Chapter 26 Respiratory System Function, Assessment, and

Download Report

Transcript Chapter 26 Respiratory System Function, Assessment, and

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