Transcript Thoracotomy By Janell Trotman Petra Ramnarine

PNEUMONIA
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Diagnosis
Definition & Explanation of
Diagnosis
Etiology & Risk Factors
Incidences Among Gender,
Age, & Ethnicity
Prognosis
Signs & Symptoms
By:
Marjorie Johnson
definition
Pneumonia: inflammation
of the respiratory
bronchioles and alveoli
 Either infectious or noninfectious
 Infectious: bacteria, viruses,
fungi, protozoa and other
microbes
 Non-infectious: aspiration
of gastric contents and
inhalation of toxic or
irritating gases
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DIAGNOSIS
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Pneumonia is often diagnosed
with difficult breathing because
the airway is filled with mucus
and fluid
A person with pneumonia
often produces delicate
crackling noises or wheezing in
the area of the lung affected by
pneumonia
In a lung with pneumonia, the
sound can be dull or muffled
because the air sacs are filled
with fluid instead of air
A doctor may take a chest x-ray
to confirm a diagnosis of
pneumonia
Other risk factors
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People with problems with
heart, liver, or kidneys.
Patient with HIV/AIDS
whose immune system are
very weak.
Patient who taking
medication that weaken the
immune system such as
cancer patients.
Patients that smoke, abuse
alcohol.
Exposure to certain
chemicals, past surgery
Patients hospitalized in an
intensive care of certain
disease (ex: coma)
prognosis
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More than a million people
are hospitalized each year
for pneumonia
1 in 4 people who had
pneumonia died
Community-acquired
pneumonia is responsible
for 350,000 to 620,000
hospitalizations
Older adults have lower
survival rates than younger
people
Pneumonia kills between
40,000 to 70,000 people each
year
Signs & Symptoms
Most people who develop
pneumonia initially have
symptoms of a cold which
are followed by:
 High fever
 Shaking
 Chills
 Sharp chest pain
 Tachycardia
 Tachypnea
 Cough with sputum
production
PNEUMONIA
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Diagnostic tests (include
rationale & nursing
implications
Medical Treatment and
Nursing Implications
Surgical Treatment and
Nursing Implications
Prevention
Complications
Discharge/Client teaching
By:
Stacy Moyston-Duckie
DIAGNOSTIC TESTS
• Diagnostic tests are usually
done by a medical doctor who
would examine the client by
auscultations of the lungs for
evidence of delicate crackling
noises or wheezing in the area
that is infected. In a lung with
pneumonia, the sound can be
dull or muffled because the air
sacs are filled with fluid
instead of air.
• Based on these findings the
doctor will order certain test to
be done to identify the
organism that is responsible
for this illness.
DIAGNOSTIC TESTS
• sputum gram stain and
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culture and sensitivity,
complete blood count (CBC)
with white blood cell (WBC),
arterial blood gases, pulse
oximetry, chest x-ray and
fiberoptic bronchoscopy
These tests may show the type
of organism (bacterial, viral or
fungal) causing pneumonia,
also other conditions such as
heart failure, lung cancer, or
acute bronchitis.
Medical treatment
With medical treatment the patient with pneumonia is generally
treated with:
 Immunization: Pneumococcal vaccine is recommended for people
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over age 65, for immunocompromised people, and for those with
chronic cardiac or respiratory conditions, diabetes mellitus,
alcoholism, or other chronic disease.
Medications: Medications used to treat pneumonia may include
antibiotics to eradicate causative organisms and bronchodilators to
reduce bronchospam and improve ventilation.
Oxygen therapy: Oxygen may be ordered when pneumonia interferes
with gas exchange. The nasal cannula delivers 24% to 45% oxygen
(room air is 21% oxygen) with flow rates of 2 to 6 liters per minute.
Other therapies: Increasing fluid intake to 2,500 to 3,000 mL/day
helps liquefy secretions, making them easier to cough up and
expectorate.
Another effective method is percussion, which is done by
rhythmically striking or clapping the chest wall with cupped hands.
Cupping traps air between the palm and the skin, causing
vibrations that loosen respiratory secretions. Postural drainage uses
gravity to help remove secretions from a particular lung segment.
SURGICAL TREATMENT
• Thoracotomy is the standard surgery for
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pneumonia.
It requires general anesthesia and an incision to
open the chest and view the lungs. The surgeon
most times has to remove dead or damaged lung
tissue. In extreme cases the entire lobe of the lung
is removed.
Treatment and nursing
implications
• Clients being treated for pneumonia need therapeutic care in order
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to successfully recover. The priority of nursing care for clients with
pneumonia is its effects on the client’s ability to maintain open
airways and on the exchange of gases in the alveoli.
