Transcript The Air We Breath - Faculty Sites

THE AIR WE BREATH
By: Diana Blum MSN
Metropolitan Community College
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Objectives
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Describe the normal anatomy and physiology of the respiratory system.
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Discuss the data to be collected from the client with a respiratory disorder.
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Describe the nursing implications of age-related changes in the respiratory system.
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Describe selected diagnostic tests and procedures for respiratory disorders and identify the related
nursing interventions.
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Describe the basic pathophysiological changes, symptoms, data commonly collected, diagnostic medical
treatment, and nursing interventions for the following conditions: Acute viral rhinitis, influenza, pleurisy,
pneumonia, pneumothorax, pulmonary embolus, acute respiratory distress syndrome.
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Recall from pharmacology the selected drug classifications used to treat diseases of the respiratory system
and list nursing interventions associated with each.
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Discuss the basic pathophysiology, risk factors, symptoms, data commonly collected, diagnostic tests,
medical treatment, and nursing interventions for chronic obstructive pulmonary disease to include: Asthma,
chronic bronchitis, and emphysema.
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Discuss the basic pathophysiology, risk factors, symptoms, data commonly collected, diagnostic tests,
medical treatment, and nursing interventions for restrictive pulmonary disease to include: Tuberculosis and
lung cancer.
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Describe nursing assessments and interventions utilized when caring for a client following thoracic surgery.
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Discuss the nursing process as it relates to the respiratory system.
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Discuss nutritional concepts as they relate to the care of a client with a respiratory disorder.
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Respiratory System
 Focuses on the energy required to carry out
ADL. When lung tissue is damage and 02 at
cellular level is severely decreased the client
may not be able to perform any of these
functions. Energy conservation tech are most
important!
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Nursing Diagnosis
 Pain r/t inflammation, tissue damage
 Ineffective breathing pattern r/t surgical incision,
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pleural effusion, decreased lung expansion
Impaired gas exchange r/t alveolar destruction,
bronchospasm, air trapping
Ineffective airway clearance r/t weak cough
Anxiety r/t hypoxemia
Activity intolerance r/t inability to meet 02 needs
Decreased cardiac output r/t pump failure (r-sided)
Imbalance nutrition: less than body require r/t
anorexia, dyspnea
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Anatomy
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Pathways
 Nose to pharynx}behind the mouth to
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esophagus (approx. 5 inches)
Larynx} voice box: air passes between
pharynx and trachea
Trachea} windpipe
Bronchi}this is the main branch that air
passes through divides into left and right
branch
Bronchioles} subdivides and connects with
alveoli for gas exchange
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More anatomy
 Epiglottis} behind the thyroid cartilage
 Has a hinged door action to larynx
 Glottis} space between the folds of vocal cords
 Air from the lungs promote it to open and close
 Lungs} 3 lobes on the right and 2 lobes on the left
 Pleura}membrane that covers the lungs
 Has a lubricant between the layers to allow inhalation
and exhalation to occur
 Cilia} hair like projections that trap debris
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Fun facts
 Mucous membranes warms and moistens the
air that passes to and from the lungs
 Upper respiratory tract consists of: the
outside chest, nose, mouth, pharynx, larynx
 Lower respiratory tract consists of: inside the
chest, trachea, bronchi, bronchioles, alveoli
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Mechanism of breathing
 Inspiration : air enters lungs
 Active process where Chest muscles and
diaphragm contract causing chest cavity to
enlarge
 Expiration: air leaves lungs
 Passive process where muscles relax and the chest
returns to normal.
