wheezing, moist inspiratory crackles
How might you diagnosis bronchitis? sputum sample (culture)to rule out bacteria and chest xray to rule out pneumonia
Medical Management of bronchitis is? promote comfort,rest, increase fluids, use a humidifier and medications
What medications would be best utilized for bronchitis? Antipyretics - fever Expectorants - loosens secretions Antitussives - cough Bronchodilators If secondary bacterial infection occurs use broad spectrum antibiotic
As a nurse, what will you do for this patient with bronchitis? Ascultate breath sounds every 4 hours Use humidification w vaporizer Encourage cough, deep breathe
How would a humidifier work for bronchitis? loosens secretions and decreases cough
What would coughing and deep breathing do to help bronchitis patients? Help expectorate (spit out) sputum
What could you teach your client regarding bronchitis? wash hands frequently cover your cough discard soiled tissues in plastic bag avoid sharing personal articles w others
What would happen if you suppressed the cough? may cause pooling of secretions and lead to further problems
Pneumonia is? inflammatory process affecting the bronchioles and alveoli. Is the 8th leading cause of death in the USA when combined with influenza
Pneumonia can result from what other problems? radiation therapy chemical ingestion or inhalation, aspiration of foreign bodies or gastric contents
Atypical pneumonias radiation pneumonia, chemical pneumonia; aspiration pneumonia
Hypoventilation of lung tissue? Over a prolonged period can occur when a client is bedridden and breathing with only part of the lungs
Hypostatic pneumonia is the outcome of? Bronchial secretions subsequently accumulating
Bronchopneumonia Infeciton is patchy, diffuse, and scattered across both lungs
Lobar pneumonia is? inflammation confined to one or more lobes of the lung
Community-Acquired Pneumoia (CAP) illness acquired in community setting and evident within 48° of admission
Hospital-Acquired Pneumonia (HAP)or nosocomial pneumonia Nosocomial acquired 48° after admission
Pneumonia in the Immunocompromised host pneumocystis carinli fungal pneumonia - tuberculosis
Aspiration pneumonia is when a client inhales a foreign body or gastric content during vomiting or regurgitation
How do the organisms that cause pneumonia reach the alveoli? by inhalation of droplets, aspiration of organisms from the upper airway, or seeding from the bloodstream (less common)
Hypoxemia results from the inability of the lungs to oxygenate blood from the heart
Atypical pneumonia the exudate infiltrates the interstitial spaces rather than the alveoli directly.
Atypical pneumonia is more scattered and increasingly interferes with gas exchange between the bloodstream and lungs.
Atypical pneumonia increases carbon dioxide in the blood stimulates the respiratory center causing more rapid and shallow breathing.
Complications of pneumonia include Congestive heart failure, empyema, pleurisy and septicemia,atelectasis, hypotension and shock
empyema collection of pus in the pleural cavity
pleurisy inflammation of the pleura
septicemia infective microorganisms in the blood
When organisms reach the alveoli what happens next? the inflammatory reaction is intense, produces and exudate that impairs gas exchange. Capillaries surrounding the alveoli become engorged and cause collapse further interfering with ventilation.
If this is atypical pneumonia and goes untreated consolidation occurs as the inflammation and exudate increase. Hypoxemia results from the inability of the lungs to oxygenation blood form the heart.
Most pneumonia has exudate, infiltrate interstitial; scattered infiltrates to impaired gas exchange
Potential complications of pneumonia Hypoxemia, bronchitis, tracheitis necrosis; circulation system compensates then falls r/t hypoxemia (heart rate speeds up then falls)leading to heart failure
Potential complications of pneumonia Empyema, pleurisy, septicemia; endocarditis (travels to the heart), Otitis, bronchitis, sinusitis and death in the elderly and very young due to the weakened immune system
Signs and symptoms of bacterial pneumonia Sudden onset - fever, chills, cough, malaise; productive cough; chest discomfort (muscle) with respiration's; sputum - rust (bacteria) colored
Signs and symptoms of Viral pneumonia Less severe; blood cultures sterile (no growth), sputum is copious; slow pulse and repirations; wekness lasting longer than bacterial up to 2-3 mos; may have secondary bacterial pneumonia
What are the diagnostic findings with pneumonia? wheezing and cyanosis;sputum culture and sensativity; chest film-infiltrates/consolidation; WBC; blood cultures
Medical Management for Pneumonia Hydration to thin secretions; oxygen - Chest physio therapy (CPT; medications; fluid and electrolyte replacements; intubation to mechanical ventilation; if bacterial you need antibiotics
Medications for pneumonia Bronchodilator; antipyretics and analgesics; cough expectorants/suppressants
Nursing Management for pneumonia Monitor lung sounds, arterial blood gases; cough and sputum production, fluid intake and out put, skin turgor, serum electrolytes, oxygenation status
Nursing Management for pneumonia Encourage elderly and at-risk clients to get pneumococcal and flu shots; turn, cough, deep breath, inspirometer use
Pleurisy or pleuritis definition An acute inflammation of the parietal and visceral pleurae.