The nurse must always wash his/her hands and wear gloves, if
indicated. Hand washing and gloves help to prevent the spread of
infection.
If the person has difficulty breathing, he or she is given oxygen,
usually by mask or cannula. Adjust the client’s position.
An orthopneic position may be necessary. Proper positioning helps
the person to be more comfortable and to breathe more easily. Place
a pillow lengthwise under the back. This action encourages fuller
chest expansion.
Assess the client’s vital signs at least every 4 hours. Frequent
monitoring is necessary to allow for prompt detection and early
intervention if problems arise.
PREVENTION
• There are a number of steps a
person can take to help prevent
getting pneumonia.
• Stop Smoking!!! Smoking
puts a smoker at high risk in getting
pneumonia.
• One must avoid contact with
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people who suffer from
respiratory tract infections, such
as colds and influenza (flu),
measles and chickenpox.
Pneumonia may develop or put
the client at risk for developing
these types of infections.
Vaccination is given mostly to
adults over 65 years of age who
are at greater risk of developing
pneumonia as well as for younger
people who are chronically ill.
PREVENTION
• Also daily diets should include
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foods such as fresh, dark-colored
fruits and vegetables, which are
rich in antioxidants and other
important food chemicals that
help, boost the immune system.
Children are given vaccination
against certain diseases such as
measles, and chickenpox. Mineral
zinc may also reduce the risk of
pneumonia in children. Zinc can
be found in foods that we eat such
as, seafood, lean red meats, beans,
and cereals.
complications
• Clients with pneumonia
must be treated
immediately to avoid
serious complications such
as by way of entering in the
bloodstream or by crosscontamination to other
parts of the body.
• Without proper treatment,
pneumonia can lead to
such life-threatening
complications as septic
shock, hypoxemia, and
respiratory failure. The
infection can also spread
within the patient’s lungs,
causing empyema or lung
abscess.
Discharge/client teaching
• It is very important that the
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nurse educate the client about
the disease and how to do selfcare.
The nurse must explain all
procedures (especially
intubation and suctioning) to
the patient and his family.
Emphasize the importance of
adequate rest to promote full
recovery and prevent a relapse.
Stress the need to take the
entire course of medication,
even if he feels better, to
prevent a relapse.
Teach the patient procedures
to clear lung secretions, such
as deep-breathing and
coughing exercises, as well as
home oxygen therapy. Explain
deep breathing and pursue-lip
breathing.
Congestive heart failure
Yvonne Prempeh
Medical Surgical Nursing
1
July 23, 2007
Objectives
Definition and explanation of
congestive heart failure
 Epidemiology: incidences among
gender, age and ethnicity
 Etiology and risk factors
 Diagnosis of CHF
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Definition and explanation of
CHF

structural or functional cardiac
disorder impairing the filling and
pumping ability of the heart
 highly
specialized muscular organ
 normal heart pump 50% of total blood
 failing heart pumps </= 40% of total blood
Epidemiology
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Younger men are more likely than women to
develop myocardial infarction
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People >/= 65 years have higher risks for
CHF
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48,500 heart attacks are associated with CHF
 23,500
heart attacks occur in women
Epidemiology cont’d
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Asians and Latinos tend to suffer least cases
of cardiovascular diseases
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African Americans are at a higher risk for
developing severe CHF
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recurrent hospitalization rate
increased mortality rate due to severe CHF
( www.american heart.org; National Institutes of Health)
Etiology and risk factors
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Causes of CHF:
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myocardial ischemia
hypertension
various types of arrhythmias
anemia
hyperthyroidism
hypothyroidism
diabetes mellitus
endocarditis
myocarditis
congenital heart defects
artherosclerosis
cardiomyopathy
Example of cardiomyopathy
Etiology & Risk Factors
Etiology and risk factor cont’d
increased cholesterol intake
 increased intake of fats
 increased sodium intake
 lack of exercise
 morbid obesity
 diabetes mellitus
 hypertension
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Diagnosis of CHF
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Targeted history and physical exam
Tests:
 BNP
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( B-type Natriuretic Peptide)
normally secreted in ventricles during filling and
stretching
BNP < 100 pg/ml : No CHF
BNP between 100-300 pg/ml: suggestive CHF
BNP > 600 pg/ml: moderate CHF
BNP > 900pg/ml: severe CHF
(www.clevelandclinic.org/heart center)
Diagnosis cont’d
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Tests cont’d:
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Serial EKG’s and cardiac iso-enzymes q6h x 3
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Troponin I
CK (creatine kinase)
CKMB (specific from heart muscle fraction)
CKMB Index (calculated by lab)
CBC
Chest x-ray: to detect pulmonary edemas a result of edema
Two dimensional echocardiogram: to check the pumping
ability of the heart and the function of the heart
Stress test to evaluate for myocardial ischemia
Signs and Symptoms
Main manifestations to watch out for:
Fatigue and dyspnea ( difficulty breathing) = Due to excess fluid in the body and
fluid in the lungs that causes congestion.