 Normal quiet breathing = 500ml of air
exchanged with each breath
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Apnea
 Temporary interruption in the normal
breathing pattern in which NO air movement
occurs
 May occur during sleep and at end of life
 http://abcnews.go.com/Video/playerIndex?id
=2927688
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~pnea
 Dyspnea} difficulty breathing or shortness of
breath
 Orthopnea} difficulty with breathing while in
a lying position
 Tachypnea} respiratory rate >20
 Bradypnea} respiratory rate <12
 Other breathing types located in table 30-1
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Data Collection
 Past history/Family history: colds, TB, Chronic
bronchitis, asthma, cancer, sinus infections, ear
infections, pneumonia, COPD, emphysema, allergies,
immunizations, diabetes, CAD, TB tine, Smoking history
(pack per year history)
 Chief complaint: obtain details on subjective complaints
r/t respiratory system
 Cough: onset, duration, severity, frequency (consistency, odor,
amount, color), type (wet/dry), sputum production
 Dyspnea: onset, duration, severity, precipitating events,
associated symptoms like fatigue or palpitations
 Pain: (chest) : location, onset, duration, precipitating events
(trauma, coughing, inspiration), radiation, associated
symptoms like fever, sweating, nausea
 Look at what meds were taken to attempt relief
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Examination
 Ask for subjective info about fatigue, weakness, fever,
chills, nasal obstruction, sinus pain, hoarseness, edema,
sore throats
 Functional assess: occupation, exposure to pathogens,
respiratory irritants, usual diet, role in family, stressors,
coping strategies
 General: appearance , facial expression, posture, alertness,
speech pattern, observable distress, VS, Ht, Wt, nasal
shape, nasal tenderness, flaring, swelling, discharge,
bleeding, septal deviation, sinus tenderness, pursed lip
breathing, lip color, throat color, tonsil appearance, trachial
alignment, enlarged lymph nodes , lung sounds, breathing
pattern, use of accessory muscles, abd distention, color of
extremities, clubbing, homan’s sign, edema, cyanosis.
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Lung sounds
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Normal Breath Sounds
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To be able to distinguish between types of abnormal
breath sounds and their location, it is important to
understand normal respiration and its effect on airway
noises that make up breath sounds. Normal breath sounds
are bronchovesicular in nature. They are loud pipe-like
sounds in the large airways, and softer blowing-like sounds
in the small airways. Normal breath sounds are loudest
during inspiration and softest during expiration. The
inspiratory phase is shorter with faster airflow. Although
abnormal sounds may be louder during inspiration, they
may be difficult to distinguish due to their short duration.
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Normal Air Flow through the Lungs
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Flow is greatest in the trachea and diminishes in the
distal lung fields, until it reaches the alveoli, where there is
no flow. Breath sounds are loudest over areas with greater
flow, and distal pathology may be communicated to these
areas. Therefore, auscultation over the trachea may reveal
pathology there or communicated from distal regions of
the lung.
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**If breath sounds are really diminished, listen over the
trachea**
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Adventitious sounds
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Wheezing: musical, whistling sound
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Usually more pronounced during expiration
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From narrowed airways
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Bronchoconstriction
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Secretions
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Interventions:
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Bronchodilation
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Hydration
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Coughing
http://www.ed4nurses.com/breathsnds.htm
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Rales: crackling sound
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Heard at the end of inspiration
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From collapsed or waterlogged alveoli
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Fine: beginning of fluid buildup / or atelectasis
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Coarse: greater volume of fluid buildup
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Interventions:
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Manage fluids
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Budget volume resuscitation
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Diuretics
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Expectorate
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Turn & position
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Deep breathing
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Forced expiration
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Vibration & percussion
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Rhonchi: bubbling
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The sound will be heard throughout inspiration and expiration.
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Louder than rales due to larger secretions
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Results from air bubbling past secretions in the airways
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Interventions:
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Deep breathing
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Coughing
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Hydration (encourage fluids, if no restriction)
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Humidify air
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Mobilize
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Friction rub: creaking, leathery sound
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End of inspiration and beginning of expiration
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Caused by rubbing of inflamed pleural surfaces against lung
tissue.
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Interventions:
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Chest x-ray
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Anti-inflammatory medications
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Lungs sounds continued
Cheyenne Stokes
Kussmal’s
 Breaths are deep than
 Regular breathing but
become shallow followed
by periods of apnea
 Cause: severe brain
pathology
breaths are deep
 Rates are >20 bpm
 Causes: metabolic acidosis,
renal failure, diabetic
ketoacidosis
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 http://rnbob.tripod.com/breath.htm
 Lung sounds
http://www.med.ucla.edu/wilkes/lungintro.ht
m
 http://www.rnceus.com/resp/respabn.html
 case studies
http://www.meddean.luc.edu/lumen/MedEd/
medicine/pulmonar/pd/step29e.htm
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Age related changes
 Muscle atrophy in pharynx and larynx and change in vocal
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cords
Loss of lung elasticity
Decreased number of alveoli
Weaker chest muscles
Diminished chest movement
Less effective cough
Work harder to breath
Enlargement of bronchioles
More suseptible to lung infections r/t decreased defense
mechanisms
Rib cage becomes more rigid and diaphragm flattens
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Diagnostics
 Chest xray
 Fluoroscopy: observes deep structures in motion, can look
at both lungs at same time
 Looks at speed and degree of lung expansion and looks for
structural defects
 No jewelry on neck or chest, no clothes from waist up except
hospital gown
 Ventilation/Perfusion Scan: used to detect pulmonary
embolisms, or other obstructions
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IV or inhaled radioactive med given
NPO for 4 hours prior to.