Pleurisy in the acute phase the pleurae are inflamed, thick and swollen eventually becoming ridgid.
Pleurisy what happens on inspiration? the pleurae rub together causing severe, sharp pain
Pleurisy usually is a consequence of a primary condition such as pneumonia, other pulmonary infections; lung cancer; pulmonary embolism; cardiac and renal disease; systemic infections
Assessment findings of pleurisy are shallow respirations r/t pain; pleural fld increases and pain decreases; friction rubs heard early in dx process disappears as fluid builds up
Assessment findings of pleurisy are dry cough; fatigues easily, dyspnea,Decreased ventilation resulting in atelectasis, hypoxemia and hypercapnia
Assessment findings of pleurisy are Chest xray; sputum culture; thoracentesis for fluid specimen or pleural biopsy
Medical Management for Pleurisy the goal is to comfort; treat underlying condition and meds
Medicines for pleurisy analgesics; antipyretic drugs; non-steroidal anti-inflammatory drug and procaine intercostal nerve block
Hypercapnia an increased amount of carbon dioxide, the waste product of respiration, in the blood.
Nursing Management of pleurisy heat or cold applications for comfort (collaborative need an order for this); client teaching in splint chest wall with pillow; anxiety r/t pain and underlying illness - client needs reassurance
Pleural Effusion abnormal fluid collection between visceral and parietal pleurae
Pleural Effusion is a complication of pneumonia; lung cancer; pulmonary embolism; partial lung collapse r/t pressure from fluid
Pleural effusion assessment findings are fever,pain, dyspnea, with chest compression the sound is dull; auscultation is diminished or absent and friction rub; CXR &CT show fluid;thoracentesis may reveal malignant cells
Medical Management for pleural effusion is eliminate cause; medications; thoracentesis; and surgery poss if cancerous
Medications for plueral effusion are antibiotics; analgesics; cardiotonic drugs if CHF
Nursing management for pleural effusion nurse prepares client for thoracentesis and supports client; if chest tube monitor function of drainage system; amount & nature of drainage (bubbling or not) (serous, etc)
chest tube care per fundamentals book assess respirations; presence of chest pain, breath sounds over affect lung area;vitals and SpO2; increased Resp distress/chest pain, dec breath sounds;cyanosis,asymmtrical chest movement;hypotension and tachycardia
chest tube care per fundamentals book Observe chest tube dressing and surrounding tube tissue; kinks, loops or clots in tube; chest drainage system remains upright and below level of insertion site;note amount of drainage
chest tube care per fundamentals book 2 rubber tiped hemostats for ea chest tube @ top of bed attached w tape. Only clamp tubing per MD under special circumstances
chest tube care per fundamentals book Assess for air leak; quickly empty or change disposable systems; performed by nurse w training;if accidental disconnection of drainage tube from collection device; assess if client is ready to have tube removed removed by MD's order
if chest tube is clamped watch client for tension pneumothorax
Position client in Semi-Fowler's to evacuate air (pneumothorax)
Position client in High-Fowler's position to drain fluid (hemothorax, effusion)
chest tube care per fundamentals book avoid excess tubing and keep tube horizontal b4 dropping vertical into drainage bottle. If client is sitting lift tubing q15min;doc time of drainage
chest tube care per fundamentals book observe water seal for fluctuations w client's inspiration and expiration
chest tube care per fundamentals book waterless system the float ball indicates amount/suction the intrapleural space is receiving
chest tube care per fundamentals book Observe water seal sys bubbling in water seal chamber; bubling in the suction-control chamber upon suctioning
chest tube care per fundamentals book observe type of fluid and measure;color; VS;skin color
chest tube care per fundamentals book mediastinal ch tube adult 50-200ml/hr -500ml/24°;100-300 pleural ch tube 1st 3°500-1000ml/24° grossly bloody postop
chest tube care per fundamentals book sudden gushes of drainage is usually due to client repositioning
Lung abscess has a localized area of pus formation in parenchyma (lung tissue); tissue necrosis as abscess increases
Lung abscesses affected area later collapses forming a cavity infecting bronchi @ pleural cavity
Lung abscess may develop from
Lung abscess Assessment findings wt loss; ch pain;productive cough,sputum,finger clubbing if chronic;dull or absent breath sounds; CXR or CT scan 4 loc ation of abscess;bld and sputum cultures identifies pathogens;thoracentesis Culture and Sensitivities
Medical and Surgical Management of lung abscess postural drainage - change position; antibiotics;last resort lobectomy removes abscess and surrounding lung tissue
Nursing management of lung abscess monitor adverse effects of antibiotics; admin chest physical therapy; deep breaht/cough;diet high proteint & calories;emotional support
Empyema definition of pus in a body cavity (general)//usually refers to pleural cavity (thoracic empyema)
Empyema is usually caused by chest trauma;pneumonia;TB
Empyema is a pus filled area that becomes walled off enclosed by thick membrane
Assessment findings of Empyema dyspnea; anorexia; malaise; breath sounds diminished or absent; CXR or CT scan
Medical and surgical management of Empyema Thoracentesis aspiration of fluid; closed drainage (ch tube)empties cavity; Thoracotomy open procedure placing several tubes to drain into underwater seal drainage.
