Transcript Respiratory system

By: Diana Blum MSN
MCC
NURS 2140
2
 Nose to pharynx}behind the mouth to
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
3
 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
4
• 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
• Pg
5
• Temporary interruption in the normal breathing
pattern in which NO air movement occurs
– May occur during sleep and at end of life
• http://www.blinkx.com/video/understandingobstructive-sleep-apnea-osa1/WDHzxnb1t77AkBsdYIYwdg
• http://www.blinkx.com/video/answered-patientsleep-disorders-living-with-sleepapnea/FjusOmVoqIX3V0lKzcwlKQ
7
• Dyspnea} difficulty breathing or shortness of
breath
• Orthopnea} difficulty with breathing while in a
lying position
• Tachypnea} respiratory rate >20
• Bradypnea} respiratory rate <12
8
 Normal Breath Sounds
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Normal breath sounds 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.
Flow is greatest in the trachea and diminishes in the distal lung fields, until it
reaches the alveoli, where there is no flow.
**If breath sounds are really diminished, listen over the trachea**
 Adventitious sounds
 Wheezing: musical, whistling sound
 Usually more pronounced during expiration
 From narrowed airways
 Bronchoconstriction
 Secretions
 Interventions:
 Bronchodilation
 Hydration
 Coughing
 http://www.ed4nurses.com/breathsnds.htm
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Rales: crackling sound
Heard at the end of inspiration
From collapsed or waterlogged alveoli
Fine: beginning of fluid buildup / or
atelectasis
Coarse: greater volume of fluid buildup
Interventions:
Manage fluids
– Diuretics if needed
Expectorate
– Turn & position & Deep breathing
– Forced expiration
– Vibration & percussion
•
•
Rhonchi: bubbling
• The sound will be heard throughout
inspiration and expiration.
• Louder than rales due to larger
secretions
• Results from air bubbling past
secretions in the airways
• Interventions:
– Deep breathing & Coughing
– Hydration (encourage fluids, if
no restriction)
– Humidify air
– Mobilize
Friction rub: creaking, leathery
sound
• End of inspiration and beginning of
expiration
• Caused by rubbing of inflamed pleural
surfaces against lung tissue.
• Interventions:
– Chest x-ray
– Anti-inflammatory medications
Cheyenne Stokes
Kussmal’s
• Breaths are deep than
become shallow followed by
periods of apnea
• Cause: severe brain
pathology
• Regular breathing but
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.htm
• http://www.rnceus.com/resp/respabn.html
• case studies
http://www.meddean.luc.edu/lumen/MedEd/me
dicine/pulmonar/pd/step29e.htm
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 Muscle atrophy in pharynx and larynx and change in vocal
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
13
Nasal Cannula: 1-6 liter flow
Simple mask: 6-8 liters/ 40-60% o2
prercentage
Partial rebreather: has reservoir bag so
patient can rebreath part of inhaled gas: 811 liters/ 50-75%
Non rebreather mask: non of exhaled gas
rebreathed. 12 liters ; 80-100%
See figure 35-3
14
• - a thrombus (most originate from lower
extremities) that travels thru venous circulation
to pulmonary circ. & partially OR
completely occludes a pulm. artery
- - a massive PE: occlusion of >50% of
pulmonary artery bed
150,000 deaths annually in US
Pg 973
16
• Obstruction in pulmonary blood vessel causing a
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
19
• How does PE occur??
•
Deep venous thrombus breaks loose (MOST
COMMON CAUSE)
•
↓
•
flows through venous circulation
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↓
•
enters right ventricle
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↓
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lodges in small pulmonary arteries
•
↓
•
embolus may dissolve, grow or fragment
• Embolus will most often lodge in Rt LL
• - - increases pulmonary artery pressure
• - - increases vascular resistance
• - - increased dead space ( disruption of
blood flow to alveoli = nonfunctioning units)
• Virchow’s triad:
•
1. damaged vascular endothelium
•
2. venous stasis
•
3. hypercoagulability
• What would cause release of a thrombus?
