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Respiratory Part 2

Cabrera Respiratory Part 2

Acute bronchitis Inflammation of the mucous membranes that line the major bronchi and their branches.
Viral infections most commonly give rise to acute bronchitis
Clients with viral Upper Respiratory Infections are more vulnerable to secondary bacterial infections which then may lead to acute bronchitis
Sputum cultures identify the causative bacterial organisms, of acute bronchitis, commonly: haemophilus influenzae, streptococcus pneumoniae, and mycoplasma pneumoniae.
Fungal infections such as aspergillus may be identified as the cause of acute bronchitis.
Chemical irritation from noxious fumes, gases, and air contaminants also may induce acute bronchitis.
Bacterial Pneumonias are referred to as typical pneumonias
Bacterial pneumonia is less common but more serious. Causative bacterial organisms include streptococcus pneumoniae, pnemocystis jiroveci, staphylococcus aureus, Klebsiella pneumoniae, pseudomonas aeurginosa, and haemophilus influenzae.
Preventing Pneumonia: Promote coughing and expectoration of secretions if client experiences increased mucus production.
Preventing Pneumonia: Change position frequently if client is immobilized for any reason.
Preventing Pneumonia: Encourage deep-breathing and coughing exercises at least every 2 hours.
Preventing Pneumonia: Administer chest physical therapy as indicated. Suction client if he or she cannot expectorate.
Preventing Pneumonia: Prevent aspiration in clients at risk. Prevent infections. Cleanse respiratory equipment on a routine basis. Promote frequent oral hygiene.
Preventing Pneumonia: Administer sedatives and opioids carefully to avoid respiratory depression.
Preventing Pneumonia: Encourage client to stop smoking and reduce alcohol intake.
Older adults are at greater risk for pneumonia and may experience a higher acuity due to concomitant health problems such as heart disease and diabetes. Vaccination against pneumococcal pneumonia is recommended for clients oder than 50 years with chronic or debilitating illness, those over age 65, and residnets in long-term care facilities. Current guidelines rec. a booster dose if the initial immunization was 5 or more years ago. Older adults should be advised to receive an flu vac
Pleurisy refers to acute inflammation of the parietal and visceral pleurae. Pleurae are inflamed, thick, and swollen, and exudate forms from fibrin and lymph.
With Pleurisy, During inspiration, the inflamed pleurae rub together and cause severe, sharp, pain.
Pleurisy S/S Abrupt and severe pain on one side of the chest. Aggravated with breathing and coughing. Especially inspiration. Dry cough, fatigue, dyspnea, friction rub
A lung abscess is a localized area of pus formation in the lung parenchyma. as the abscess increases, the tissue becomes necrotic. Late rthe affected area collapses and creates a cavity.
Empyema is a general term used to denote pus in a body cavity.
Flu Mist is not recommended for the following groups: People with: underlying med condtns (diabetes), known or suspected immunodeficiency, Hx of Guillain-Barre, Children or adolescents who reg. take aspirin, Pregnant, hypersensitivity to eggs, <2 or >50.
Chronic obstructive pulmonary disease is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.
Cardinal Signs of Lung Cancer Cough, Mucopurulent or blood streaked sputum. I
Why is lung cancer not normally caught early? because cough is tolerated and people don't get it checked out like it should.
Non-Rebreathing Mask Gives the most oxygen without intubation.
Flail Chest S/S severe dyspnea, cyanosis, increased respiratory rate, increased heart rate, paradoxical movement of chest.
What is flail chest? occurs when two or more adjacent ribs fracture in multiple places (2 or more) and the fragments are free-floating.
Chest tube care: Fluctuation of the fluid in the water-seal chamber is initially present with each respiration. Fluctuations cease whent he lung reexpands. The time for lung reexpansion varies. Fluctuations may cease if: the chest tube is clogged, The wall suction unit malfunctions, a kink or dependent loop develops in the tubing.
Chest tube care: Bubbling in the water-seal chamber occurs in the early postop period. If bubbling is excessive the nurse checks... the system for leaks. If leaks are not apparent, the nurse notifies the physician.