Chronic Empyema if adequately treated thick coating over lung; decortication and evacuation of pleural space
Nursing Management of Empyema requires long treatment, provide emotional support; teach client breathing exercises as prescribed
Influenza is an acute respiratory disease of relatively short duration.
Influenza is transmitted through droplet through the respiratory tract
Influenza is transmitted easily and it becomes an epidemic quickly
is Influenza viral or bacterial? Viral and the strains are A, B, C; subtypes are swine and avian(bird)
swine and avian are subtypes what do these types do? mutate and produce variants
Prevention of influenza annual flue shot, hand washing, cover mouth
Signs and symptoms of influenza incubation 1-3 days; without symptoms but contagious
what is the onset of influenza? sudden, fever, chills, HA, muscle ache accept elderly immune system won't generate those symptoms
what is the progression of influenza? 7-10 days; fever 3days;anorexia, weakness, apathy, malaise; conjunctival irritation; respitoratory sneezing, pharyngitis, laryngitis, rhinitis, cough
complications of influenza are tracheobronchitis; cardiovascular disease;2° bacterial pneumonia, staphylococcal pneumonia
Can you die from pneumonia? yes, bacterial complications, pregnant women; elderly or debilitated clients; chronic cardiac disease or emphysema
Diagnostic studies for influenza CXR or sputum analysis to r/o other disease; annual flue vaccinations
who should get flu shots? elderly, young, healthcare workers, people at high risk
Nursing care for influenza isolation of clients;airborne or droplet precautions; mask, door closed; private room or pneumonia together;antivirals for those not affected (collaborative)
Who should stay home? those with symptoms should stay home staff and visitors!
What are the different Immunizations for influenza? Standard injection; flu-mist - live attenuated influenza vaccine for ages 5-50; administered intranasally
Who should not be immunized for influenza? x-husbands; allergy to eggs; immunosupressed, pregnant; history of Gillian-Barre
Pulmonary Tuberculosis aka TB; consumption
Tuberculosis is a bacterial infectious disease; may affect lungs, kidneys, bones, and other organs; world wide health problem
Tuberculosis as a bacterial infection disease is a mycrobacterium tuberculosis; gram positive,rod shaped; acid fast; aerobic; can live for months in dried sputum (who keeps their sputum that long?);destroyed by UV light in a couple of hours, heat, pastuerization
What is the leading cause of death with pts w HIV? tuberculosis; vaccination is in its 1st phase of human testing
How is TB transmitted? by droplet; coughing, sneezing, spitting;many who are infected never become ill
what are the predisposing factors of TB? inadequate health care; malnutrition; over crowding; classification of TB
TB is older adults is twice that of the general population; most prevalent in 65 or older in long term care facilities
What did she mean by TB classification? TB is classified in a systemic way to monitor the epidemiology and treatment. Based on Clients history, physical exam;skin test,CXR, mcirobiologic test
TB is characterized by stages of early infection, latency, & potential for recurrence after the primary disease then becoming secondary TB. Bacilli may remain dormant for years and then reactivates producing clinical symptoms
Early onset of TB is asymptomatic then fatigue & wt loss
Immune activation occurs within two weeks which is when a tissue reaction results in formation of a granuloma, which then through the dx process is eaten from the inside out causing a cavity and could be spreading through pts breath to others making it airborne,
Healing of the primary lesion of TB occurs through resolution, fibrosis and calcification. This is called Ghon complex and is visible on xray
Latent Period of TB you can be in latent period for years or a lifetime w/o symptoms. Depending upon immune status if the pt develops clinical disease.