•
- direct trauma
•
- muscle contraction
•
- changes in perfusion
• - may have no predisposing factors
• - immobilization, obesity, pregnancy,
•
estrogen use, aging, major trauma
•
or surgery within 4 weeks, malignancy
•
DVT, indwelling catheter, electrodes in
•
right heart (pacer), CHF, acquired
•
disorder (heparin-induced
thrombocytopenia, postspleenectomy)
•
•
•
•
•
•
Hx of DVT
> 40 yrs of age
Extensive abdominal or pelvic surgery
(many PE originate in femoral – iliacpelvic veins)
Long-bone or pelvic fractures
- - occurs suddenly
- - associated with acute Rt hrt failure
(  ‘d pulmonary artery systolic
pressure & pulm. vasc resistance)
- - ↓’d CO
- - may have crushing substernal CP
- - Shock: hypotension, dypnea, cyanosis,
apprehension, coma
• - - resp rapid, shallow, gasping
• “impending doom” if pt conscious
•
•
•
•
•
•
•
• Core pulomonale pg 980
• Pulmonary hypertension from pulmonary
arterial obstruction
• Sudden obstruction & total: sudden
death
• Pulmonary infarction
• Stroke, MI, dysrhythmias, liver failure,
acute respiratory distress syndrome,
shock, death
• Ultrasound
• D-dimer test: not specific, fibrin product – if
positive will do further testing
• Pulmonary Venography: gold standard, inject
dye noninvasive tests first
• MRI with contrast
• CT contrast spiral
• V/Q scanning (dye give IV AND inhaled )
• Heparin: Load 80 Units/kg
•
Drip 18 Units/kg/hr
• Measure PTT every 6 hours
•
Goal: PTT 1.5 to 2.0 X control
• Vena Cava Filter: for contraind. anticoag OR
clot develops while adeq anticoagulated
• Embolectomy: if not anticoag candidate &
•
acutely unstable
• Thrombolytics: tPA
•
• Platelet count monitored about every 3 days
for heparin-induced thrombocytopenia
• Oral Coumadin by day 3 of heparin
• Titrate dose heparin so PTT is 1.5-2.5 times
normal control.
• ADVERSE EFFECTS:
•
hemorrhage, hypersensitivity,
thrombocytopenia
•
measured PTT
•
<35 sec (1.2 X )
•
• 35-45 sec (1.2-1.5X)
•
•
• 46-70 sec (1.5-2.3X)
• 71-90 sec (2.3-3X)
>90 sec (3X control)
Heparin adjust
80U/kg then 
rate by 4U/kg/hr
40U/kg bolus
then  rate by 2U/
kg/hr
NO CHANGE
↓rate by 2U/kg/hr
Stop infusionX1hr
then ↓ rate by 3U/kg/hr
• Leg elevation
• Sequential compression devices
• EARLY POSTOPERATIVE AMBULATION ( THE
•
MOST IMPORTANT)
•
•
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•
•
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High-fowler’s
Oxygen (prepare for intubation)
Auscultate breath sounds
Admin thrombolytics/anticoag (monitor
bleeding)
***HEPARIN/THROMBOLYTICS IV
– INCOMPATIBLE IN SAME IV LINE
• Analgesics to ↓pain, ↓ anxiety
• Maintain calm environment
•
•
•
•
•
•
Impaired gas exchange
Ineffective breathing pattern
Anxiety
Decreased CO
Risk for inability to sustain spontaneous
ventilation
• Adequate oxygenation
• Reversal of thrombus
• Reduction in risk for additional
thrombus formation
• Prevention of pulmonary infarction
• Improved V/Q ratio
• V = ventilation
• Q = perfusion
• The amt of air reaching lung must be equal to
blood reaching lung for the ideal exchange of O2
and CO2, ratio is 0.8
• If airway is blocked, then ventilation zero
• If blood flow blocked, (PE) VQ is infinite “dead
space”
• Pg 974
• V/Q ratio > 0.8 dead space producing
•
- PE, pneumothorax
•
- increased vent with decrease perfusion
• V/Q ratio < 0.8 Shunt producing
•
- hypoventilation, obstructive
•
- decreased vent with increase perfusion
• Pg 1005
• Situation: 55 yr old woman returned to her room at
2 pm yesterday following abdominal hysterectomy.
