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Respinursing 110215173709 Phpapp02 PDF
Respinursing 110215173709 Phpapp02 PDF
MS
Abejo
2.
3.
4.
Nasopharynx
Oropharynx
Laryngopharynx
5. Tonsils and Adenoids
6. Larynx voice production, coughing reflex
Made up of framework of:
Epiglottis valve that covers the opening
to the larynx during swallowing.
Glottis opening between the vocal cords
Hyoid bone u shaped bone in neck
Cricoid cartilage
Thyroid cartilage, forms the Adams apple
Arythenoid cartilage
Speech production and cough reflex
Vocal cords
7. Trachea - consists of cartilaginous rings
Passageway of air
Bronchi
Subsegmental Bronchi
Bronchioles
Terminal Bronchioles
Lecithin
Sphingomyelin
L/S ratio indicates lung maturity
2:1 normal
1:2 immature lungs
PULMONARY CIRCULATION
Provides for reoxygenation of blood and release of CO2
PULMONARY ARTERIES, carry blood from
the heart to the lungs.
PULMONARY VEINS, is a large blood vessel
of the circulatory system that carries blood
from the lungs to the left atrium of the heart.
MS
RESPIRATORY MUSCLES
PRIMARY: diaphragm and external intercostal muscles
ACCESORY: sternocleidomastoid (elevated sternum),
the scalene muscles (anterior, middle and posterior
scalene) and the nasal alae
Pleural cavity
Parietal
Visceral
Pleural Fluid: prevents pleural friction rub
(as seen in pneumonia and pleural effusion)
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NEUROCHEMICAL CONTROL
MEDULLA OBLONGATA respiratory center
initiates each breath by sending messages to primary
respiratory muscles over the phrenic nerve
has inspiration and expiration centers
PONS has 2 respiration centers that work with the
inspiration center to produce normal rate of breathing
1. PNEUMOTAXIC CENTER affects the inspiratory
effort by limiting the volume of air inspired
2. APNEUSTIC CENTER prolongs inhalation
NOTE: Chemoreceptors responds to changes in ph, increased
PaCO2 = increase RR
Background information
A. Abnormal patterns of breathing
1. Sleep Apnea
cessation of airflow for more than 10 seconds more
than 10 times a night during sleep
causes: obstructive (e.g. obesity with upper narrowing,
enlarged tonsils, pharyngeal soft tissue changes in
acromegaly or hypothyroidism)
2. Cheyne-Stokes
periods of apnoea alternating with periods of
hyperpnoae
pathophysiology: delay in medullary chemoreceptor
response to blood gas changes
causes
left ventricular failure
brain damage (e.g. trauma, cerebral,
haemorrhage)
high altitude
3. Kussmaul's (air hunger)
deep rapid respiration due to stimulation of respiratory
centre
causes: metabolic acidosis (e.g. diabetes mellitus,
chronic renal failure)
4. Hyperventilation
complications: alkalosis and tetany
causes: anxiety
5. Ataxic (Biot)
irregular in timing and deep
causes: brainstem damage
6. Apneustic
post-inspiratory pause in breathing
causes: brain (pontine) damage
AIRWAY RESISTANCE
Resistance is determined chiefly by the radius size of the
airway.
Causes of Increased Airway Resistance
1. Contraction of bronchial mucosa
2. Thickening of bronchial mucosa
3. Obstruction of the airway
4. Loss of lung elasticity
RESPIRATION
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- asthma
- carcinoma of bronchus
- left ventricular failure
- interstitial lung disease
- ACE inhibitors
Sputum
volume
type (purulent, mucoid, mucopurulent)
presence or absence of blood?