Clients at high risk are those with HIV; diabetes; on chemotherapy or long-term steroids. Only a small % of infected ppl actually develop clinical symptoms
Progressive stage of TB you have a low fever; night sweats; cough w blood streaked sputum
Later stage of TB pts are weak; hemoptysis; dyspnea
Secondary TB is reactivation of initial infection, then immune response, lesions form in lungs and the process begins again of eating inside out etc; spreading to other areas via the lymph system; exacerbation and remission
Diagnostic findings of TB TB screening test; CT scan, MRI;analysis of sputum & other body fluids 4 bacilli & confirm diagnosis;gastric lavage:gastric aspiration;bronchoscopy
Med and Surg Management of TB drug therapy - controls pathogen & allow immune sys to overcome;combined therapy w drugs-toxicity & resistance;C&S - 2-3 wks to grow;segmental resection;surgery of wedge resection, lobectomy,pneumonectomy
Nursing process of TB asses breath sounds, breathing patterns,overall resp status;assess pain/discomfort experienced w breathing;inspect sputum color, viscosity; amount; signs of blood
Diagnosis/planning & interventions ineffective airway clearance - encourage fluids, discontinue smoking,eat light balanced diet; notify physician w sudden chest pain & dyspnea; activity intolerance
Medications for TB INH, rifampin, pyrazinamide are ALWAYS related to TB; take meds for many months
Chronic Obstructive Pulmonary disease aka COPD is an umbrella term for bronchiectasis;emphysema; chronic bronchitis
COPD IS.... obstructive airflow in lungs, resistance to inspiration is decreased, where as resistance to expiration is increased prolonged expiratory phase of respiration
COPD is . . . chronic cough and expectoration, dyspnea, impaired exp flow; bronchiectasis, chronic bronchitis, emphysema
other diseases associated w COPD asthma- episodic and acute; sleep apnea syndrome; cystic fibrosis - genetic; all these get progressively worse
Bronchiectasis assessment chronic infection; characterized by irreversible dilation of airways; chronic cough;fatigue, wt loss, anorexia, dyspnea;CXR, bronchoscopy reveal bronchioles size;sputum C & S test; PFT
Bronchiectasis chronic cough purulent sputum, possibly hemoptysis; sputum - frothy, clear saliva, purulent
Medical Management of bronchiectasis goal improve breathing; help raise secretions to improve drainage of purulent material; meds; surgical removal if small area is involved
Meds for bronchiectasis bronchodilators, mucolytics; humidification loosens secretions(nebulizers)
Nursing management for bronchiectasis client eduation postural drainage techniques - positions promote drainage specific lobe must keep position for 10-15 min ea; client coughs & expectorates secretions; provide oral care after treatment
Clients with COPD are at greater risk for Atelectasis - collapse of alveoli r/t obstruction of bronchi or lower air passages r/t mucous plug, foreign body obstruction; fluid or air in thoracic cavity; enlarged heart, aneurysm
Atelectasis air is trapped in lung- gradually absorbed into blood stream leaves collapsed area of lung
Atelectasis risk factors supine position w limited turning; splinting the chest; respiratory depression, muscle weakness
Atelectasis assessment basilar crackles posteriorly; dyspnea, cyanosis, cough, increased TPR, dec sat; chest discomfort
Atelectasis diagnosed by CXR, decreased breath sounds, bronchoscopy
Atelectasis treatment incentive spirometer, turn cough deep breath; removal of secretions; other dependent upon cause; meds; bronchodilators, humidification; oxygen admin
Nursing management of Atelectasis focus on prevention of Atelectasis; post operative: TCDB; use of incentive spirometer
Chronic bronchitis is chronic inflammation caused by continuous exposure to infectious or non infectious irritants
What are chronic irritants to bronchitis? Asthma, tobacco smoke, 2nd hand smoke; air pollution, toxic fumes, dust
Chronic bronchitis is defined as excess production of mucous and chronic cough lasting 3 mos/year for 2 consecutive years; more evident in winter months
Pathophysiology and Etiology of chronic bronchitis hyper-secretion of mucus w recurrent infections and altered ability of cilia; mucus plugs with focal tissue death; factors associated w chronic bronchitis diagnosis
Signs and symptoms of ch bronchitis chronic dough; bronchospasm; respiratory infections; progressive stage - yellow sputum prolonged expiration, cyanosis; dyspnea,right sided heart failure w edema
Diagnostic findings w ch bronchitis physical exam; pulmonary fucntion test; CXR; consolidation; bronchoscopy; sputum examination; lung scan
Medical Management of ch bronchitis prevent recurrent irritation - bronchial mucosa; removal of secretions; smokking cessation; bronchodilators; increase fluid intake; postural drainage; steroid therapy