Her vitals have been stable & dressing dry, intact. She
was up to the side of the bed & ambulated a few feet
before returning to bed. A few minutes later, she
turns on her call light stating she is having difficulty
breathing. The nurse hurries to her room & finds the
pt tachycardic, diaphoretic, gasping for air, & C/O
Chest pain.
• 1. How can the nurse determine if the pt is
experiencing a PE or a MI?
• 2. Why is it essential to establish the cause of
the pt’s symptoms as rapidly as possible?
• 3. What risk factors does the woman have for
development of PE?
• 4. What can nurses do to help identify those
pts at  ‘d risk for PE?
• - the result of abnormalities in
ventilation, perfusion, or compliance
which leads to hypercapnia &/or
hypoxemia
• - respiratory acidosis
• - must identify underlying condition
before treatment
• Pg 1006
• - an alteration in oxygenation is most
common form of resp. failure
• - perfusion (Q)exceeds ventilation (V)
• which is a low V/Q ratio causes
decreased oxygenation of venous blood
& a mixing of less oxygenated blood
with arterial blood
• - so have reduced arterial oxygen value
PE
Pneumonia
CVA
COPD
Pneumothorax
Lung trauma
atlectasis
Pulm. Edema
• Tachycardia, atrial dysrhythmias tachypnea,
dyspnea on exertion or rest, labored
breathing, use of accessory muscles, rales
• - correct hypoxia & acidosis with CPAP
or may need intubation, ventilator, PEEP
• - if medication induced: discontinue med
• - if due to trauma or ICP must focus on
relieving the ICP
• - if due to high V/Q ratio (dead-space)
must reestablish perfusion (if from PE,
thromolytic therapy)
• Ability to sustain spontaneous ventilation
• Adeq. Ventilation: pH 7.35-7.45
•
PCO2 35-45
• SaO2: >92%
•
•
•
•
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Correction of hypoxia & acidosis:
- CPAP, ET, mechanical vent, PEEP
Resp. muscle rest
Control of shock
nutrition
•
•
•
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Severe resp & met acidosis
Infection
Failure to wean from ventilator
Lack of adeq. Nutitional support
48
• Progressive pulmonary disorder after chest trauma 196 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
• Pg 1014
49
• 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
50
• H&P
• S/S: > respirations, rapid and shallow, adventitious lung sounds-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
51
• AIMED TO; preserve O2 consumption &
•
tissue perfusion
•
- reduce fever
•
- use sedatives to reduce muscle
•
activity & prevent further
•
excessive O2 use
•
May also need corticosteroid therapy
• DEATH USUALLY OCCUS AS RESULT OF THE
PRECIPITATING EVENT OF ARDS (NOT JUST ARDS
ALONE)
• Mechanical ventilation
• - alveoli to remain open (or further
damage results)
• - PEEP used to stabilize alveoli & keep
•
open. (PEEP of 10-15 cmH2O)
•
- tidal volume of 4 – 6 mL/kg needed
•
to avoid overdistention of alveoli
• - supports ventilating function to improve
oxygenation thru supplemental O2 & positive
pressure
• PRIMARY OBJECTIVE:
•
- decrease work of breathing,
•
- reverse hypoxia
•
- reverse hypercapnea
• Pg 1021
• 1. inability to adeq ventilate
- chest trauma, excessive sedation,
neuromuscular disease, fatigued respiratory
muscles
• 2. Inability to adequately oxygenate
- pneumonia, PE, pulm edema, ARDS
• 3. Excessive work of breathing
- severe bronchospasm, airway obstruction
• 4. Airway protection
- unconscious, massive resuscitation, facial or
head trauma
• 1. Resp impairment
•
- tachypnea >30 breaths/minute
•
- dyspnea
• 2. Neurological impairment
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- loss of gag reflex
•
- altered mental status
• 3. Gas exchange impaired
•
PaCO2 >60, PaO2 <70, SaO2 <90
• Endotracheal Tubes
•
- may insert nasal or oral
•
- must be trained to insert
•
- Post-intubation MUST have CXR for
•
confirmation of placement
•
- complications: laryngeal trauma
•
- intubation into right mainstem
•
bronchus
•
- infection
• Nasal intubation:
• - not used with ICP, head trauma
• - disadvantages: tissue necrosis,
nosebleed, rupture of nasal polyps,
submucosal dissection
