Transcript Chapter 26 Respiratory System Function, Assessment, and

Respiratory System Function,
Assessment, and Therapeutic
Measures
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Upper Respiratory Symptoms
Lower Respiratory Symptoms
Exposures/Smoking
Current Treatments
Family History
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Where Is It?
How Does It Feel?
Aggravating and Alleviating Factors
Timing
Severity
Useful Other Data
Patient’s Perception
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Symmetry
Dyspnea
Use of Accessory
Muscles
Color
Respiratory Rate
and Rhythm
Chest Shape
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Normal Breath
Sounds
Adventitious Sounds
Compare Bilaterally
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Crackles—Coarse or Fine
Wheezes
Stridor
Friction Rub
Diminished
Absent
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CBC
ABGs
D-Dimer
C&S
SaO2
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Chest X-Ray
VQ Scan
PFTs
Angiography
Bronchoscopy
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Smoking Cessation
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Ask
Advise
Assess
Assist
Arrange
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Interventions
◦ Behavior
Modification
◦ Counseling
◦ Setting Quit Date
◦ Nicotine
Replacement
◦ Drug Therapy
◦ Hypnosis
Deep Breathing and Coughing
 Breathing Exercises
 Positioning
◦ Fowler’s
◦ Semi-Fowler’s
◦ Good Lung Down
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Nasal Cannula
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Indications
Chest Tube Insertion
Drainage System
Nursing Care
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Definition
Indications
Nursing Care
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Suctioning
Cleaning
Communication
Teaching
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Invasive
◦ Indications
◦ Nursing Care
◦ Trouble-Shooting
Alarms
Nursing Care of Patients with Upper
Respiratory Disorders
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Causes
◦ Trauma
◦ Hypertension
◦ Hemophilia
◦ Medications
◦ Recreational Drug Use (Cocaine)
Positioning
 Direct Pressure
 Ice
 Nasal Packing
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Nasal Balloon
Catheter
 Vasoconstrictive
Agent
 Electrocautery
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 Usually
Benign
 Occur More Often with Allergies
 Treatment
◦ Control Allergies
◦ Surgery
◦ Avoid Aspirin Postop
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Symptoms
◦ Stuffy Nose
◦ Blocked Sinus
Drainage
◦ Headaches
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Treatment
◦ Nasoseptoplasty
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Monitor Vital Signs/Bleeding
Report Excess Swallowing
Monitor Dressing
Teach
◦ Avoid Activities That Increase Pressure
◦ Avoid Aspirin
 Inflammation
◦ Bacterial
◦ Allergic
 Signs
of Sinus Mucosa
and Symptoms
◦ Pain Over Affected Sinus
◦ Fever
◦ Nasal Discharge
Decongestants
 Hot Packs
 Saline Irrigation
 Acetaminophen/
Ibuprofen
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Humidification
 Oral Fluids
 Positioning
 Antibiotics
 Surgical Drainage
 Rest
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 Rhinitis
 Pharyngitis
 Laryngitis
 Tonsillitis
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Pathophysiology
◦ Primary Tumor of Mucosal Epithelium
◦ Metastasizes to Lungs, Liver, Lymph Nodes
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Etiology
◦ Associated with Smoking, Alcohol
◦ More Common in Men
Hoarseness
 Change in Voice
 Pain
 Dyspnea
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Cough
 Dysphagia
 Airway
Obstruction
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 Laryngoscopy
 CT
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Radiation
Chemotherapy
Laryngectomy
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Ineffective Airway Clearance
Acute Pain
Impaired Verbal Communication
Imbalanced Nutrition
Impaired Swallowing
Grieving
Disturbed Body Image
Nursing Care of Patients
with Lower Respiratory
Tract Disorders
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Pathophysiology
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Acute Lung Infection
Inflammation and Alveolar Damage
Alveoli Filled with Exudate
Reduced Surface Area for Gas Exchange
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Bacteria, Uusually Steptococcus pneumoniae
Virus
Fungus
Aspiration
Artificial Ventilation (VAP)
Hypostasis
Chemical
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Very Young
Elderly
Hospitalized
Intubated
Immunocompromised