Stridor
croaking noise loudest on inspiration
is a sign that requires urgent attention
causes: (obstruction of larynx, trachea or large
broncus)
- acute onset (minutes)
inhaled foreign body
acute epiglottitis
anaphylaxis
toxic gas inhalation
- gradual onset (days, weeks)
laryngeal and pharyngeal tumours
crico-arytenoid rheumatoid arthritis
bilateral vocal cord palsy
tracheal carcinoma
paratracheal compression by lymph nodes
post-tracheostomy or intubation
granulomata
Hoarseness
causes include:
- laryngitis
- laryngeal nerve palsy associated with
carcinoma of lung
- laryngeal carcinoma
7. Paradoxical
the abdomen sucks with respiration (normally, it
pouches uotward due to diaphragmatic descent)
causes: diaphragmatic paralysis
B. Cyanosis
1. Refers to blue discoloration of skin and mucous
membranes , is due to presence of deoxygenated
haemoglobin in superficial blood vessels
2. Central cyanosis = abnromal amout of deoxygenated
haemoglobin in arteries and that blue discoloration is
present in parts of body with good circulation such as
tongue
3. Peripheral cyanosis = occurs when blood supply to a
certain part of body is reduced, and the tissue extracts
more oxygen from normal from the circulating blood, e.g.
lips in cold weather are often blue, but lips are spared
4. Causes of cyanosis
Central cyanosis
decreased arterial saturation
decreased concentration of inspired oxygen:
high altitude
lung disease: COPD with cor pulmoale,
massive pulmonary embolism
right to left cardiac shunt (cyanotic congenital
heart disease)
polycythaemia
haemoglobin abnromalities (rare):
methaemoglobinaemia, sulphaemoglobinaemia
Peripheral cyanosis
all causes of central cyanosis cause peripheral
cyanosis
exposure to cold
reduced cardiac output: left ventricular failure or
shock
arterial or venous obstruction
The Hands
Clubbing
commonly cause by respiratory disease (but NOT
emphysema or chronic bronchitis)
occasionally, clubbing is associated with hypertrophic
pulmonary osteoarthropathy (HPO)
characterised by periosteal inflammation at distal ends
of long bones, wrists, ankles, metacarpals and
metatarsals
sweelling and tenderness over wrists and other
involved areas
Staining
staining of fingers - sign of cigarette smoking (caused by
tar, not nicotine)
Wasting and weakness
Pulse rate
Flapping tremor (asterixis) - unreliable sign
ask patient to dorsiflex wrists and spread out fingers, with
arms outstretched
flapping tremor may occur with severe carbon dioxide
retention (severe chronic airflow limitation)
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The Face
Eyes
Horner's syndrome? (constricted pupil, partial ptosis and
loss of sweating which can be due to apical lung tumour
compressing sympathetic nerves in neck)
Nose
polpys? (associated with asthma)
engorged turbinates? (various allergic conditions)
deviated septum? (nasal obstruction)
Mouth and tongue
look for central cyanosis
evidence of upper respiratory tract infection (a reddened
pharynx and tonsillar enlargement with or without a
coating of pus)
broken tooth - may predispose to lung abscess or
pneumonia
sinusitis is indicated by tenderness over the sinuses on
palpation
some patients with obstructive sleep apnoea will be obese
with a receding chin, a small pharynx and a short thick neck
Harrison's sulcus
innar depression of lower ribs just above costal margins
at site of attachment of diaphragm
causes:
severe asthma in childhood
rickets
Kyphosis , exaggerated forward curvature of spine
Scoliosis , lateral bowing
Kyphoscoliosis: causes:
idiopathic (80%)
secondary to poliomyelitis (inflammation involving
grey matter of cord)
(note: severe thoracic kyphoscoliosis may reduce lung
capacity and increase work of breathing)
Lesions of chest wall
scars - previous thoracic operations or chest drains for a
previous pneumothorax or pleural effusion
thoracoplasty (was once performed to remove TB, but
no longer is because of effective antituberculosis
chemotherapy) invovled removal of large number of
ribs on one side to achieve permanent collapse of
affected lung
erythema and thickening of skin may occur in
radiotherapy; there is a sharp demarcation between
abnormal and normal skin
Diffuse swelling of chest wall and neck
pathophysiology: air tracking from the lungs
causes:
pneumothorax
rupture of oesopahagus
Prominent veins
cause: superior vena caval obstruction
Asymmetry of chest wall movements
assess this by inspecting from behind patient, looking