• - increases susceptibility to infection due
to increased mucus production from the
irritant properties of the tube itself
• Oral intubation:
•
- direct visualizaition, rapid intubatoin
•
- must reposition to opposite side of
•
mouth every 24 hr
•
Disadvantages:
•
- increased dryness of oral mucosa
•
-produx of mucus
•
- susceptibility to infection
• Tracheostomy
•
- May need to be performed for
•
long-term ventilatory support
•
- this can bypass upper airway
•
obstrux
•
-maxillofacial injuries
•
- may help prevent aspiration
•
- may decrease necrosis or
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tracheoesophageal fistula
•
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•
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Improves pt comfort
Oral hygiene
Ease of secretion removal
More secure airway
• - to maintain airway patency
• - closed system, multiple use catheter
• - hyperoxygenation prior to suctioning reduces hypoxemia
from suctioning
– - instillation of saline should not be done as increases risk of
ventilator associated pneumonia (thin secretions by
adequate fluid intake)]
• - stimulation of cough, very effective to remove
secretions
• - inflatable cuff provides seal & reduces aspiration of fluids
into lungs
• - must use soft- low pressure cuffs to minimize tracheal
necrosis/fistulas
• - must have pressure of 25 cmH20 or less
•
( if more pressure is needed then may
•
need an larger tube inserted)
• - CUFF IS NOT DEFLATED WHILE ON VENTILATOR
• - always suction pt orally before deflating cuff to
•
remove secretions on top of cuff so will not
•
aspirate these secretions
• - risk for airway plugging (tube is foreign
body)
• - tube can become misplaced
• -Tension pneumothorax
• -tracheal dilation, ischemia, necrosis
• - infection
• MUST GIVE FREQUEST ORAL HYGIENE FOR
COMFORT AS WELL AS DECREASE
INFECTION
• Goal} improve to improve oxygen and CO2 exchange by removing
excess mucus with a suction catheter…Follow facility guidelines!
• Procedure:
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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68
• Hypotension (positive pressure decreases
•
venous return to heart which decreases
•
CO which decreases BP)
• So, may see decreased UO, cardiac
arrythmias
• INFECTION: most common WHY??
• Atelectasis
• Pneumothorax (esp with PEEP)
• 1. FiO2 (avoid >60%)
•
- start low, maintain O2 sat >90%
•
- PEEP helpful to decrease FiO2
•
requirements while maintain O2 sats
•
O2 TOXICITY: damage to lungs with FiO2
>60%
• 2. Minute Ventilation:
• MV= Tidal volume x breaths/min
• (tidal vol: the vol inspired or expired with
each normal breath)
• 3. Pressure support: 5-10 cm H20
• 4. PEEP (positive end expiratory pressure)
• - increases alveolar vent by preventing small
airway collapse
• - FiO2 can be decreased ( decrease O2
toxicity)
• - too hi PEEP, compromises venous return
• - affects ICP (caution)
• 5. Inspiratory to expiratory (I/E) ratio
•
Normal ½ or 1/3
Controlled Mechanical Ventilation:
- pt receives ONLY ventilator breaths
Assist-control ventilation:
-resp rate can be determined by pt but
the ventilator delivers full tidal volume with each breath
(watch for respiratory alkalosis with tachypneic pts)
Synchronous Intermittent Mandatory Ventilation (SIMV):
ventilator delivers set
tidal volume with a minimum set rate (pt assumes more
work of breathing) USE THIS MODE For FULL SUPPORT OR
CAN USE FOR WEANING
- decrease rate over time to wean
• CPAP: Continuous Positive Airway Pressure
•
- pt breathes at own effort
•
- pressure set for up to 20 cm H20
•
- used to assess extub potential
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Mode: intermittent mandatory vent
TV: 6-8 mL/kg
Vent rate: 10 breaths/min
Fi02: 100% but wean down
PEEP: 5 cm H20
-change according to ABG
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•
•
•
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Airway or ET tube obstruction
Bronchospasm
ARDS
Mucous plug
CHF (pulm edema)
• 1. increase FiO2
• 2. increase PEEP
• HOW CAN YOU DECREASE PCO2 IN THE
VENTILATED PT?