Chest tube care: Bloody drainage is normal but drainage should not be bright red or copious
Chest tube care: The drainage tubes must remain patent to allow fluids to escape from the pleural space.
Chest tube care: Clogging of the catheter with clots or kinking causes drainage to stop. The lung cannot expand and the heart and great vessels may shift to the opposite side. The nurse must be alert to the proper functioning of the drainage system. Malfunctions need immediate correction.
Chest tube care: If a break or major leak occurs in the system, the nurse... clamps the chest tube immediately with hemostats kept at the bedside. He or she notifies the physician.
Lung Abscess S/S chills and fever, weight loss, CP, Productive cough, purulent and blood tinged, finger clubbing, diminished breath sounds.
Chronic Bronchitis Treatments Increase fluid to 2L/day to aid sputum movement, Sleep with humidifier, expectorants, bronchodilators, Ox to maintain: PaO2 50-60, SaO2 90%, 1-3L/min per NC. Stop Smoking. Chest physio. Percussion,vibration. Postural drainage. Air filtration. Exercise.
Pt care after thoractomy Maintain patent airway, oxygen therapy as needed, suction as ordered and prn, Turn q 2 hours, Semi-Fowlers to High-Fowlers, Cough deep breathing exercises, Splint incision, Ambulation, Keep patient ON AFFECTED SIDE.
What is Cystic Fibrosis? Hereditary. Multisystem. All ages. Dysfunction oof the exocrine glands to produce thick, tenacious mucus. There is no cure.
Cystic Fibrosis S/S Begins in infancy or childhood. Failure to thrive. Meconuium ileus, cough, purulent sputum, thick mucus. Fingure clubbing. Hemoptysis. Frothy, bulky, stinky poos due to malabsorption of fats.
Cystic Fibrosis treatments are aimed at relieving symptoms because there is no cure: Postural drainage. Chest physio. Flutter valve. Vests. Hydration. BD. Mucolytics. Antibiotics. Pancreatic enzyme replacement (every meal). Fat soluble vitamins. High Cal Diet. Lung Transplant. Mucus thinning drugs. NSAIDS. Gene therapy.
Positive Homan's Sign indicates Possible DVT.
Asthma Reversible obstructive disease of lower airway. Inflammation of airway.
Three types of asthma allergic: extrinsic; idiopathic: intrinsic; mixed: both
Prevention of occupational lung disease Frequent examination.s. Laws require areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection. Workers are encouraged to quit smoking. Get fitted for a mask.
Encourage clients with asthma to consume adequate calories and protein to optimize health and rest infection. Large meals may aggravate asthma by distending the stomach, small frequent meals may be better tolerated.
Certain vitamins are important for the asthmatics immune function AC B6 and Zinc. Food allergens that may trigger asthma may include milk, eggs, seafood and fish.
Bronchodilators areused to manage acute breathing disorders, such as acute asthma attacks or reversible bronchospasm. Examples of bronchodilators include adrenergic drugs. Levels should be maintained in the terapeutic range of 10-20mcg. Levels over 20 are a/w toxicity.
Initial drug combo for tuberculosis INH, RIF, and PZA for 4months. INH and RIF for an additional 2 months.
Prophylactic TB drug isoniazid (INH) May use vitamin B6 to minimize side effects. Use for 6-12 months.
Preventing Atelectasis: Monitor vital signs every 15 minutes for at least 2 hours after return from postanesthesia care unit and then less frequently as condition stabilizes.
Preventing Atelectasis: force preop instructions about deep breathing, coughing and incentiveRei Atelectasis: spirometry. Remind client to do these exercises every 1-2 hours.
Preventing Atelectasis: Position client with HOB elevated to 30 to 40 degrees initially.
What constitutes a positive Mantoux Test 10 mm or greater induration (indicative of TB)
S/S of TB (if answer yes to 3 or more it could be TB) CP and Tightness, Fatigue, Anorexia, Weight loss, Productive cough, Bloody sputum, low grade fever.