down the clavicles during moderate respiration diminished movement indicates underlying lung disease
the affected side will showed delayed or decreased
movement
causes of reduced chest wall movements on one side are
localised:
localised pulmonary fibrosis
consolidation
collapse
pleural effusion
pneumothroax
causes of bilateral reduced chest wall movements are
diffuse:
chronic airflow limitation
diffuse pulmonary fibrosis
The Trachea
causes of tracheal displacement:
toward the side of the lung lesion
upper lobe collapse
upper lobe fibrosis
pneumonectomy
upper mediastinal masses, such as retrosternal goitre
tracheal tug (finger resting on trachea feels it move inferiorly
with each inspiration) is a sign of gross overexpansion of the
chest because of airflow obstruction
The Chest: inspection
Shape and symmetry of chest
Barrel shaped
anteroposterior (AP) diameter is increased compared
with lateral diameter
causes: hyperinflation due to asthma, emphysema
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cardiac dullness:
area of cardiac dullness is uaully present on left side of
chest
this may decrease in emphysema or asthma
chest expansion
place hands firmly on chest wall with fingers extending
around sides of chest (fugyre 4.5)
as patient takes a big breath in, the thumbs should move
symmetrically apart about 5 cm
reduced expansion on one side indicates a lesion on that
side
note: lower lobe expansion is tested here; upper lobe is
tested for on inspection (as above)
apex beat
(discussed in cardiac section)
for respiratory diseases:
displacement toward site of lesion - can be caused by:
collapse of lower lobe
localised pulmonary fibrosis
displacement away from site of lesion - can be caused
by:
pleural effusion
tension pneumothorax
apex beat is often impalpable in a chest which is
hyperexpanded secondary to chronic airflow limitation
vocal fremitus
palpate chest wall with palm of hand while patient repeats
"99"
front and back of chest are each palpated in 2 comparable
positions with palms; in this way differences in vibration on
chest wall can be detected
causes of change in vocal fremitus are the same as those for
vocal resonance (see later)
ribs
gently compress chest wall anteroposteriorly and laterally
localised pain suggests a rib fracture (may be secondary to
trauma or spontaneous as a result of tumour deposition or
bone disease)
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pulmonary thromboembolism
marked obesity
sleep apnoea
severe kyphoscoliosis
The Abdomen
palpate liver for enlargement due to secondary deposits of
tumour from lung, or right heart failure
Other
Permberton's sign
ask patient to lift arms over head
look for development of facial plethora, inspiratory
stridor, non-pulsatile elevation of jugular venous
pressure
occurs in vena caval obstruction
Feet
inspect for oedema or cyanosis (clues of cor
pulmonale)
look for evidence of deep vein thrombosisd
Respiratory rate on exercise and positioning
patients complaining of dyspnoea should have their
respiratory rate measured at rest, at maximal tolerated
exertion and supine
if dyspnoea is not accompanied by tachypnoea when
a patient climbs stairs, one should consider
malingering
look for paradoxical inward motion of abdomen
during inspiration when patient is uspine (indicating
diaphragmatic paralysis)
Temperature: fever may accompany any acute or chronic
chest infection
DIAGNOSTIC EVALUATION
The Heart
lie patient at 45 degrees
measure jugular venous plse for right heart failure
examine preacordium; pay close attention to pulmonary
component of P2 (which is best heard at 2nd intercostal
space on left) and should not be louder than A2; if it is
louder, suspect pulmonary hypertension
cor pulmonale (also called pulmonary hypertensive heart
disease) may be due to:
chronic airflow limitation (emphysema)
pulmonary fibrosis
MS
Abejo
2. Pulse Oximeter
3. Chest X-ray
This is a NON-invasive procedure involving the use of xrays with minimal radiation.
The nurse instructs the patient to practice the on cue to
hold his breath and to do deep breathing
Instruct the client to remove metals from the chest.
Rule out pregnancy first.
7. Indirect Bronchography
A radiopaque medium is instilled directly into the
trachea and the bronchi and the outline of the entire
bronchial tree or selected areas may be visualized
through x-ray.
It reveals anomalies of the bronchial tree and is
important in the diagnosis of bronchiectasis.