Nursing management of ch bronchitis education clients to manage the disease; eliminate irritants; pneumonia and flu immunizations; measures to improve health - diet, rest and activity
Nursing management of ch bronchitis continued instruct use of aerosolized, metered dose inhaler, corticosteroids; bronchodilators; postural drainage techniques; determine amnt of aerobic activity - dyspnea
Importance of aerobic activity in ch bronchitis is so that don't loose the volume that they already have
Pulmonary emphysema is a chronic disease characterized by abnormal distention of the alveoli, destruction and occurs over many yrs; major cause of disability in US
Pathophysiology and etiology of pulmonary emphysema alveoli lose elasticity and trap air; destruction causes large air sacs over lung surface and capillaries are destroyed and fibrous scars replace normal tissue
Symptoms of pulmonary emphysema first symptom is exertional dyspnea; progressive stage chronic cough; diff inspiration r/t barrel shaped chest, expiration prolonged, difficult, wheeze;
Assessment of pulmonary emphysema client leans forward, purse lip breathing, anxious, pale, short, jerky communications; O2 sats begin to fall low 90s into 80s
Advanced stage of COPD dyspnea @ rest; impaired respiratory function; memory loss; carbon dioxide narcosis
COPD advanced stage Assessment diminished breath sounds, wheezing, crackles, muffled heart sounds; fan for comfort
Diagnostic findings of COPD advanced stage xray;fluoroscopy;PFT; ABG analysis - blood gases acute problems interventions working or not working
Medical Management of COPD advanced stage smoking cessation, meds - bronchodilators, Nebulizers; antibiotics; corticosteroids; inc fluids; postural drainage w CPT aerosol therapy
Nursing management of COPD advanced stage id environmental irritants cold air, wind (cause broncho spasms)
Prevening infections w COPD advanced stage monitor sputum and treat infection early;diet exercise, rest; pneumovax; annual flu shot;avoid ppl w resp disease (avoid crowded areas, peak times)
Hypoxic drive w COPD advanced stage chronic CO2 elevation medulla becomes less sensitive to CO2; O2 level drives respiration - hypoxic drive; O2 admin too much causes resp arrest; never admin O2> 2 or 3L/min may cause them to stop breathing
Diagnosis, plan, and interventions w COPD advanced stage ineffective airway clearance; impaired gas exchange teach pursed lip breath & abd breathing; risk for atelectasis; eval of expect outcomes
Asthma is an obstructive disease of lower airway
Asthma is caused by inflammation; hyper responsiveness of airway to stimuli
3 types of asthma allergic (extrinsic) idiopathic instrinsic mixed
Pathophysiology & Etiology of acute asthma obstruction r/t bronchospasms & constriction r/t reactive airways; inflammation & edema; thick mucus
Pathophysiology & Etiology of allergic asthma causes immunoglobulin E(Igf)inflammatory response,antibodies attach to mast cells in lung/reexposure to antigen causes release of mast cell histamine
Pathophysiology and Etiology of asthma alveoli hpyerinflate and trap air in lungs causing wheezing; poor perfusion; poor gas exchange poss Atelectasis or resp failure
Assessment findings of asthma shortness of breath; wheezing; coughing; thick sputum; fear & anxiety; duration hours to weeks; orthopnea-classic sitting position
Assessment findings of Asthma onset prolonged expiration; coughing initially unproductive; as attack subsides thick stringy mucus
Severe Asthma attack assessment findings cyanosis, perspiration; status asthmaticus - persistent & life threatening
Diagnostic findings of asthma breath sounds - expiratory wheezing may have inspiratory wheeze; diminished breath sounds; hypoxemia; decreased forced expiratory volume and vital capacity
classic sitting position for ppl w breathing problems body leaning slightly forward and the arms at shoulder height. position facilitates chest expansion and more effective excursions of the diaphragm
ABG's related to asthma show O2 stable r/t hyperventilation; CO2 varies w stage of attack. Early PaCO2 levels decrease due 2 resp increase; later you might have a normal PaCO2 which indicates impending respiratory failure
Medical Management of Asthma is prevention - avoid allergens; desensitization allergy shots/antihistamine therapy; AC;humidification of air; O2 if cyanosis or hypoxia
Meds for Asthma Bronchodialators; anticholinergis;corticosteroids
Beta agonist albuterol SE palpitations theophyline epinephrine SE nervousness
Anticholinergics Ipratropium SE pallor
Corticosteriods SE insomnia and decreases or prevent inflammation
Mast cell inhibitors cromolyn