Monitor for anaphylaxis
Radioactive material is excreted in urine
Inform importance of hand washing and if anyone else handles
urine they should glove as well
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Diagnostics continued
 Cat scan: visualize lesions
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Needs to be still
With or without contrast
Check for iodine allergy
IV access
 MRI: looks for tumors, lesions, etc.
 Lie flat, mechanical noises
 NO metal allowed
 Pulse oximetry: non invasive method to evaluate o2
levels in blood
 May be continuous or intermittent
 Small censor on finger or ear
 Indicate level of oxygen with result
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Diagnostics continued
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PFTs: used to diagnose disease, monitor progression, assesses medications
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Measures lung volumes and capacities
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Total lung capacity, forced expiratory volume, functional residual capacity, inspiratory capacity,
vital capacity, forced vital capacity, minute volume, and thoracic gas volume (table 30-2)
A clip is placed on the nose that the patient breathes through a mouth piece to determine
mechanics (flow rates of gas in and out of lungs) and diffusion (movement of gas across
aveoli/capillary membrane)
ABGs: measures the concentrations of oxygen and carbon dioxide in the arterial
blood to determine if exchange is adequate across the alveolar membrane
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pH: 7.35-7.45
PaCo2: 35-45
PaO2: 80-100
HCO3: 22-26
Sats: 96-100
http://www.youtube.com/watch?v=IBJtQtzN7O8&feature=related
http://www.youtube.com/watch?v=Xsr5wF-WDrw&feature=related
http://www.youtube.com/watch?v=7s6OGhMfUqI&feature=related
http://www.youtube.com/watch?v=LcmjGMWDbXw&feature=related
http://www.youtube.com/watch?v=t9x4tB9GOi8&feature=related
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Diagnostics Continued
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Bronchoscopy: performed by inserting a small camera through the nose
or mouth into the bronchial tree under local anesthesia
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It allows direct visualization of structures
Explain procedure and assess allergies
Consent needs to be obtained
NPO 6-8 hours prior
No smoking days prior
dentures removed and document loose teeth
Administer sedatives as prescribed (cetacaine)
 Atropine may also be given to decrease secretions
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post procedure:
 NPO until gag reflex returns
 Semi fowler’s position
 Monitor vitals
 Monitor for edema, hemoptysis, stridor, asymmetric movement of chest
 Report abnormal findings to doctor!
http://www.youtube.com/watch?v=DS6MHZCGlJk
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thoracentesis
 Removal of pleural fluid for examination or to
allow for lung re-expansion
 Obtain consent
 Post :
 Assess respiratory status
 Document amount, color of fluid
 Monitor dressing for bleeding
 Label specimen bottle and send to lab
http://www.youtube.com/watch?v=noDxydboLrA&fea
ture=related
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Diagnostics continued
 Tuberculin test (A.K.A. TB Tine)
 Determines past or present exposure to tuberculosis
 Pre:
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Inform the client about intradermal need stick
Cleanse skin and inject intradermally into lower anterior forearm
Mark and record site
Instruct pt that skin reaction can last 1 week and not to scratch it.
Inform patient they need to return in 48-72 hours for
interpretation of positive or negative response
 ***Reddness, swelling of 5mm or more is considered positive
 A pt with a history of BCG vaccination (foreign born) will always
test positive regardless of exposure.
 Post: follow up depends on response.