= Mostly observable when a person is walking halfway and gets tired easily
eventhough he just walk halfway.
Edema or swelling of the ankle and feet) = Due to fluid overload in the tissue
which causes congestion.
= mainly observe during the day and every time the feet is used.
Other symptoms include:
Nausea, abdominal pain and decreased appetite.
Diagnostic Tests
Tests to confirmed the presence of congestive heart failure:
1.
EKG or EGC ( Electrocardiogram)
2. X-ray examination
3. Echocardiography
4. Cardiac catherization
Purpose: Evaluate heart function and valve dysfunction.
NURSING IMPLICATION:
Discuss situation with the client the procedure.
Distinguish the possible effects of the procedure to the well-being of the
patient.
Rationale:
Discussing will help the client to be more familiar with the procedure
hence, it will decrease anxiety.
Client will be able to deal with her fear by the information gathered
from the nurse.
Medical Treatment
Digoxin
= Cardioglycoside
= slows heart rate.
= stimulate heart muscle which increases the force of systole.
=Decreased the workload of the heart.
NURSING IMPLICATION:
= Monitor apical pulse before administering the medication.
= If less than 60 bpm, withhold the medication, then notify MD.
Diuretics
=Help fluid from building up
=Decrease fluid retention
= make the fluids run through the kidneys
NURSING IMPLICATION:
Monitor BP, I&O, daily weight.
Assess feet, legs, and sacral area for edema DAILY>
Prognosis
Congestive heart failure has a very poor
prognosis.
Only 50% of CHF patients lives within 5 years.
On the other hand, only 20% survive within 8 to
12 years prior to diagnose.
HALF OF THE PATIENT WILL DIE IN 5 years.
Congestive heart
failure
Surgical Treatment/
Nursing Implications
 Prevention
 Complications
 Discharge/Client
Teaching
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by Marie Jimenez
Surgical Treatment
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2.
Types of surgical
treatment for
CHF:
Cardiac
transplantation
Dynamic
cardiomyoplasty
Cardiac
Transplantation
Primary treatment for
end-stage heart failure
 Transplanted organs
are from young
accident victims with
no evidence of cardiac
trauma
 Client or (recipient)
heart is removed,
leaving posterior atria
intact
 Donor heart is sutured
to the remaining atrial
walls
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Cardiac Transplant:
NURSING IMPLICATIONS
Risks for surgical
treatment of CHF:
 Infection
 Rejection of donor’s
heart
Nursing Implication:
 Monitor for infection
 Administering
immunosuppresive
drugs to prevent the
rejection of the
transplanted organ
 Route: IV, PO, IM
Dynamic cardiomyoplasty
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Dynamic cardiomyoplasty
involves using the client’s
own skeletal muscle
(particularly the latissimus
dorsi) to enhance the
function of the heart and
improve circulation.
The muscle is positioned
around the heart or aorta,
and a cardiomyostimulator
and leads are implanted to
stimulate muscle
contractions.
This type of surgical
procedure may be
implemented as an
alternative to cardiac
transplantation for clients
who refuse organ
transplantation.
PREVENTION
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The prevention of CHF includes modifiable lifestyle
changes relating to diet, smoking, alcohol, and exercise
Limit sodium intake
Alcoholics Anonymous & Smoking cessation programs
Providing awareness of the negative effects of smoking
and alcohol and recommending “regular, moderate
exercise to improve their overall fitness” will greatly
reduce in the prevention of congestive heart failure.
(Merck Manual, 1997)
complications
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Hepatomegaly (enlargment
of the liver)
Spenomegaly (enlargement
of the spleen)
Thrombus & emboli
Cardiogenic shock which
“occurs when the left
ventricle is unable to
supply the tissues with
enough oxygen and
nutrients to meet their
needs. [It] is a lifethreatening condition that
requires immediate
treatment (Williams, 2003,
p. 332)
Picture on right: IABP
(intra-aortic balloon pump)
to increase coronary
perfusion
Discharge & client
teaching
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Nursing interventions for
discharge:
Explain heart failure and its
effects on the client’s life – this
helps the client understand the
reasons for ordered treatments
Stress the importance of
medications in managing heart
failure and provide verbal and
written information regarding
each specific medication to
encourage compliance
Teach the client and family about
the prescribed diet
Instruct to keep regular follow-up
appointments to monitor disease
progression and effects of therapy
Chronic Obstructive Pulmonary Disease
(COPD)
Student Name: Na Pang
Nursing Diagnosis:
• Ineffective Airway
Clearance
• Imbalanced nutrition: less
than body requirements,
• compromised family
copying
• Decisional conflict:
smoking.