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Chest Pain
Fever, Chills
Cough, Dyspnea
Yellow, Rusty, or Blood-Tinged Sputum
Crackles, Wheezes
Malaise
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Pleurisy
Pleural Effusion
Atelectasis
Spread of Infection
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Chest X-Ray
Sputum Culture
Blood Cultures
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Antibiotics - PO or IV
Antiviral Medication (Zovirax)
Bronchodilators
Expectorants
Oxygen
Fluids
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Pathophysiology
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AFB Implant on Bronchioles or Alveoli
Tubercle Formed
Immune System Keeps in Check
5%-10% Infected Become Ill
May Activate with Impaired Immunity
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Elderly
Alcoholics
Crowded Living Conditions
New Immigrants
HIV
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Cough
Blood-Tinged Sputum
Night Sweats
Anorexia and Weight Loss
Low-Grade Fever
Dyspnea, Chest Pain (Late)
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PPD Skin Test
Chest X-Ray
Sputum Cultures
QuatifFERON-TB Gold
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Combination of Drugs for 6 - 24 Months
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INH
Rifampin
Streptomycin
Ethambutol
Occasional Surgical Removal
Isolation
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Impaired Gas Exchange
Ineffective Airway Clearance
Ineffective Breathing Pattern
Activity Intolerance
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Monitor
◦ Lung Sounds,
Respiratory Rate
and Effort
◦ Dsypnea
◦ Mental Status
◦ SaO2, ABGs
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Position
◦ Fowler’s
◦ Good Lung Down
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Administer Oxygen
Teach Breathing
Exercises
Discourage
Smoking
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Monitor
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◦ Lung Sounds
◦ Sputum
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Encourage
◦ Fluids
◦ Deep Breathing
◦ Coughing
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Administer
Expectorants
Turn q2h or
Ambulate
Suction prn
Consider CPT or
Mucus Clearance
Device
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Monitor
◦ Respiratory Rate,
Depth, Effort
◦ ABGs, SaO2
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Determine/Treat
Cause
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Position
Teach
Diaphragmatic
Breathing
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Monitor Response
to Activity
◦ Vital Signs
◦ SaO2
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Use Portable O2 for
Ambulation
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Allow Rest Between
Activities
Obtain Bedside
Commode
Increase Activity
Slowly
Refer to Pulmonary
Rehabilitation
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Clean, Well-Ventilated Living Areas
Isolation of Patients who have Active TB
High-Efficiency Filtration Masks
Gowns, Gloves, Goggles If Contact with
Sputum Likely
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Combination of
◦ Chronic Bronchitis
◦ Emphysema
◦ Asthma
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Chronic Airflow
Limitation
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Chronic Bronchitis
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Chronic Inflammation
Low-Grade Infection
Hypertrophied Mucous Glands in Bronchi
Impaired Ciliary Function
Ineffective Airway Clearance
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Destruction of Alveolar Walls
Loss of Elastic Recoil
Damage to Pulmonary Capillaries
Air Trapping
Impaired Gas Exchange
Diagnosed After Ill 3 Months of Year for 2
Consecutive Years
Emphysema
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Smoking
Passive Smoke Exposure
Pollutants
Familial Predisposition
α1AT Deficiency (Emphysema)
Smoking!!
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Cough
Sputum Production
Dyspnea
Prolonged Expiration
Barrel Chest
Activity Intolerance
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Wheezing, Crackles
Chronic Cough
Dyspnea
Thick, Tenacious Sputum
Increased Susceptibility to Infection
Mucous Plugs
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Diminished Breath Sounds
Dyspnea
Progressive Activity Intolerance
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Cor Pulmonale
Weight Loss
Pneumothorax
Respiratory Failure
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Chest X-Ray
CT Scan
ABGs
CBC
Spirometry
Sputum Analysis
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Stop Smoking!!