•
1. increase resp rate
•
2. increase tidal vol
• 1. may need sedation
•
- IV benzodiazepine & opiates
• 2. decubitus ulcers
•
- repositioning
•
- air mattress
• 3. venous thrombosis
•
- SQ Heparin, LMWH
•
- pneumatic compression boots
• 4. GI mucosal injury
•
- H2 receptor antagonists
•
- antacids
• 5. Nutrition needs
•
- delayed gastric emptying with sedatives
•
- metoclopramide (promotility agent)
•
•
•
- if GI works, use It
- enteral feedings
- parenteral nutrition for severe GI
pathology
•
•
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•
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•
•
Barotrauma (high pressure=overdistends lung tissue)
- pneumomediastinum
-SQ emphysema
- pneumothorax
Nosocomial pneumonia
Vent assoc. pneumonia =leakage around cuff
O2 toxicity
Tracheal stenosis
deconditioning of respiratory muscles
Hypotension (from elevated intrathoracic pressures
will decrease venous return)
• GI: stress ulceration
• Gallbladder: Cholestasis from increased
intrathoracic pressure on portal veins
• Pg 1031
• First assess:
•
- vital capacity: the amount expired
after maximum inspiration
•
- tidal volume: The vol. of inspired
gas during a normal breath (6-8 mL/kg)
•
- spontaneous resp rate
•
- lung compliance
• 1. reduce Fi02 to 40% while monitoring
•
SpO2
• 2. reduce IMV rate to 4-8 breaths/min
• 3. reduce PEEP in increments of 2 to 3 cm
water while maintaining Sp02 >90% until a
level of 5 cm of water is reached
• 4. reduce PS by increments of 2-3 cm water
monitor resp rate, work of breathing, minute
ventilation
• Change of LOC
• Change in Vitals
•
- diastolic BP >100
•
-fall in systolic BP
•
- heart rate >110/min OR >10 breaths
•
per minute increase over baseline
• Falling Pulse Ox
• Tidal vol <250 ml
• increase CO2
• ECG: PVC’s >5 minute, ST segment elevation,
•
ventricular conduction changes
1. Explain procedure to pt
2. Elevate HOB 45 to 90 degrees
3. Disconnect ET tube from vent tubing
4. suction ET tube & oropharynx
5. have pt take deep breath
6. as pt expires forcefully, deflate cuff, remove tube
7. suction any secretions & admin 02 through nasal cannula at
2-4 L/min
• 8. check postextubation ABGs
• 9. Be prepared to reintubate if necessary
•
•
•
•
•
•
•
• - coronaviruses
• -affects cells from resp tract with triggers
inflam process
• -spread easily by droplet, also on surfaces of
objects (but not long periods)
• -high fever
• Headache, aches
• Xray: pneumonia like pattern
•
•
•
•
•
Not test specific
No agents to kill virus at this time
Oxygen
Full isolation
Pt’s door closed
• 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
90
91
•
•
•
•
•
•
•
•
Develop gradually
Low grade fever-specific pattern
Persistent cough
Hemoptysis
Hoarseness
Dyspnea on exertion
Night sweats, fatigue, wgt loss
TB IS COMMON CAUSE OF FEVER OF
UNKNOWN ORIGIN
92
• 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
93
94
• + finding = INH 6-12 months prophylactic.