8. Bronchoscopy
This is the direct inspection and observation of the
larynx, trachea and bronchi through a flexible or rigid
bronchoscope.
Passage of a lighted bronchoscope into the bronchial
tree for direct visualization of the trachea and the
tracheobronchial tree.
Diagnostic uses:
To examine tissues or collect secretions
To determine location or pathologic process
and collect specimen for biopsy
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MS
9. Lung Scan
Procedure using inhalation or I.V. injection of a
radioisotope, scans are taken with a scintillation camera.
Imaging of distribution and blood flow in the lungs.
(Measure blood perfusion)
Confirm pulmonary embolism or other blood- flow
abnormalities
Therapeutic uses
To Remove foreign objects from
tracheobronchial tree
To Excise lesions
To remove tenacious secretions obstructing the
tracheobronchial tree
To drain abscess
To treat post-operative atelectasis
Nursing interventions BEFORE Bronchoscopy
Informed consent/ permit needed
Explain procedure to the patient, tell him what
to expect, to help him cope with the unkown
Atropine (to diminish secretions) is
administered one hour before the procedure
About 30 minutes before bronchoscopy,
Valium is given to sedate patient and allay
anxiety.
Topical anesthesia is sprayed followed by
local anesthesia injected into the larynx
Instruct on NPO for 6-8 hours
Remove dentures, prostheses and contact lenses
The patient is placed supine with
hyperextended neck during the procedure
Nursing interventions:
Early morning sputum specimen is to be
collected (suctioning or expectoration)
Rinse mouth with plain water
Use sterile container.
Sputum specimen for C&S is collected before
the first dose of anti-microbial therapy.
For AFB staining, collect sputum specimen for
three consecutive mornings.
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LUNG CAPACITIES:
Functional Residual Capacity (ERV 1100 mL + RV 1200 mL =
2300 mL )
The volume of air that remains in the lungs after normal,
quiet exhalation
Inspiratory Capacity (TV 500 mL + IRV 3000 mL = 3500 mL )
The amount of air that a person can inspire maximally
after a normal expiration
Vital capacity (IRV 3000 mL + TV 500 mL + ERV 1100 mL =
4600 mL )
The maximum volume of air that can be exhaled after a
maximum inhalation
Reduced in COPD
Total Lung Capacity (IRV 3000 mL + TV 500 mL + ERV 1100
mL + RV 1200 mL = 5800 mL )
Total of all four volumes
Nursing interventions:
Utilize a 10-ml. Pre-heparinized syringe to
prevent clotting of specimen
Soak specimen in a container with ice to
prevent hemolysis
If ABG monitoring will be done, do Allens
test to assess for adequacy of collateral
circulation of the hand (the ulnar arteries)
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1. Oxygen Therapy
Oxygen is a colorless, odorless, tasteless, and dry gas that
supports combustion
Man requires 21% oxygen from the environment in order
to survive
Indication: Hypoxemia
Signs of Hypoxemia
o Increased pulse rate
o Rapid, shallow respiration and dyspnea
o Increased restlessness or lightheadedness
o Flaring of nares
o Substernal or intercostals retractions
o Cyanosis
17. Thoracentesis
Procedure suing needle aspiration of intrapleural fluid or
air under local anesthesia
Specimen examination or removal of pleural fluid
Nursing intervention BEFORE Thoracentesis
Secure consent
Take initial vital signs
Instruct to remain still, avoid coughing during
insertion of the needle
Inform patient that pressure sensation will be
felt on insertion of needle
MS
Note: * can be used for both low and high flow administration
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2. Tracheobronchial suctioning
Suction only when necessary not routinely
Use the smallest suction catheter if possible
Client should be in semi or high Fowlers position
Use sterile gloves, sterile suction catheter
Hyperventilate client with 100% oxygen before and
after suctioning
Insert catheter with gloved hand (3-5 length of catheter
insertion) without applying suction. Three passes of the
catheter is the maximum, with 10 seconds per pass.