Oxygen 1-2 L/m
Supportive Care
Pulmonary Rehab
Surgery
Mechanical
Ventilation
End-of-Life
Planning
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Medications
◦ Bronchodilators
◦ Corticosteroids
◦ Expectorants
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NMT/MDI
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Pathophysiology
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Inflammation of Bronchial Mucosa/ Bronchial Tree
Spasm of Bronchial Smooth Muscles
Air Trapping
Reversible
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Smoking
Allergens
Infection
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Sinusitis
Stress
GERD
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Dyspnea
Wheezing
Cough
Sputum
Use of Accessory Muscles
May Be Worse at Night
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Status Asthmaticus
◦ Severe, Sustained Asthma
◦ Worsening Hypoxemia
◦ Respiratory Alkalosis Progresses to Respiratory
Acidosis
◦ May Be Life Threatening
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History and Physical Examination
Spirometry
ABGs
Allergy Skin Testing
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Bronchodilators
 Adrenergic (Ventolin, Serevent)
 Leukotriene Inhibitors (Accolate, Singulair)
 Theophylline (Rare)
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Corticosteroids
 Inhaled, IV, PO
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Mast Cell Inhibitors (Exercise Induced)
Antihistamines
Oxygen PRN
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Pathophysiology
◦ Exocrine Gland Disorder
◦ Thick Tenacious Secretions
◦ Blocked Pancreatic Enzymes
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Etiology
◦ Heredity
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Thick Tenacious Sputum
Frequent Respiratory Infections
Finger Clubbing
Malabsorption
Fatty, Foul Smelling Stools
Death From Antibiotic-resistant Infection
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Hydration
Inhaled Mucolytic Medication
Bronchodilators, Corticosteroids
Expectorants
Chest Physiotherapy
Antibiotics
Prevent Infection
Pancreatic Enzyme Replacement (Pancrease,
Viokase)
Ibuprofen May Slow Lung Deterioration
Lung Transplant
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Pathophysiology
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Blood Clot in Pulmonary Artery
Ventilation-Perfusion Mismatch
Impaired Gas Exchange
Lung Infarction
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DVT Most Common
Fat Emboli From Compound Fracture
Amniotic Fluid Emboli During L&D
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Regular Ambulation
Prompt Treatment of DVT
In High-risk Patients
◦ Warfarin (Coumadin)
◦ Heparin
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Sudden Onset Dyspnea
Tachycardia
Tachypnea
Cough
Crackles
Hemoptysis
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Small Cell Lung Cancer
Large Cell Carcinoma
Adenocarcinoma
Squamous Cell Carcinoma
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Smoking
◦ Smokers 13× as Likely to Develop Cancer as
Nonsmokers
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Environmental Tobacco Smoke
Other Carcinogens
◦ Asbestos
◦ Arsenic
◦ Pollution
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None Until Late
Productive Cough
Recurrent Infection
Dyspnea
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Hemoptysis
Anorexia and
Weight Loss
Pain
Wheezing/Stridor
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Pleural Effusion
Superior Vena Cava Syndrome
Ectopic Hormone Secretion
◦ ADH (SIADH)
◦ ACTH (Cushing’s Syndrome)
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Actelectasis
Metastasis
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Chest X-Ray
CT Scan
Sputum Analysis
Biopsy
Additional Tests to Find Metastasis
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Stage (TNM System)
Chemotherapy (Usually Palliative)
Radiation (Usually Palliative)
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Pneumonectomy
Lobectomy
Resection
VATS
Transplant
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Monitor Respiratory Status
Teach
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Routine Preop Teaching
What to Expect
Visit SICU
Include Family
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Intensive Care Setting
Monitor
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Vital Signs
SaO2, ABGs
Hemodynamic Parameters
Lung Sounds
Ventilator
Chest Tubes