• CXR & Sputum for AFB to confirm active TB
• Active = Isonaizid, Rifampin, Pyrazinamide & after 3 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
95
• - all cases reported to state/local health
• -resp isolation
• -DRUGS: “RIPE”
•
Rifampin (body fluids turn orange)
•
INH (Vit B6 to prevent periph neuritis)
•
Pyrazinamide
•
Ethambutol
• 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
97
• 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
98
• Wedge resection- small triangular resection of
tissue
• Lobectomy- remove lobe
• Pneumonectomy-remove entire lung
• Segmental resection-remove section of lung
• Bronchoscopic laser
99
•
•
•
•
•
•
s/s: fever, sepsis, fatigue
Diagnostic: CXR
CT scan
bronchoscopy
Treat: antib
Surgery: lobectomy of lobe with abscess
• -most common severe genetic disease in US
• -DIAGNOSIS
•
-sweat chloride test
• S/S:
•
- recurrent infections, cyanosis, digital clubbing,
cough, dyspnea, hemoptysis
• - fatty stools, pancreatitis
• Fat soluble vitamin deficiency due to
malabsorption
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•
•
•
- aims to improve quality of life
-decrease # exacerbations & hospitalizations
-decrease mortality
THERAPY FOCUS; CLEAR PULMONARY
SECRETIONS & CONTROL INFECTIONS
• Treatment:
• - inhaled bronchodilators
• - airway clearance: postural drainage with
chest percussion & vibration (vest)
• Dnase (decrease viscosity of sputum)
• Hypertonic saline (4 ml of 7% saline) inhaled
BID to reduce exacerbations (admin.
Bronchodilator first to avoid bronchospasm)
•
•
•
•
•
•
- antibiotics (sputum cultures)
-short term glucocorticoid
Pulm rehab
Oxygen
May need lung transplant
Yearly flu vaccine
• -defined at mean pulmonary arterial pressure of
>25 mmHg (most often with young or mid-age
women)
• CAUSES:
• - left side hrt failure
•
- COPD (hypoxic vasoconstriction)
•
- thromboembolic disease
• Pg 976
• -dypnea with exertion, fatigue, lethargy
• Snycope with exertion,
• Diagnosis:
•
- CXR: enlargement of central pulm
arteries
• - echocardiogram: rt vent overload
• Treatment:
•
- oxygen
•
- anticoagulation
•
- vasodilators
•
-diuretics
• Inflammation of both layers of the pleura
– It may develop with pneumonia, TB, upper respiratory
infection, after trauma, PE, Cancer
– Viseral layer has nerves
– Parietal layer does not
• S/S: SOB, severe pain with inspiration. As fluid
accumulates pain diminishes
– Described like stabbing knife
• Dx: friction rub with auscultation, chest x-ray, sputum
analysis, thoracentesis, biopsy
• Tx: pain management, NSAID (indocin), splint with
cough and movement
• Accumulation of thick purulent fluid in the pleural
space. May or may not encapsulate.
• Most occur from bacterial pneumonia, lung
abscess, chest trauma, post surgery
• S/S: similar to pneumonia (fever, nite sweats,
pleural pain, cough, dyspnea, anorexia, wt loss),
decreased or absent sounds over affected area
• Dx: CT, thoracentesis
• Tx: Thoracentesis, Chest tube, education on tube
and infection
• 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&featur
e=related
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• inserted to drain blood, fluid, or air and allow full expansion of the
lungs.
• placed in the pleural space.
• 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).
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• Tidaling: the middle water seal chamber is observed for expected 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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• Stomach content/ food in the lung
• May cause pneumonia
• S/S: tachycardia, dyspnea, cyanosis, hyper or
hypo tension, death
• May be silent
• Death/ complications a result of volume and
type of aspirate
• If fecal matter is the aspirate=fatal
•
•
•
•
•
•
•
Seizures
Decreases LOC
N/V
Stroke
Swallow disorders
Cardiac arrest
Silent aspiration
•
•
•
•
•
•
•
This is the goal!!!
HOB at least 30-45 degrees
Chin tuck
Monitor tube placements
Speech therapy
May need antibiotics
Remember ABCs
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