Transcript RESPIRATORY ppt SP 09

The Respiratory
System
Rachel S. Natividad, RN, MSN, NP
N212 Medical Surgical Nursing 1
Structure and Function
Gas exchange
Changes associated to Aging
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↓ recoil and compliance
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 AP diameter
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↓ functional alveoli
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↓ in Pa02
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Respiratory defense
mechanisms less effective
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Altered respiratory controls
 More gradual response to
changes in O2 and Co2
levels in blood
Diagnostics
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Pulse Oximetry
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Chest X-Ray
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Computed Tomography
(CT scan)
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Bronchoscopy
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Thoracentesis
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Pulmonary Function
Tests
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Sputum Specimen and
Cultures
Diagnostics: Pulse Oximetry
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Measures arterial oxygen
saturation
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Pulse oximetry probe on
forehead, ears, nose, finger,
toes,
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False readings
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Intermittent or continuous
monitoring
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Ideal values: 95-100%
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When to Notify MD
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< 91%
86% (Medical Emergency)
Diagnostics: Chest X-Ray
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Screen, diagnose,
evaluate treatment
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Instructions: No
metals/jewelry
Diagnostics: Chest X-Ray Cont.
Nodule
Infiltrates
Posterior Anterior View
Left Lateral View
Diagnostics: Sputum Specimen
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To diagnose; evaluate treatment
Specimen: ID organisms or abnormal
cells
Culture & Sensitivity (C&S)
 Cytology
 Gram stains
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(e.g. Acid Fast Bacilli)
Diagnostics: Computed
Tomography: CT Scan
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Images in crosssection view
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Uses contrast
agents
Right upper Lobe
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Instructions:
Diagnostics: Bronchoscopy
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Diagnose problems and assess
changes in bronchi/bronchioles
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Performed to remove foreign
body, secretions, or to obtain
specimens of tissue or mucus for
further study
Procedure Care/Instructions:
NPO 6 -8 hrs prior
Sedation during procedure
Post Procedure:
HOB elevated
Observe for hemorrhage
NPO until gag reflex returns
Diagnostics: Pulmonary
Function Test (PFTs)
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Evaluate lung function
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Observe for increased
dyspnea or
bronchospasm
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Instructions:
No bronchodilators 6
hours prior
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Diagnostics: Thoracentesis
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Specimen from
pleural fluid
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Treat pleural
effusion
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Assess for
complications
Post-Procedure care:
 CXR after procedure
Positions
•Sitting on side of bed over bedside table
chest
elevated
•Lying on affected side
•Straddling a chair
Assessment: Cues to
Respiratory Problems
Dyspnea
Cough
Sputum
Pneumonia: Case Study
Pathophysiology
Pneumonia: Pathophysiology Cont.
Pneumonia: Etiology
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Cause
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bacteria (75%)
viruses
fungi
Mycoplasma
Parasites
chemicals
Pneumonia: Classifications
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Community-acquired pneumonia (CAP)
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Onset in community or during 1st 2 days of hospitalization
(Strep. pneumoniae most common)
Hospital-acquired Pneumonia(HAP/nosocomial)
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Occurring 48 hrs or longer after hospitalization
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Aspiration pneumonia
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Pneumonia caused by opportunistic organisms
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Pneumocystis Carinii
Pneumonia: Risk Factors
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CAP
Older adult
Chronic/coexisting
condition
Recent history or
exposure to viral or
influenza infections
History of tobacco or
alcohol use
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HAP
Older adult
Chronic lung disease
ALOC
Aspiration
ET, Trach, NG / GT
Immunocompromised
Mechanical ventilation
Pneumonia: Clinical
Manifestations
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Fevers, chills, anorexia
Pleuritic chest pain
SOB
Crackles/wheezes
Cough, sputum production
Tachypnea
Pneumonia: Clinical
Manifestations-Cont.
Mycoplasma (Atypical)
 feeling tired or weak,
headaches, sore throat,
or diarrhea.
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Eventually, most develop
a dry cough. They can,
also, develop fever, chills,
earaches, chest pain
“walking pneumonia”
Pneumonia: Diagnosis
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Diagnosis →
 Physical exam →
crackles,
rhonchi/wheezes
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CXR →area of increased
density
(infiltrates/ consolidation)
Sputum specimen –
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Gram stain
LUL Infiltrates
Pneumonia :Interventions/Tx
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Treatment
 Antibiotics → choose based on age,
suspected cause & immune status
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Supportive care → IV fluids, supplemental
oxygen therapy, respiratory monitoring, cough
enhancement
*may take 6-8 weeks for CXR to normalize
Nursing Diagnoses…
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Impaired gas exchange R/T
Pneumonia
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Pain R/T infection in lung
Pneumonia
Pneumonia: Complications
Hypoxemia
Pleural effusion
Atelectasis
Pleurisy
Atelectasis
Pleurisy
Pleural Effusion
Toxic sprinkles anyone?
Any Questions?