Apply suction only during withdrawal of catheter
The suction pressure should be limited to less than 120
mmHg
When withdrawing catheter rotate while applying
intermittent suction
Suctioning should take only 10 seconds (maximum of 15
seconds)
Evaluate: clear breath sounds on auscultation of the chest.
Postural drainage
Use of gravity to aid in the drainage of secretions.
Patient is placed in various positions to promote flow of
drainage from different lung segments using gravity.
Areas with secretions are placed higher than lung
segments to promote drainage.
Patient should maintain each position for 5-15 minutes
depending on tolerability.
Percussion
Produces energy wave that is transmitted through the
chest wall to the bronchi.
The chest is struck rhythmically with cupped hands over
the areas were secretions are located.
Avoid percussion over the spine, kidneys, breast or
incision and broken ribs. Areas should be percussed for
1-2 minutes
Vibration
Works similarly to percussion, where hands are placed on
clients chest and gently but firmly rapidly vibrate hands
against thoracic wall especially during clients exhalation.
This may help dislodge secretions and stimulate cough.
This should be done at least 5-7 times during patient
exhalation.
b. Aerosol inhalation
done among pediatric clients to administer brochodilators or
mucolytic-expectorants.
.
c. Medimist inhalation
done among adult clients to administer bronchodilators or
mucolytic-expectorants.
4. Chest Physiotheraphy ( CPT )
Includes postural drainage, chest percussion and vibration,
and breathing retraining. Effective coughing is also an
important component.
MS
12
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Suctioning
Nursing Interventions in CPT
Verify doctors order
Assess areas of accumulation of mucus secretions.
Position to allow expectoration of mucus secretions
by gravity
Place client in each position for 5-10 to 15 minutes
Percussion and vibration done to loosen mucus
secretions
Change position gradually to prevent postural
hypotension
Client is encouraged to cough up and expectorate
sputum
Procedure is best done 60 to 90 minutes before
meals or in the morning upon awakening and at
bedtime.
Provide good oral care after the procedure
5. Incentive Spirometry
Nursing care
MS
13
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Three-bottle system
The first bottle is the drainage bottle;
The second bottle is water seal bottle
The third bottle is suction control bottle.
7. Artificial Airway
a. Oral airways- these are shorter and often have a larger lumen.
They are used to prevent the tongue form falling backward.
b. Nasal airways- these are longer and have smaller lumen Which
causes greater airway resistance
c. Tracheostomy- this is a temporary or permanent surgical
opening in the trachea. A tube is inserted to allow ventilation and
removal of secretions. It is indicated for emergency airway access
for many conditions. The nurse must maintain tracheostomy care
properly to prevent infection.
I.
Next, the nurse moves the clamp towards the bottle checking the
bubbling in the water seal bottle.
If bubbling stops, the leak is between the clamp
and the distal part including the bottle.
But if there is persistent bubbling, it means that the
drainage unit is leaking and the nurse must obtain
another set.
In the event that the water seal bottle breaks, the
nurse temporarily kinks the tube and must obtain a
receptacle or container with sterile water and
immerse the tubing.
She should obtain another set of sterile bottle as
replacement. She should NEVER CLAMP the tube
for a longer time to avoid tension pneumothorax.
In the event the tube accidentally is pulled out, the
nurse obtains vaselinized gauze and covers the
stoma.
She should immediately contact the physician.
MS
A.
14
ETIOLOGIC AGENTS
1. Streptococcus
pneumoniae
(pneumococcal
pneumonia)
2. Hemophilus influenzae (bronchopneumonia)
3. Klebsiella pneumoniae
4. Diplococcus pneumoniae
5. Escherichia coli
6. Pseudomonas aeruginosa
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B.
C.
PREDISPOSING FACTORS
1. Smoking
2. Air pollution
3. Immunocompromised
(+) AIDS
Kaposis Sarcoma
Pneumocystis Carinii Pneumonia
DOC: Zidovudine (Retrovir)
Bronchogenic Ca
4. Prolonged immobility (hypostatic pneumonia)
5. Aspiration of food (aspiration pneumonia)
6. Over fatigue
D.
E.