 If positive pt will be sent for chest x-ray to confirm active
tuberculosis
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Diagnostics Continued
 Sputum analysis} the mucous membrane lining in the lower
respiratory tract responds to acute inflammation by
producing an increase in secretions
 Specimens are examined for volume, consistency, color, odor
 Sputum that is thick, foul smelling, and yellow, green, or rust
colored may indicate bacterial infection
 Pt needs to expectorate the specimen into a sterile container after
coughing deeply if unable induction may need to be done to
obtain
 C & S} determines presence of bacteria, id’s specific organism,
and appropriate treatment
 Acid fast} done to determine the presence of acid fast bacilli
including TB. Collection is 3 samples
 Cytologic} used to determine the presence of carcinoma or
infection. Special collection chamber is needed. Ask facility
laboratory.
 CBC:
 Hemoglobin-assess 02 carrying capacity
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Breathing exercises
 Cough and deep breath (pg. 522)
 Incentive Spirometry: instruct the pt to use 10 times every hour
awake or with every commercial break if watching t.v.
 Purse lip breathing: pucker lips like you are going to blow a kiss,
whistle, or blow out a candle. Inhale through the nose and exhale
through the pursed lips. Exhalation should last longer than
inhalation.
 Percussion and vibration
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Percussion} clapping of cupped palms against chest wall to dislodge
secretions ( only in areas protected by the rib cage) lasts 20-30 secs
 Vibration} as pt exhales the therapist creates a shaking movement with
the palms
 Contraindications for both include: lung ca, bronchospasm, hemorrhage,
hemoptysis, increased ICP, chest trauma, PE, pulmonary edema, GERD,
anxiety, rib fractures
http://www.youtube.com/watch?v=8rI5y2hyC2c&fe
ature=related
 Postural Drainage ( page 523-524)
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Suctioning
 Goal} improve to improve oxygen and CO2 exchange by
removing excess mucus with a suction catheter…Follow
facility guidelines!
 Procedure:
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Use sterile technique for tracheal and clean technique for oral.
Administer O2 before inserting catheter WHY?
Moisten cath in sterile water and insert through nose or mouth before
applying suction
Apply suction as the catheter is withdrawn from the airway
Maintain pressure gauge b/w 80-100 mmHg
Limit EACH pass to 10 seconds
Allow the patient to rest briefly, encourage deep breathing and rinse
catheter with sterile water before each pass.
Monitor for patient’s response
 If tachycardia or increased respiratory distress develops, stop the
procedure immediately and give the patient oxygen as ordered
Document the amount, color, odor, and consistency of the secretions as
well as pt status before and after procedure.
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Nasal Cannula: 1-6 liter flow
Simple mask: 6-10 liters/FiO2 35-55%
Partial rebreather: has reservoir bag
so patient can rebreath part of inhaled
gas: 6-10 liters/ FiO2 35-60%
Non rebreather: non of exhaled gas
rebreathed. FiO2 70-100% (venturi
mask)
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Monitor O2
 Monitor liter flow to make sure it is as
prescribed. Assess pt response to therapy
(ABGs as ordered)
 Maintain sterile water in the humidity
reservoir
 Clean and replace equipment according to
agency policy
 NO SMOKING signs need to be posted if not
a smoke free facility
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Artificial Airways
 Oral: temporary tube that rests at base of tongue
 Nasal: (trumpet) soft rubber tube inserted through
nose to tongue. Rotate nares q8 hours
 Endotracheal: these have cuffs. From mouth or nose
to trachea. Prevents aspirations and facilitates
mechanical ventilation.
 Tracheostomy: surgical airway created through
neck. May or may not have cuffs
 See mechanical vent handout
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Care after thoracic surgery
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Manage pain with attention to resp status HOB elevated!!
VS as per post-op protocol & relate to client’s norms
Assess resp closely: rate, rhythm, effort
Lung sounds, chest rising and falling with each resp
Note absence of cyanosis or dyspnea
Maintain patent airway, TCDB, IS q 1 hour while wake, suction prn
Care to chest tube and drainage system
02 responsibilities based on ABGs-02sats
IV responsibilities
Provide for a safe environment r/t: pain meds
Wound assessment and care as ordered
Activity progression as ordered and tolerated
I&0 q 8 hours to include chest tube
Assess lab: h&h, lytes, bun and cr, PT/INR, PTT, CBC
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Chest Tubes
 Chest tubes are inserted to drain blood, fluid, or air and allow full
expansion of the lungs. The tube is placed in the pleural space.
