Transcript Resp.Fundamentals with Notes

Respiratory Fundamentals
Linda Winn, RN, MSN Ed., BA Ed.
Major Topics
• Anatomy
http://www.argosymedical.com/Respiratory/samples/animations/Respirat
ion/index.html
http://www.argosymedical.com/Respiratory/samples/animations/Sherwo
od%20Respiration/index.html
• Assessment
• Labs
• Diagnostics
• Meds
• Common Diagnoses
Activity
•
Each team will be assigned one of the following topics to research and
present to the entire group:
– Assessment
• Normal assessment – what makes up a complete respiratory assessment?
• Abnormal findings & significance
– Labs
• What labs are relative to respioratory status?
• Normals
• Abnormals & significance
– Diagnostics
•
•
•
•
What diagnostic tests are relative to pulmonary status?
Normals
Abnormals & significance
Any significant patient care measure before, during, or after tests
– Meds
• Major categories / actions of Respiratory meds
• Significant side-effects
• Nursing measures specific to meds
Respiratory Assessment
Assessment
• Screening Exam Techniques
http://depts.washington.edu/physdx/pulmonary/tec
h.html
http://depts.washington.edu/physdx/pulmonary/de
mo.html
Resp Assessment
• Breathing Pattern
– I:E ratio
– Kussmaul
– Rate
• Dyspnea
– Orthopnea
– PND – Paroxysmal nocturnal dyspnea
• Cough and Sputum
–
–
–
–
–
–
–
Frequency
Dry / moist
Amount
Color
Thickness
Odor
Hemoptysis
Assessment (Cont.)
• Inspection
– Symmetry
– Skin color – lip color / finger clubbing
– WOB – accessory muscles
• Auscultation
– Adventitious sounds
• Chest pain
• History
– Diagnoses
– Smoking
• Quick, Focused Assessment
Breath Sounds Link
• Normal and Adventitious breath sounds
http://faculty.etsu.edu/arnall/www/public_html/heartlung/breathsounds/conte
nts.html
Diagnostics & Labs
Labs
• H/H
• Sputum Analysis
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–
–
–
C&S
Gram Stain
Acid-Fast smear (AFB)
Cytology
• ABG’s
• WBC
• O2 Sats
Diagnostic Tests
• CXR
• CT Chest
• MRI
• V/Q Scan
• Bronchoscopy
http://www.nlm.nih.gov/medlineplus/tutorials/bronchoscopy/htm/_no_50_no_0.htm
• Thoracentesis
• PFTs – Pulmonary Function Tests
–Spirometry
Diagnostics
• PFR
– http://www.argosymedical.com/Respiratory/samples/
animations/Peak%20Flow%20Meter/index.html
Diagnostic Tests
• Endoscopic Exams
– Bronchoscopy: direct
inspection of airways
• Only __________
___________ of
airways
– Purposes:
• diagnose diseases
• find obstructions
• obtain tissue samples
• remove mucous plugs,
foreign bodies
• find bleeding sources
Pulmonary Meds
Pulmonary Meds
• Oxygen (later)
• Corticosteroids
http://www.argosymedical.com/Respiratory/sample
s/animations/Inhaled%20Corticosteroids/index.ht
ml
• Antibiotics
• Beta-Agonists
Respiratory Med Delivery
Metered Dose Inhalers
– deliver constant dose of drug directly to
airways
– requires hand-lung coordination
– propellant based
– compact & portable
– relatively inexpensive
How & Why Is the Spacer
Used?
Spacer
http://www.mayoclinic.com/health/asthma/MM00608
Methods of Delivery
Dry Powder Inhalers
– no propellants used
– breath activated easier to use
– delivers more drug to airways than MDIs
http://www.mayoclinic.com/health/asthma/MM00405
Methods of Delivery
Nebulizers
– used at home or hospital
– continuous aerosol spray with external energy
source (O2)
– takes longer to deliver drug
– choice if patient unable to use MDIs
Respiratory Treatments
• Coughing and Deep Breathing (later)
• Incentive Spirometry (later)
• Oropharngeal Suctioning
• Inhaled Medication
• Oxygen Therapy (Supplementation)
Coughing & Deep Breathing
•
Position for maximal lung expansion
•
Splint with hand(s) or pillow
•
Slow inspiration via nose, hold 3-5 seconds, exhale via
mouth. Cough after 2-3 breaths.