Nursing Management of asthma nursing dx - anxiety and restlessness
Nursing Management of asthma nursing dx - anxiety and restlessness
Nursing intervention of asthma O2 administration; high Fowler's; rest & fluids; check IV site for extravasation
Nursing intervention of asthma O2 administration; high Fowler's; rest & fluids; check IV site for extravasation
Client education re asthma teach use of flow meter; instruct asthma action plan; use of inhalers; id triggering events; relax & breath techniques
Cystic fibrosis definition Exocrine gland dysfunction
Cystic fibrosis definition Exocrine gland dysfunction and multi-system disorder - eventually becomes fibrontic
Exocrine gland dysfunction Faulti transport of NaCl; thick sticky mucus; altered electrolyte balance
multi-system disorder respiratory skin GI - pancreas, intestines
Assessment findings for Cystic Fibrosis newborns meconium ileus and salty tasting skin Children- failure to thrive;finger clubbing;frequent respiratory infection/hemoptysis;malabsorption of fats and fat soluble vit - foul smell/greasy stool;risk for bowel obstruction; clubbing finger tips
diagnostic findings of CF sweat test; CXR sonsolidation, fibrotic changes over aerated; GI system - fibrotic changes; Feces- steatorrhea; PFT's
Medical Management of CF Respiratory postural drainage, CPT Bronchodilator meds Nebulized mist treatments
Medical Management of CF Digestive system Pancreatic enzyme replacement (Pancrease) fat-soluble vitamin supplements High-calorie diet
Medical Management of CF Respiratory digestive system Mucus-thinning drugs; nSAIDS' Gene therapy - experimental
Surgical Management CF for end stage disease liver and lung transplants
Nursing Management of CF Teach 2 prevent respiratory inf -prompt treatment Strict adherence - pulmonary toilet(cleansing) CPT,DB&C, suction, nebulize treatments
Nursing Management of CF Chest wall oscillation prophylactic antibiotics-teach adm home IV ABX to prevent hospitalization; diet high cal & balanced, enzyme meds
Cause of Occupational lung disease Esposure organic and inorganic dusts noxious gases
Cause of Occupational lung disease Pneumoconiosis fibrous inflammation of lungs after prolonged exposure
Cause of Occupational lung disease examples silicosis, asbestosis,black lung disease
Occupational lung disease symptoms dyspnea cough coal dust- black streaked sputum YUMMO
Occupational lung disease DIAGNOSIS CXR PFT - abnormal conservative treatment O2 therapy- severe dyspnea
Occupational lung disease Nursing Management Prevent by using protective equipment avoid smoking care is as for clients w emphysema
Pulmonary Hypertension definition is continuous high pressure in the pulmonary arteries and results from heart disease, lung disease or both
Primary Pulmonary Hypertension is rare and has a familial tendency most often in women 20-40 yr old and fatal within 5 yrs
Secondary Pulmonary Hypertension accompanied by other heart and lung conditions most commonly COPD
Pulmonary Hypertension patients have difficulty breathing pt presents very ill
Pulmonary vessel normal Pulmonary arteriole is normally thin and distensible
Pulmonary Hypertension early vessel looks like thickening of the medial muscular layer
Pulmonary Hypertension late vessel resembles extensive intimal fibrosis and medial thickening
Pulmonary Hypertension Assessment findings reveals dyspnea on exertion, weakness; right ventricular failure distended neck veins; peripheral edema; EKG rt vent hypertrophy
Diagnostic exams for Pulmonary Hypertension Cardiac cath pulmonary function studies Echocardiography ventilation-perfusion scan pulmonary angiography
Medical management for Pulmonary Hypertension Right sided failure - digitalis; diuretics Vasodilators, anticoagulants Primary disease - heart lung transplant secondary dx - management of underlying disease, O2
Nursing Management for Pulmonary Hypertension Observe for resp distress Administer O2 prevent fatigue - ADL's Reduce need for O2
PULMONARY EMBOLISM DEFINITION OBSTRUCTION OF PULMONARY ARTERIES OR BRANCHES; CAUSE THROMBUS IN HEART
Pathophysiology and Etiology of PULMONARY EMBOLISM Embolus travels to lungs; occludes pulmonary artery; causes infarction and then scar tissue
PULMONARY EMBOLISM examples Clots formed in venous system Endocardium - endocarditis, MI Fat embolus- fx of long bone Bed rest, recent child birth Virchow's triad - venostasis, hypercoagulability, disruption of venous lining
Signs and symptoms of PULMONARY EMBOLISM Vary w size of affected area Pain, tachycardia, dyspnea, petechiae Fever, cough, bld streaked sputum cyanosis, restlessness, shock sudden death
Assessment findings of PULMONARY EMBOLISM CXR - atelectasis ECG to r/o MI Lung and CT scan Pulmonary angiography Ultrasonography Impedance plethysmography VQ scan