The area where the tube will be inserted is numbed (local
anesthesia). The patient may also be sedated. The chest tube is
inserted between the ribs into the chest and is connected to a
bottle or canister that contains sterile water. Suction is attached
to the system to encourage drainage. A stitch (suture) and
adhesive tape is used to keep the tube in place.
 The chest tube usually remains in place until the X-rays show that
all the blood, fluid, or air has drained from the chest and the lung
has fully re-expanded. When the chest tube is no longer needed,
it can be easily removed, usually without the need for
medications to sedate or numb the patient. Medications may be
used to prevent or treat infection (antibiotics).
http://www.atriummed.com/PDF/ManagingChestDrainage.ppt#438,37,Remove fluid &
air
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 Tidaling: the middle water seal chamber is observed for expected
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rise in fluid level with expiration.
Air leak: noted when continuous bubbling is observed in the main
water seal chamber
Suction may be wet or dry
 A gentle bubbling sound is normal to hear with a wet system
 Dry systems have a orange accordion looking object visible when
suction is applied
Change the recepticle only when chambers are full using sterile
technique
Heimlich Flutter Valve: air and fluid are expelled and not
rebreathed in
READ THORACIC SURGERY page 530-531
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Drug Therapy
 Corticosteroids: Used to decrease inflammation and
edema
 May be given parenteral, oral, inhaler
 Many SE, masks S/S of infection, cause F&E imbalances
 NI: Rinse mouth after each inhaler use, instruct to not to d/c
abruptly, takes up to 10 days to obtain a blood level
 Decongestants: mimics epinephrine, (stimulates HR
and BP increases) cause vasoconstriction, reduces
mm swelling—example: sudafed
 NI: monitor pulse, BP, mental status
 Avoid if HTN, DM or hyperthyroid clients
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Drug Therapy Continued
 Bronchodilators: Relax smooth muscles in the
bronchial tree & help widen the passageway
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Used for asthma and COPD
May be given oral, IV, by Inhalation
Does stimulate CNS and cardiac activity
Aminophyline, Isuprel, Brethine, Atrovent, Albuterol NI:
Monitor HR, oral hygiene, avoid caffeine
 Antitussives: Decreases frequency and intensity of
cough by suppressing cough reflex but without
eliminating it
 Codeine popular but is a narcotic
 Dextromethorphan is non-narcotic
 NI: force fluids
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Drug Therapy Continued
 Antimicrobials: Will kill or inhibit the growth of bacteria, virus, or
fungi
 Obtain C & S before administration of 1st dose
 NI: Assess for allergies
 Instruct on importance of taking all of prescription
 Mast Cell Stabilizers: Helps prevent asthma attacks by preventing
the release of histamine and slow-reacting substance
anaphylaxis (SRS-A)
 Does not help after onset of S/S
 Intal (cromolyn) most common med
 NI: instruct to use prior to activity
 Expectorants: Given to thin secretions
 Pill or syrup form
 Robitussin is a popular OTC
 NI: assess effectiveness of cough
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Drug therapy Continued
 Antihistamines: Block allergic responses. (Histamine
1 blockers)
 Can be purchased without prescription
 Dry MM
 Mild sedation and antiemetic effects
 Benadryl (1st generation)
 Claritin (2nd generation)
 May worsen cough by drying bronchial secretions
 Not recommended for clients with asthma
 NI: Care with operating machinery, being in a situation
where sound judgment is imperative. Avoid alcohol
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Acute Viral Rhinitis
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common cold—lasts 2-14 days
Inflammation and edema of nasal mm
Based on H&P
S/S: nasal stuffiness, sneezing, running nose, ha,
sore throat, fatigue, fever
 Most contagious first 3 days
 NI: Prevent spread of infection-handwashing, proper
disposal of tissue
 Rest, fluids to exceed 3000ml
 Humidifier, antipyretics, analgesics
 Call MD if T > 101, severe sore throat with white patches,
chest pain, purulent sputum
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Influenza
 Several strains and more common in winter
 Is an acute viral respiratory infection with fever and
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aches, chills, ha, cough
Complications: bronchitis, pneumonia
Spread by droplet/physical contact
Incubation 1-3 days, illness lasts 2-8day
NI: Rest, fluids, balanced diet, antipyretics,
analgesics, antiviral agents (which must be started
24-48 hours after S/S)
 Use of immunizations to prevents – 70-90% effective
 Go to MD office only if chest pain or increase on chest
congestion.