•
Pulmonary disease: exhale via pursed lips & cough after
expiration started
•
More frequent coughing if productive
•
Coughing contraindicated: post-eye, ear, brain
or neck surgery
Incentive Spirometry
• Prevents atelectasis & PNA
– Position for maximal lung expansion
– Exhale completely
– Close mouth around mouthpiece
– Inhale slow & deep, watching meter for flow rate
– Make inspiration last for 3-5 seconds
– 10 X Q/hr WA
Respiratory Diagnoses
• Asthma
• COPD
– Chronic Bronchitis
– Emphysema
• Pneumonia
Major Pulmonary Diagnoses
• COPD
– http://video.about.com/copd/Emphysema.htm
– http://video.about.com/copd/COPD.htm
• Pneumonia
– CAP vs HAP
Major Pulmonary Diagnoses
• Asthma
– http://www.argosymedical.com/Respiratory/samples/animation
s/Asthma%20TLC_AZ/index.html
– http://www.argosymedical.com/Respiratory/samples/animation
s/Asthma/index.html
• Sleep Apnea
– http://www.argosymedical.com/Respiratory/samples/animation
s/CPAP%20Sleep%20Apnea/index.html
Pneumonia Collaborative Care
• Appropriate antibiotic
therapy
• Reduced activity and
rest
• Increased fluid-- 3
liters/day
• Antipyretics
• Supplemental oxygen
• Good nutrition--1500
cal/day
• Vaccine prophylaxis
• analgesics
• CORE Measure
Assessment Findings
• Fever, restlessness, fatigue, splinting painful chest
• (New) cough with or without sputum
• Shortness of breath, RR & HR
• Pleuritic chest pain
• Infiltrates on CXR
• Crackles or bronchial sounds in the peripheral lung
fields
Collaborative Care
• Appropriate antibiotic
therapy
• Reduced activity and
rest
• Increased fluid-- 3
liters/day
• Antipyretics
• Supplemental oxygen
• Good nutrition--1500
cal/day
• Vaccine prophylaxis
• Analgesics
• Oxygen
• CORE Measure
Oxygen
• Medication
– Requires MD order
– Side Effects
• Highly combustible gas
– Clear
– Odorless
• Set-up is part of initial room check
Indications for O2 therapy
• Goal
– Prevent or relieve hypoxia
• Keep SaO2 > 90%
– Reduce work of breathing
– Room Air / FIO2 = 21%
• Used with hypoxia due to:
– Respiratory Disorders
– Cardiovascular disorders
– Central nervous system disorders
Safety Precautions
• O2 sign posted
• No smoking or flames
• Electrical equipment grounded
• Check tank level before transport
• No oil-based lubricants / lotions
Delivery Devices
• Nasal Cannula
• Masks
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–
–
–
Simple face
Partial rebreathing
Non-rebreathing
Venturi (Venti Mask)
• Tracheostomy
– Collar
• Ventilator
• Flow Meter
• Humidification
Oxygen Safety
Nasal Cannula
• Advantages
– Safe, simple, tolerated well
– Allows eating and drinking
– Can humidify
• Disadvantages
– Easily dislodged
• Check regularly
– Skin breakdown
• Check regularly
• O2 Concentrations
– 1L/min = 24%
– 2L/min = 28%
– 3L/min = 32%
Simple Face Mask
• RA enters via side holes
• Advantages
– Humidified
• Disadvantages
– Imprecise FIO2
– High FIO2 needed to prevent rebreathing CO2
• Concentrations
– 5-6L/min = 40%
– 6-7L/min = 50%
– >7L/min = 60%
Non-rebreather Mask
• Use
– Valve prevents air from flowing
back into bag
– Last step, usually, before intubation
• Advantages
– High O2 concentrations
– Accurate
• Disadvantages
– Can’t use high humidity
– uncomfortable
Venturi Mask
• Venti-mask
– High flow
– Adjustable
• Advantages
– Very precise
– Mask of choice for
COPD
• Disadvantages
– uncomfortable
O2 and COPD
• Historically…
– Never give O2 >2L/min to COPD pts.
• However…
“There has been concern regarding the dangers of
administering O2 to COPD pts and reducing their
drive to breath.”
“This has been a pervasive myth but is not a serious
threat.”
“In fact, not providing adequate O2 to these patients is
much more detrimental.”
Lewis, p. 643 (7th ed.)
Patient Education
• Monitor color of sputum
• Self care: at-home meds & treatments; avoid triggers
• Prevention
– Pneumococcal vaccine, flu shot
• Frequent oral hygiene
• Encourage fluids
• Environmental hazards
– altitude, smog, allergies, smoke
• Follow up medical care
• American Lung Association
– www.lungusa.org