Medical and Surgical Management of PULMONARY EMBOLISM IV heparin - monitor coag studies; IV thrombolytic drug; Anticogulants-long term Pulmonary embolectomy; Inferior vena cava device - umbrella filter device - greenfield filter
Nursing Management of PULMONARY EMBOLISM Assess - Homan's sign, petechia, O2sat, ABGs, cough, hemoptysis, diaphoresis, dyspnea
Nursing Intervention for PULMONARY EMBOLISM activate rapid response team Administer Vasopressors; ECK monitoring I & O
cause of Pulmonary edema right side of heartdelivers more flood to pulmonary circulation; fluid accumulation in interstitium and alveoli of lungs
Signs and symptoms of PULMONARY EMBOLISM dyspnea, feeling of suffocation; skin cool, moist, cyanotic; Continual blood tinged, frothy sputum cough; medical treatment discussed in CV unit
Respiratory failure definition of Inability to exchange sufficient amounts of O2 and C02; Expected ABD values pO2<50, pCO2>50, pH<7.25; Maybe acute or chronic
Pathophysiology and Etiology PULMONARY EMBOLISM acute Life-threatening condition; Alveoli cannot expand; Impaired neuro control of respiratory; trauma to chest wall
Pathophysiology and Etiology PULMONARY EMBOLISM CHRONIC copd; neuromuscular disorders; gas exchange dysfunction; chronic resp acidosis
Assessment findings of PULMONARY EMBOLISM use of accessory muscles, dec sat -S&S of underlying disorder; Restlessness; wheezing;cyanosis, fatigue,HA; MENTAL STATUS CHANGE, DYSRHYTHMIAS, RESP ARREST; CXR; Serum electrolyte determinations (venous CO2)
Medical Management of PULMONARY EMBOLISM Venturi and rebreather masks; Humidified O2; Endotracheal entubation or tracheostomy tube; Mechanical ventilation; treat underlying cause
Nursing management of PULMONARY EMBOLISM Assess respirations, breath sounds, cyanosis, pulse ox; Emergent resuscitative eequip & rapid resp team; notify MD if symptoms occur suddently; ABG results; prevent complications; reduce anxiety
ACUTE RESPIRATORY DISTRESS SYMDROME ARDS Adult respiratory distress syndrome Non cardiogenic pulmonary edema; high mortality rate
Non cardiogenic pulmonary edema no left sided heart failure; sudden; Progressive loss of lung compliance
Pathophysiology of ACUTE RESPIRATORY DISTRESS SYMDROME Injury related to platelet clumping and inflammation which increases permeability of cap membrane and alveolar collapse
Etiology of ACUTE RESPIRATORY DISTRESS SYMDROME aspiration, near drowning; drug overdose; DIC massive transfusion
Assessment findings of ACUTE RESPIRATORY DISTRESS SYMDROME Severe respiratory distess w/in 8-48°; Inc respiratory rate causing distress; hypoxemia unrelieved by O2 adm; CXR- bilateral infiltrates- no evidence of left sided heart failure; Inc pulmonary artaery pressure
Medical Management of ACUTE RESPIRATORY DISTRESS SYMDROME HUMIDIFIED OXYGEN - endotracheal or tracheostomy tube Mechanical ventilation using PEEP TREAT SHOCK-administration of IV fluids; colloids; NUTRITIONAL suppoft is essential once stabilized tube feedings
Nursing Management of ACUTE RESPIRATORY DISTRESS SYMDROME provide explanations and support Provied alternative methods to communicate if on vent
LUNG CANCER Common cancer and #1 cause of cancer death in US - breast, prostate and colon less than lung cancer;
LUNG CANCER Risk factors Smoking and second hand smoke
LUNG CANCER Incidence greater in men than women >49 year olds
Pathophysiology and Etiology of LUNG CANCER cause long term exposure to irritants
Pathophysiology and Etiology of LUNG CANCER cells Large- undifferentiated small- oat cell Epidermod - squamous Adenocarcinoma
Lung Cancer begins in bronchus then invades and spreads blocking lumen of bronchus; tumor may bleed causing hemoptysis
Assessment Findings of LUNG CANCER Early sign blood streaked sputum
Assessment Findings of LUNG CANCER Progressive stage Fatique, anorexia - wt loss; dyspnea and pain at site
Assessment Findings of LUNG CANCER Indicating Mets Head and neck edema pericardial effusion vocal cord paralysis
Diagnostic findings of LUNG CANCER Sputum for cells; CT scan or MRI; CXR; Bronchoscopy; Fine-needle aspiration; Lung and bone scan; lymph node biopsy; Mediastinoscopy
Medical and surgical management of lung cancer Tumor removal via lung resection; Radiation therapy - slows spread, shrinks tumor palliative ; Chemo - palliative
Metastasis of lung Cancer Mediastinum, cervical lymph nodes; Liver, brain, spinal cord; bone, other lung
Nursing Management of Lung cancer Same as that for Malignant disease and lung disease
Mediastinal tumors usually are malignant and metastatic
Mediastinal tumors cause is unknown, initially asymptomatic
Mediastinal tumors symptoms chest pain; dysphagia; dyspnea; Orthopnea; Dx - Mediastinoscopy w biopsy of the lesion
Medical Management of Mediastinal tumors Malignant - inoperable; Benign - usually operable