DIAGNOSTICS
1. Sputum GS/CS confirmatory; type and sensitivity;
(+) to cultured microorganism
2. CXR (+) pulmonary consolidation
3. CBC
Elevated WBC
4. ABG PO2 decreased (hypoxemia)
F.
MS
Nursing management:
Monitor VS and BS
Best performed before meals/breakfast or
2-3 hours p.c. to prevent gastroesophageal
reflux or vomiting (pagkagising maraming
secretions diba? Nakukuha?)
Encourage DBE
Administer bronchodilators 15-30 minutes
before procedure
Stop if pt. cant tolerate the procedure
Provide oral care after procedure as it may
affect taste sensitivity
Contraindications:
Unstable VS
Hemoptysis
Increased ICP
Increased IOP (glaucoma)
12. Provide pt health teaching and d/c planning
Prevention of complications
Atelectasis
Meningitis
NURSING MANAGEMENT
1. Enforce CBR (consistent to all respi disorders)
2. Strict respiratory isolation
3. Administer medications as ordered
Anti-pyretics
Mucolytics/expectorants
4. Administer O2 inhalation as ordered
5. Force fluids to liquefy secretions
6. Institute pulmonary toilet measures to promote
expectoration of secretions
DBE,
Coughing
exercises,
CPT
(clapping/vibration), Turning and repositioning
7. Nebulize and suction PRN
8. Place client of semi-fowlers to high fowlers
9. Provide a comfortable and humid environment
10. Provide a dietary intake high in CHO, CHON,
Calories and Vit C
11. Assist in postural drainage
II.
15
Internal
External
RETROLENTAL FIBROPLASIA retinopathy/blindness in
immaturity d/t high O2 flow in pedia patients
PRECIPITATING FACTORS
1. Malnutrition
2. Overcrowding
3. Alcoholism: Depletes VIT B1 (thiamin) alcoholic
beriberi malnutrition
4. Physical and emotional stress
5. Ingestion of infected cattle with M. bovis
6. Virulence (degree of pathogenecity)
B.
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C.
D.
E.
MS
DIAGNOSTICS
1. Skin testing
NURSING MANAGEMENT
1. Enforce CBR
2. Institute strict respiratory isolation
3. Administer O2 inhalation
4. Forced fluids
5. Encourage DBE and coughing
Intensive phase
INH
SE: peripheral neuritis (increase vit
B6 or pyridoxine
Rifampicin
SE: red orange color of bodily
secretions
PZA
May be replaced with Ethambutol
(SE:
optic
neuritis)
if
(+)
hypersensitivity to drug
SE: allergic reactions; hepatotoxicity
and nephrotoxicity
1. Monitor liver enzymes
2. Monitor BUN and CREA
INH given for 4 months, PZA and
Rifampicin is given for 2 months, A.C. to
facilitate absorption
These 3 drugs are given simultaneously to
prevent development of resistance
Standard Regimen
Streptomycin injection (aminoglycosides)
Neomycin, Amikacin, Gentamycin
1. common SE: 8th CN damage
tinnitus hearing loss
ototoxicity
2. nephrotoxicity
a. BUN (N = 10-20)
b. CREA (N = 8-10)
9. Health teaching and d/c planning
PREDISPOSING FACTORS
Productive cough
Cyanosis
Dyspnea
Hemoptysis
3.
DIAGNOSTICS
4.
NURSING MANAGEMENT
Enforce CBG
Forced fluids
Prevent complications
Bronchiectasis, atelectasis
Prevention of spread
Spraying of breeding places
Kill bird and owner! Hehe!
1.
2.
3.
4.
16
Chronic Bronchitis
Bronchial Asthma
Bronchiectasis
Pulmonary Emphysema
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I.
MS
A.
PREDISPOSING FACTORS
1. Smoking
2. Air pollution
B.
Peripheral edema
Cor pulmonale
C.
DIAGNOSTICS
1. ABG analysis: decreased PO2, increased PCO2,
respiratory acidosis; hypoxemia cyanosis
D.