ARDS or Acute Respiratory Distress Syndrome is a progressive pulmonary disorder that follows trauma to the lung. Considered noncardiogenic pulmonary edema
ARDS is characterized by sudden and progressive pulmonary edema, increasing bilateral infiltrates, severe hypoxemia, loss of lung compliance (disability to expand).
Treatment of ARDS Early detection is cretical, intubation, treatment of underlying cause, antimicrobials, corticosteroids, humidified o2, Stabilization of
What is the main complication with ARDS treatment? Over oxygenation! Be sure to monitor
COPD broad nonspecific term that describes a group of pulmonary disorders with symptoms of chronic cough and expectoration, dyspnea, and impaired expiratory airflow.
COPD includes: Bronchiectasis, atelectasis, chronic bronchitis, emphysema, sleep apnea, cystic fibrosis.
S/S of Right sided heart failure SOB, Fluid build-up in the lungs, Fatigue due to inefficiency of blood circulation. cyanosis, peripheral edema, "blue bloater" dyspnea
Low oxygen S/S restless, discolored nailbeds give oxygen. Check pulse ox.
Pleurisy S/S ABRUPT AND SEVERE PAIN ON ONE SIDE OF THE CHEST. aggravated with breathing and coughing, especially inspiration. dry cough. fatigue. dyspnea. friction rub. complications: pleural effusion. atelectasis. hypoxemia. hypercapnia.
Empyema is pus or infected fluid in the pleural cavity. May occur after chest trauma, pneumonia or TB
S/S of Empyema fever, CP, dyspnea, anorexia, malaise, dimished or absent breath sounds.
Treatments for Empyema: Thoracotomy Closed Surgical opening of the thoracic cavity and chest tubes inserted to facilitate drainage.
Treatment for Empyema: Thoracotomy Open Sections of the ribs are removed to create an opening chest tubes inserted for drainage area left open only covered with dressing.
Position of pt after thoracic surgery On affected side to facilitate drainage with HOB elevated 30-40 degrees. Semi Fowlers.
Complications of untreated empyema "stiff lung" inability of the lung to expand R/T thick coating over the lung.
Chest tubes! Check levels of drainage. Make sure everything is TIGHT! Keep lower than chest.
Care after thoracic surgery: Continue to perform arm exercises to prevent stiffness and pain. Eat a well-balanced diet. Take rest periods throught the day until fatigue decreases. Pracice breathing exercises. Deep breaths. Contact the physician if breathing is difficult. drainage excessive redness or pain develops around the incisiion; fever develops; or pain ocurs elsewhere int he body. Avoid infections or irritants. Increase activities slowly and avoid fatigue. Take drugs as prescribed!!
When administering a narcotic to a client who has had thoracic surgery, count the respiratory rate before and 20 to 30 minutes safter the client receives the meds. if the respiratory rate is below 10 breaths per minute at either time, notify the physician immediately.
A chest tube placement is usually an emergency surgery to remove an abnormal collection of fluid or air from the pleural space.
Tuberculosis is bacterial infection disease primarily caused by M. Tuberculosis. leading cause of death from infections diseases and among people with HIV. Spread by droplet.
Emphysema is a chronic disease characterized by enlargement of airways beytond the terminal bronchioles. By the time of diagnosis the damage is permanent. Most common COPD.
2 Types of Emphysema Centrilobular (smoking) and Panlobular
S/S of Emphysema SOBOE which further declines to SOB at REST, cough, mucopurulent sputum, thin, barrel chest, rigid chest cage, use of accessory muscles, called "pink puffer" normal abgs and normal skin color will become pale in advanced stages, decreased lung/heartsounds
COPD pts get how much oxygen? 2-3L
Right Sided Heart Failure SS (MORE JVD, Orthopnea, peripheral edema
Early signs of respiratory failure anxiety and restlessness
Chronic respiratory failure is typically accompanying a disease. Fdilure occurse over time and is irreversible. Emphysema.
Created by: christinego