Chest trauma - fractured ribs Common injury; Causes are due to fall; blunt chest trauma - MVA-airbag; Assault; contact sports
Pathophysiology and Etiology of fractured ribs causes painful but not life threatening unless broken rib punctures a lung; chest wall become unstable ie multi rib fx
Pathophysiology and Etiology of fractured ribs FLAIL CHEST IMPAIRMENT OF CHEST WALL MOVEMENT creating ineffective movement of air in and out of thoracic cavity (paradoxical)
Assessment findings of fractured ribs Pain-severe, inspirations and expiration Shortness of breath; Flail chest symptoms-impaired gas exchange, inc CO, hypotension -Respiratory acidosis - hypercapnia; -Radiographs sometimes difficult to visualize
Medical Management of rib fractures Analgesics - regional nerve block; Elastic bandage-rib belt-complications-atelectasis, PNE; Flail chest-mechanical ventilation, suctioning, ABX
Nursing Managment of rib fractures Apply immobilization device and instruct: applicationand removal of rib belt; deep breath; care based on respiratory needs; Monitor for signs of respiratory distress, infection and increased pain
CHEST TRAUMA - BLAST INJURIES COMPRESSION OF CHEST BY EXPLOSION RUPTURES ALVEOLI SUBCUTANEOUS EMPHYSEMA-CREPITATION, SLIGHT SWELLING; TX-BEDREST, VERY CLOSE OBSERVATION, RESP SUPPORT, THORACENTESIS, CHEST TUBE; DEATH-hemorrhage --asphyxiation
CHEST TRAUMA PENETRATING WOUNDS Types- gunshot-usually high velocity; stab wounds-low velocity
Consequences of CHEST TRAUMA PENETRATING WOUNDS Often life threatening; Pneumothorax; Hemopneumothorax; Subcutaneous emphysema; Injury to chest tissue and organs
Assessment findings of CHEST TRAUMA PENETRATING WOUNDS Dyspnea; bleeding - trachea shifts away from affected side; Respiratory distress/shock; radiographs; ABG; Pulse Ox; ECGs
Emergency treatment of CHEST TRAUMA PENETRATING WOUNDS Do not remove foreign body b4 victim is hospitalized - may prevent entry of air;may stabilize blood vessels; Emergency treatment of pneumothorax-application of a tight pressure dressing-prevents entry of air;-O2 adm, establish IV
medical and Surgical Management of CHEST TRAUMA PENETRATING WOUNDS Airway management; Thoracentesis & chest tube insertion; Thoracotomy prn to repair injury; Indwelling catheter; nasogastric tube
Nursing management of CHEST TRAUMA PENETRATING WOUNDS similar to that of a client who has thoracic surgery
Thoracic surgery Thoracotomy-surgical opening of chest wall; Reasons removal of fluid, blood, tumor, foreign body; Open heart surgery; repair trauma,
Preoperative nursing management of thoracic surgery prepare for surgery; obtain as much history as possible support resp
Postoperative nursing management of thoracic surgery assess client's neurologic status, heart rate, lung sounds; drain thoracic cavity - air & fluid,chest tubes-more note drainage-bloody or serous;record output frequently
Post op nursing for thoracic surgery Dressings-minimal draining; report subcutaneous emphysema; Impaired mobility-shoulder on affected side assess lateral ROM Passive ROM qid; Encourage client to use arm in ADL's
Underwater seal drainage system Secure all connections - tube coming from pt must always be under water; Maintain wall suction as ordered (<20cmH2O pressure);
Underwater seal drainage system Record fluctuation w/resp-normal initially, cease when lung is expanded bubbling-NI initally, cease when pneumo is resolved; excess bubbling-check for leaks/notify physician
Chest tube troubleshooting Patency must be immediatly addressed; do not allow kinking; clogging- milk; strip
GENERAL CONSIDERATIONS NUTRITIONAL EMPHYSEMA mALNUTRITION-SMALL FREQ FEEDINGS PREVENT DYSPNEA WHILE EATING; ENCOURAGE FLUIDS R/T SLOWED PERISTALSIS
GENERAL CONSIDERATIONS NUTRITIONAL EMPHYSEMA dietary RECOMMENDATIONS INCREASE CALORIE NEEDS 40% FAT, 40% PROTEIN, 20% CHO
GENERAL CONSIDERATIONS NUTRITIONAL ASTHMA FOOD ALLERGENS MAY INCLUDE EGGS, SEAFOOD, FISH; SUPPORT IMMUNE SYSTEM ENCOURAGE ADEQUATE CALORIES AND PROTEIN; ENCOURAGE VIT A, C, B6 AND ZINC
GENERAL CONSIDERATIONS NUTRITIONAL ASTHMA CONT Obese CLIENTS WITH EMPHYSEMA - LOOSE WEIGHT!; SPECIAL ENTERAL FEEDING FORMULAS CONTINUOUS
pharmacologic GENERAL CONSIDERATIONS NUTRITIONAL asthma respiratory tract infection:culture and ABX; COUGH MEDICINES -SUPPRESSING COUGH MAY LEAD TO INFECTION; BRONCHODILATORS OFTEN PRESCRIBED; THEOPHYLLINE THERAPEUTIC LEVELS - 10-20ug; TB-INH is prophylactic for family; Narcotics - monitor resp closely
GENERAL CONSIDERATIONS GERONTOLOGIC prone to PNE after riB FRACTURE AND URI; Flu vaccine-annual; Vaccination-once pneumococcal pneumonia>50yrsold;nursing home residents; debilitated clients; Post op period-may be confused protect tubes; include family in teaching
Created by: kgion