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Pneumonia
 Bacteria often pneumococcus which releases
toxins=inflammation=damage
 Viral, fungal, hypostatic, aspiration,
nosocomial, chemical
 Classified by location: lobar, bronchial
 At risk: smokers, altered LOC,
immunosuppressed, chronically ill, tube
feeders, trach and ET tube clients
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Pneumonia Diagnosis
 H&P
 C&S of sputum
 CXR
 WBC
 Blood cultures
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S/S
 Chills, fever, sweats, chest pain, cough,
purulent sputum production, hemoptysis,
dyspnea, headache, herpes simplex,
leukocytosis (WBC=20,000-30,000),
tachycardia, crackles, wheezes, N/V
 ****Elderly=confusion
 Complications: Pleurisy, Pleural-effusion
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NI
 HOB > 30-45 degrees, keep warm and dry, VS
q 4 h, assess lung sounds, skin color and signs
of hypoxia
 What Is Hypoxia?
 FF, I&O q 8 h, freq oral cares, care of
expectorations, safety precautions r/t fever,
fatigue
 TCDB q 2h, measures to mobilize secretions,
hi protein diet
 Assess fluid and electrolyte balance
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Pleurisy
 Inflammation of the pleura
 Causes: pneumonia, TB, injury
 S/S abrupt / severe pain. Breathing and
coughing aggravates
 Tx: analgesics, anti-inflammatory,
antitussives, antimicrobials, heat
 NI: Assess and Tx pain, Splint with cough,
HOB >, meds as appropriate
48
Chest trauma
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2 types: penetrating and non penetrating
Penetrating: stab wounds , gun shot wounds
Non penetrating: MVA, Falls, blunt injuries
S/S: visible trauma, chest pain, Dyspnea, cough,
asymmetric movement, cyanosis, rapid weak pulse
decreased blood pressure, tracheal deviation, JVD,
bloodshot or bulging eyes
 Tx: stablize and prevent further injury, remove
clothing to assess injury and observe for other
injuries like bleeding. Immediately treat the
bleeding cover chest wound and tape on 3 sides
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Pneumothorax
 Accumulation of air in the pleural cavity resulting in
complete or partial collapse of the lung.
 Spontaneous (smokers, blebs)
 Tension pneumothorax-air entering space > causing pressure on
heart and great vessels
 Diagnosis: CXR, H&P
 S/S:dyspnea, tachypnea, tachycardia, restlessness, pain, anxiety,
decreased movement in chest wall, < lung sounds, progressive
cyanosis, sucking chest wound with open pneumothorax.
 TX: Chest tube insertion to remove air or fluid
 Closure of open chest wound or tear in structures
 NI: Fowlers or semi-Fowlers
http://video.google.com/videoplay?docid=1169503917162980359&q
=%22chest+tube+%22&total=14&start=0&num=10&so=0&type=
search&plindex=1
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Pulmonary Embolus
 Obstruction in pulmonary blood vessel causing a
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ventilation-perfusion mismatch resulting in hypoxemia,
followed by < CO, bronchial constriction, collapsed
alveoli and may result in sudden death
Cause: blood clot, fat , air, amniotic fluid, clumps of
bacteria
Diagnosis: H&P, ABGs, VQ scan, EKG
S/S: sudden severe chest pain increases on inspiration,
tachypnea, dyspnea, diaphoresis, hemoptysis, abnormal
lung sounds, fever, tachycardia
Tx: Anticoagulation: PTT 2-21/2 normal
 Heparin then oral Coumadin using PT and INR to
regulate doses
 Therapeutic coumadin range varies per doctor but most use
goal of 2.0-3.0
 O2, IV ms, support CV system
 Surgically may do embolectomy and insert a vena
cava filter
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ARDS
 Progressive pulmonary disorder after chest trauma 1-
96 hrs after
 Also seen with aspiration, prolonged mechanical
ventilation, severe infection and open heart surgery
 Involves: pulmonary capillary damage with
loss of fluid and interstitial fluid, Impaired
alveolar gas exchange and tissue hypoxia due
to pulmonary edema, Altered surfactant
production, Collapse of alveoli, Atelectasis
resulting in labored breathing and ineffective
respirations
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ARDS Continued
 The damaged tissue of the lungs has increased
capillary permeability and fluid accumulates in the
tissues of the lungs. The production of pulmonary
surfactant < and atelectasis occurs. Lung
compliance < meaning the lungs are losing the
ability to carry out the process of breathing.
