PNEUMONIA Cough due to mucous production and

- lower respiratory tract infection that causes irritation of the airways

inflammation of the alveolar sac. It could be Crackles due to fluid within the alveolar space
bacterial or viral and smaller airways
- lobar pneumonia, bronchopneumonia, Rhonchi due to mucus in airways
interstitial pneumonia Wheezing due to inflammation within the
- unilateral or bilateral larger airways
- CAP or HAP Discolored, possibly blood-tinged, sputum
Pathophysiology due to irritation in the airways or
O2+microbes enter airway lungs will microorganisms causing infection
produce mucus filled with mucus and Tachycardia and tachypnea as the body
fluid  DOB  Impaired gas exchange attempts to meet the demand for oxygen
Hypoxia, Acidosis, Impaired Ventilation Pain on respiration due to pleuritic
Classifications inflammation, pleural effusion, or atelectasis
1. Community Acquired Pneumonia Development
2. Hospital Acquired Pneumonia Headache, muscle aches (myalgia), joint
3. Pneumonia in the immuno-compromised pains, or nausea may be present depending
4. Aspiration Pneumonia on the infecting organism
Causative agents
Diagnostic Studies
Typical pneumonia refers to pneumonia Shadows on chest x-ray, indicating infiltration,
caused by: may be in a lobar or segmental pattern or
- Streptococcus pneumoniae more scattered.
- Haemophilus influenzae, Culture and sensitivity of the sputum to
- S. aureus identify the infective agent and the
- Group A streptococci appropriate antibiotics.
- Moraxella catarrhalis Elevated WBC (leukocytosis) showing sign of
- anaerobes and aerobic gramnegative infection.
bacteria. Low oxygen saturation on pulse oximetry.
S/SX Arterial blood gas may show low oxygen and
-High grade fever elevated carbon dioxide levels.
-Productive cough
-Location: lobar Treatment
-productive cough, high fever -Supplemental oxygen is given to help meet
-tachycardia the body's needs.
-Antibiotics are given for the most likely
Atypical pneumonia is mostly caused by: organism (empirically) until the sputum
- Legionella culture results are returned.
- Mycoplasma pneumoniae -Patients may need bronchodilators to help
- Chlamydia pneumoniae open the airways.
S/SX -Administer oxygen as needed.
Low grade fever For bacterial infections, administer
Dry cough ANTIBIOTICS such as
Location: interstitial macrolides = azithromycin, clarithromycin
Pleuritic chest pain, flulike, low fever fluoroquinolones = levofloxacin, moxifloxacin
betalactams = amoxicillin/clavulanate,
Signs and Symptoms cefotaxime, ceftriaxone, cefuroxime axetil,
Shortness of breath (due to inflammation cefpodoxime, ampicillin/sulbactam
within the lungs) ketolide = telithromycin
- impairing gas exchange -Administer ANTIPYRETICS when fever >38.3 C
Difficulty breathing (dyspnea) due to acetaminophen, ibuprofen
inflammation and mucus within the lungs -Administer BROCHODILATORS to keep
Fever due to infectious process airways open, enhance airflow if needed
Chills due to increased temperature
albuterol, metaproterenol, levalbuterol via
nebulizer or metered dose inhaler
-Increase fluid intake to help loosen
secretions and prevent dehydration.
-Instruct the patient on how to use the
incentive spirometer to encourage deep
breathing; monitor progress.
Nursing Diagnoses
Risk for aspiration
Impaired ventilation
Ineffective airway clearance
Nursing Intervention
*Monitor respiration for rate, effort, use of
accessory muscles, skin color, and breath
sounds.
*Record fluid intake and output for
differences, signs of dehydration.
*Record sputum characteristics for changes in
color, amount, and consistency
*Properly dispose of sputum
*Explain to the patient:
*Take adequate fluids-3 liters per day-to
prevent excess fluid loss through the
respiratory system with exhalation.
*Use of incentive spirometer.
PULMONARY TUBERCOLOSIS
- AKA: Koch’s Dse.
- is an infectious disease caused by bacteria
that are usually spread from person to person
through the air.
- It usually infects the lung but can occur at in
any site in the body
- The bacilli of TB infect the lung, forming a
tubercle (lesion).
The tubercle:
May heal, leaving scar tissue.
May continue as a granuloma, then heal, or
be reactivated.
May eventually proceed to necrosis,
liquefaction, sloughing, and cavitation
Mode of Transmission
- Airborne, droplet method through coughing
or sneezing
- Direct invasion through mucous membranes
or breaks in the skin may
occur but is extremely rare.
- Bovine tuberculosis results from exposure to
tuberculosis cattle, usually
unpasteurized milk or dairy products
Period of Communicability
- As long as viable tubercle bacilli are being
discharged in the sputum
Incubation Period:
- 2 to 20 weeks
Signs and Symptoms
*Weight loss and anorexia
*Night sweats
*Fever, possibly low-grade due to infection
*Productive cough with discolored, blood-
tinged sputum
*Shortness of breath due to lung changes.