NURSING MANAGEMENT
1. Enforce CBR
2. Administer medications as ordered
Bronchodilators
Antimicrobials
Corticosteroids
Mucolytics/expectorants
3. Low inflow O2 admin; high inflow will cause
respiratory arrest
4. Force fluids
5. Nebulize and suction client as needed
6. Provide comfortable and humid environment
7. Health teaching and d/c planning
avoidance of smoking
prevent complications
CO2 narcosis coma
Cor pulmonale
Pleural effusion
Pneumothorax
II.
17
A.
PREDISPOSING FACTORS
1. Extrinsic (Atopic/Allergic Asthma)
Genetics
B.
C.
DIAGNOSTICS
1. PFT decreased vital lung capacity
2. ABG analysis PO2 decreased
D.
NURSING MANAGEMENT
1. Enforce CBR
2. Administer medications as ordered
Corticosteroids
Mucolytics/expectorants
Mucomyst
Antihistamine
3. Administer oxygen inhalation as ordered
4. Forced fluids
5. Nebulize and suction patient as necessary
6. Encourage DBE and coughing
7. Provide a comfortable and humid environment
8. Health teaching and d/c planning
Prevention of complications
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Status asthmaticus
DOC: Epinephrine
Aminophylline drip
Emphysema
Regular adherence to medications
Importance of ffup care
D.
SURGERY
1. Segmental lobectomy
2. Pneumonectomy
E.
NURSING MANAGEMENT
1. Enforce CBR
2. Low inflow O2 admin; high inflow will cause
respiratory arrest
3. Administer medications as ordered
Bronchodilators
Antimicrobials
Corticosteroids
(5-10
minutes
after
bronchodilators)
Mucolytics/expectorants
4. Force fluids
5. Nebulize and suction client as needed
6. Provide comfortable and humid environment
7. Health teaching and d/c planning
Avoidance of smoking
Prevent complications
Atelectasis
CO2 narcosis coma
Cor pulmonale
Pleural effusion
Pneumothorax
A.
MS
PREDISPOSING FACTORS
1. Recurrent lower respiratory tract infection
Histoplasmosis
2. Congenital disease
3. Presence of tumor
4. Chest trauma
B.
C.
DIAGNOSTICS
1. ABG analysis reveals low PO2
2. Bronchoscopy direct visualization of bronchi
lining using a fibroscope
Pre-op
Secure consent
Explain procedure
NPO 4-6 hours
Monitor VS and breath sounds
Post-operative
Feeding initiated upon return of gag reflex
Instruct client to avoid talking, coughing
and smoking as it may irritate respiratory
tract
Inelasticity of alveoli
Air trapping
18
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B.
C.
D.
MS
PREDISPOSING FACTORS
1. Smoking
2. Air pollution
3. Hereditary: involves alpha-1 antitrypsin for
elastase production for recoil of the alveoli
4. Allergy
5. High risk group elderly degenerative
decreased vital lung capacity and thinning of
alveolar lobes
V.
TYPES
1. Spontaneous air enters pleural space without an
obvious cause
B.
PREDISPOSING FACTORS
1. Chest trauma
2. Inflammatory lung condition
3. tumors
SIGNS AND SYMPTOMS
1. Sudden sharp chest pain, dyspnea, cyanosis
2. Diminished breath sounds
3. Cool, moist skin
4. Mild restlessness and apprehension
5. Resonance to hyperresonance
C.
DIAGNOSTICS
1. ABG analysis reveal
Bronchodilators
Antimicrobials
Corticosteroids
Mucolytics/expectorants
3. Low inflow O2 admin; high inflow will cause
respiratory arrest and oxygen toxicity
4. Force fluids
5. Pulmonary toilet
6. Nebulize and suction client as needed
7. Institute PEEP in mechanical ventilation
Avoidance of smoking
Prevent complications
Atelectasis
CO2 narcosis coma
Cor pulmonale
Pleural effusion
Pneumothorax
19
D.
DIAGNOSTICS
1. ABG analysis: PO2 decreased
2. CXR confirms collapse of lungs
E.
NURSING MANAGEMENT
1. Assist in endotracheal intubation
2. Assist in thoracentesis
3. Administer meds as ordered
Antibiotics
4. Assist in CTT to H20 sealed drainage
Abejo