 As a result, hypoxia develops. Some clients recover
but the scar tissue becomes fibrous and lung fibrosis
may progress.
 Systemic effects: cardiac dysrhythmia, renal failure,
stress ulcers
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Diagnosis and treatment
 H&P
 S/S: > respirations, rapid and shallow, adventitious lung sounds


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crackles, agitation, tachycardia, mental confusion, cyanosis, etc.
CXR-non cardiac pulmonary edema
ABGs (hypoxia-respiratory acidosis)> PC02 and < PO2
Rapid identification of the problem
Intubate and place on ventilator with PEEP (keeps airways open
and decreases hypoxia)
Maintain patent airway, suction as needed
Diuretics to reduce pulmonary edema
Steroids
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COPD
 5th leading cause of death
 Asthma, Chronic Bronchitis, Emphysema
 Conditions associated with long-term
obstruction of airflow both entering and
leaving the lungs. Requires effort (energy) to
push air out thru obstructed airway
 Etiology: Unknown
 Dx: H&P, Pulmonary Function Tests=
assesses airway dynamics and lung volumes.
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COPD continued
 S/S: Marked SOB, Easy fatigability, Pursed lip breathing, Change in
speech pattern, Distended neck veins, Clubbing of digits,
Intermittent episodes of expiratory wheezing, Chronic cough which
becomes productive
 Interventions: Maintain an open airway, Relieving bronchospasm,
Breathing exercises-pursed lip & diaphragmatic, Postural drainage
maneuvers, Diet-6 small meals a day, Avoid underweight or obesity,
Avoid intake of ice cold food and drink esp during asthma attach—
cold causes gastric distension and inhibits movement of diaphragm,
Avoid gas forming foods –cause abd distension and inhibit
movement of diaphragm, Avoid sudden temp changes, cover
mouth/ nose, Avoid very dry or very humid air, Avoid fatigue, may
precipitate attack
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COPD Continued
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
Practice stress management tech-breathing tech before activity to >>>
02
Avoid crowds during cold and flu season, have decreased resistance to
illness
Prevent constipation, causes abd distention
Elevate head and shoulders when resting (not just head) to allow better
lung expansion
Avoid respiratory irritants: hair sprays, wind, dust
Know S/S of infection and when to call MD
02 at 1-3 L/nc only due to reliance on hypoxic drive to breathe. Elevated
C02 levels no longer prompt breathing
Immunize: flu and pneumonia
Teach!!! Energy conservation tech, STOP SMOKING, assess use of
inhalers
Pulmonary Rehab
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COPD Continued
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Asthma
 Inflammation of mucosal lining of bronchial tree and


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
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spasm of bronchial smooth muscles causing
bronchospasms.
Intermittent and reversible
Know triggers and avoid them
2 phases
1) triggers-occurs 30-60 min after exposure to trigger
and resolves in 30-90 min
2) late phase-begins 5-6 hours after early phase
response and this lasts several hours to days.
Airways hyper reactive
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Asthma continued
 Diagnosis: H&P, PFT and ABG
 S/S: Dyspnea, productive cough, use of
accessory muscles, audible expiratory
wheeze, tachycardia, tachypnea
 **Status asthmaticus —severe persistent
bronchospasm with diaphoresis, pulse may
become weak, thready—may need ventilator
& ICU environment
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Asthma
 Treatment:
 Relievers: in acute stage-Beta 2 receptor agonists and

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sometimes anticholinergics
Long-term: use Controllers – inhaled glucocorticoids,
leukotriene inhibitors, long-acting Beta 2 receptor agonists,
mast cell stabilizer, xanthenes
02 as ordered + COPD Tx listed above
Assess VS carefully, Fowler’s, 02, lung sounds,
3000ml/24hours to liquefy secretions
Restful environment, have family member stay if possible
Instruct on peek expiratory flow meter (PEFR)—if PEFR
drops 20% call MD
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Emphysema
 Affects alveolar walls and lose elasticity
 Degenerative and nonreversible
 Alveoli become distended and impairs gas exchange.