Definition and Explanation of
Diagnosis:
• Chronic obstructive pulmonary disease
(COPD) is a term referring to two lung
diseases, chronic bronchitis and
emphysema, that are characterized by
obstruction to airflow that interferes with
normal breathing. Both of these
conditions frequently co-exist, hence
physicians prefer the term COPD.
Etiology and Risk Factors:
• Etiology: In COPD, there is
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decreased elastic recoil of the
lungs (mainly emphysema) and
increased airway resistance
(mainly bronchitis).
Risk factors: Smoking is the
primary risk factor for COPD.
Approximately 80 to 90 percent
of COPD deaths are caused by
smoking.
Incidence Among Gender, Age and Ethnicity:
• 1. Chronic bronchitis affects people of all ages, but is higher in those
over 45 years old.
• 2. Females are more than twice as likely to be diagnosed with
chronic bronchitis as males. In 2004, 2.8 million males had a
diagnosis of chronic bronchitis compared to 6.3 million females.
• 3. Chronic bronchitis prevalence for Hispanics (27.7 per 1,000) was
significantly lower than for both Whites (45.7 per 1,000) and Blacks
COPD PROGNOSIS
• None of the existing medications for COPD
has been shown to modify the long-term
decline in lung function that is the
hallmark of this disease. Therefore, the
goal of pharmacotherapy for COPD is to
provide relief of symptoms and prevent
complications and/or progression of the
disease with a minimum of side effects.
Signs and symptoms:
• 1. Cough
• 2. Sputum (mucus) production
• 3. Shortness of breath, especially
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with exercise
4. Wheezing (a whistling or squeaky
sound when you breathe)
5. Chest tightness
Chronic Obstructive
Pulmonary Disease
Student Practical Nurse, Anaïse Ikama
Spring II 2007
Diagnostic Tests
The following test can be used to
diagnose COPD
• Pulmonary function testing
a spirometry is used to
identifies how much air your
lung can hold and how fast
you can blow the air out of
your lung
• Chest X-ray
helps in the identification of
emphysema (causes large
abnormal air spaces in the
lungs by destroying alveolar
walls)
Diagnostic Test
• Serum alpha1-antitrypsin levels
to screen the enzyme deficiency that can cause
lung tissue destruction
• Arterial Blood Gas
measures deficiency of oxygen
• Other test such as a computed Tomography can
determine if the client will benefit from surgery
Medical Treatment
• Bronchodilators as prescribed
to relax the muscles that wrap around the
airways
allow tubes to become larger and easier to
breath through
• Inhaled steroids/corticosteroids
reduces swelling in the breathing tube
Surgical Treatment
• Lung Volume Reduction
The removable of the inflated air sacs that
causes healthy air sacs to work poorly
• Lung Transplant
Replacement of one or both lungs
Nursing Interventions
Administer inhaler and oxygen as ordered
before activity
Assist the pt. with the use of a spirometer,
percussion and postural drainage
Reassure and provide emotional support (r/t
fear of death)
Prevention
• “Avoiding – never starting or stopping –
smoking is the only way to prevent COPD
and to its progression” (Burke, Lemone &
Mohn-Brown, pp 557).
Complication
• Due to impaired defense mechanisms
*Respiratory infection such as influenza
and pneumonia can develop
*Increase BP in pulmonary veins
*Lung cancer
*Feeling of depression (from progressive &
incurable disease)
Client Teaching
• Nurses should:
a- Teach effective coughing and
breathing mechanism
b- Advice client to maintain fluid
intake of 2 to 2 ½ quarts daily
c- Discuss aerobic physical exercise (e.g.:
20 mn walk
d- Stress the importance of eating
small frequent meal
e- Reinforce teaching about prescribed
medication
REMEMBER
TO TEACH YOUR CLIENT TO NEVER
SMOKE
Eitology
Types of Thoracotomy
Nursing Diagnosis
Nursing Implication
Assess client for s&s of impaired res.
function. (rapid, shallow or slow
respiration)
 Perform action to reduce pain
 Perform actions to maintain patency and
integrity of chest drainage system if
present
 Maintain oxygen therapy as ordered
 Administer bronchodilators as ordered
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Risk Factors
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Smoking