Will have VQ mismatch.
 May experience: Cor Pulmonale – right sided heart
failure, rising C02 with decreasing 02, bullea/blebs
 S/S:
 Dyspnea, use of accessory muscles to breath, shape of
chest wall changes-barrel shaped.
 Pink-puffer as may have normal ABGs
 Tend to be thin due to energy required to breath
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Emphysema Continued
 Treatment
 Medications-inhalers to keep airway open
 Antidepressants
 02 1-3 l/nc
 Pulmonary Rehab / See above tx COPD
 Will advise client to stop smoking
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Bronchitis
 Bronchial tree inflamed with increased mucous,
chronic cough at least 3 months of the year for 2
consecutive years.
 Inflammation caused by inhaled irritant often a
smoker.
 Blue bloater.
 S/S:







Productive cough
Exertional dyspnea
Wheezing
Develops resp infections readily
>>RBC formation
SOB, wheezes and crackles
TX same as for other COPD
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TB
 Mycobacterium tuberculosis
 Inhaled into lungs
 Infection: host susceptibility, virulence,
number inhaled
 Requires prolonged exposure
 Those at Risk: malnurished, crowded living,
compromised immune systems, HC workers
providing care to hi risk pop
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S/S of TB
 Develop gradually
 Low grade fever-specific pattern
 Persistent cough
 Hemoptysis
 Hoarseness
 Dyspnea on exertion
 Night sweats, fatigue, wgt loss
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Screening of TB
 Mantoux skin test-0.1cc purified protein




derivative (ppd),
ID
Read test @ 48 – 72 hrs
Palpable swelling 5mm = induration = +
+ indicates only exposure and development
of antibodies
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Treatment of TB
 + finding = INH 6-12 months prophylactic.
 CXR & Sputum for AFB to confirm active TB
 Active = Isonaizid, Rifampin, Pyrazinamide & after 3

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

weeks no longer contagious but requires long term TX
Well balanced nutrition
Hydration to liquefy pulmonary secretion
Activity as tolerates
Hospitalized client:
 Airborne & Standard Precautions
 Isolation room with neg air pressure
 Doors and windows closed
 Staff to wear particulate respirator that fits securely
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Treatment of TB continued
 Well balanced meals with adequate hydration
 Instruct: TB is spread by airborne droplets—protect




others by covering mouth when coughing and wash
hands often
Keep all clinic appts, continue meds for
the prescribed length of time and take all meds as
directed
If on isoniazid, avoid foods containing tyramine (aged
cheese, smoked fish) and histamine (tuna and
sauerkraut). Meds + these foods will make client ill.
Rifampin causes body fluids to become red-orange and
may stain contact lenses
78
Treatment of TB continued
 Instruct: takes 3 weeks of med before no
longer considered contagious, so if home
needs to: Cover mouth and nose when
cough/sneeze and wash hands freq, dispose
of tissue in a closed bag, avoid close contact
with others, sleep alone in bedroom, clean all
eating utensils thoroughly and separate
79
Surgical treatment of TB
 Wedge resection- small triangular resection


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
of tissue
Lobectomy- remove lobe
Pneumonectomy-remove entire lung
Segmental resection-remove section of lung
Bronchoscopic laser
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Lung Cancer
 Malignant growth of tissue occurring in lung tissue
 2 major categories: 1.) slow growing are--squamous

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
cell, adenocarcinoma, large cell
2.) (SCLC) small cell lung cancer (oat cell) grows
quickly and metastasizes early
Leading cause of CA deaths in the US
Cause: cigarette smoking, 2nd hand smoke, other
pollutants
DX: H&P, CXR, Bronchoscopy with BX, CT scan,
sputum cytology
Scans for mets=bones, liver, brain
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S/S of lung cancer
 persistent cough with sputum production,
recurrent resp infections, dyspnea,
hemoptysis, chest pain, recurring pneumonia,
or bronchitis
 Anorexia, fatigue, weight loss=late S/S
 May develop shoulder or other bone pain=
mets
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Treatment of Lung cancer
 Radiation
 Chemotherapy
 Surgical removal of tumor
 Options arrived at after type and staging
complete
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