*Malaise and fatigue due to active illness
affecting lungs
Diagnostic Studies
Positive Mantoux (PPD) skin test or Sensitivity
Test shows exposure to tuberculosis due to
development of cell-mediated immunity
MantouxTest: intradermal injection of a
Purified Protein Derivative (PPD)
Interpretation:
*10mm or more positive reaction
*5 –9mm generally d/t a cross reaction to
other mycobacterium infections
may also be d/t incompletely developed
sensitivity or sometimes to technical errors
*3 mm or less suggestive of secondary
infection especially if accompanied by
erythema
Induration of 5 mm or more in diameter
Considered positive in:
*People with human immunodeficiency virus
(HIV).
*People who have had recent contact with
active TB.
*People who have fibrotic changes on chest
X-ray, consistent with healed TB.
Induration of 10 mm or more in diameter
Considered positive in:
*People with medical conditions, such as
substance abuse, TB within past 2 years,
diabetes mellitus, silicosis, head and neck
cancer, leukemia, end-stage renal disease,
gastrectomy, intestinal bypass,
*prolonged corticosteroid therapy.
*Medically underserved, low-income
populations.
*Residents of long-term care facilities.
*Children younger than age 4 years;
adolescents exposed to adults in high-risk
categories.
*I.V. drug users
*Mycobacteriology laboratory personnel
Diagnostic Studies
*Chest x-ray may show areas of granuloma or
cavitation.
*Sputum test identifies M. tuberculosis
bacteria
*Acid fast-staining done to initially screen for
TB-bacillus - will hold stain
*Culture confirms the diagnosis but is slow-
growing.
Treatment
• Administer antitubercular medications to
treat and prevent transmission: isoniazid,
rifampin, pyrazinamide, ethambutol,
streptomycin
• Respiratory isolation for in-hospital care-the
bacteria are spread by increase protein,
carbohydrates, and vitamin C diet for
patients.
Nursing Intervention
*Monitor respiration for rate, effort, use of
accessory muscles, and skin color changes.
*Increase fluid intake to help liquefy any
secretions.
*Record fluid intake and output.
*Explain to the patient
-How to prevent spreading the disease
-The importance of finishing all prescribed
medication.
*Plan for rest periods during the day.
ACUTE RESPIRATORY DISTRESS SYNDROME
- a type of respiratory disease in which the
lungs stiffen as a result of a build-up of fluid in
the lungs. (Fluid builds up in the tissue of the
lungs (interstitium) and the alveoli.)
- This fluid and stiffness impair the lungs'
ability to move air in and
out (ventilation).
There is an inflammatory response in the
tissues of the lungs.
- Damage to the surfactant within the
Alveolileads to alveolar collapse, further
impairing gas exchange.
Causes:
Direct injury to the lungs:
Chest trauma, such as a heavy blow
Breathing vomit
Breathing smoke, chemicals, or salt water
Burns
Indirect injury
Severe infection
Massive blood transfusion
Pneumonia
Pancreatitis
Overdoses of alcohol or certain drugs
Lung and bone marrow transplantation
Signs and Symptoms
Hypoxemia- insufficient level of oxygen in the
blood, despite supplemental oxygen at 100
percent.
Dyspnea- increased need for oxygen to meet
body's demand.
Pulmonary edema- fluid build-up in the lungs.
Tachypnea- breathing becomes faster in an
attempt to get oxygen into the body.
Decreased breath sounds - no air movement
in collapsed alveoli.
Anxiety - secondary to not getting enough
oxygen.
Rales (crackles)- heard in the lungs-air moving
through fluid in alveoli and small airways on
inspiration and expiration
Wheezing (rhonchi)- inflammation develops
or mucous is created.
Restlessness due to decreased oxygen levels.
Cyanosis due to lack of oxygenation.
Accessory muscle use for respirations
Diagnostic Result
Pulse oximetry- shows lowered oxygen levels
below 90%.
Arterial blood gases (ABGs)- show respiratory
acidosis-increased PaCO2 (>45 mmHg),
decreasing PaO, level even with supplemental
oxygen.
Chest x-ray- both lungs show infiltrates within
lung fields. "whiteout" or ground glass
appearance.
Treatment
Bedrest.
Endotracheal intubation.
Mechanical ventilation
Administer anesthetic to ease comfort during
insertion of endotracheal tube: propofol
Administer neuromuscular blocking agent-
These drugs allow respiratory muscles to rest:
pancuronium, vecuronium
Administer diuretics to help decrease excess
fluid in lungs: furosemide, ethacrynic acid,
bumetanide
Administer H2 blocker or proton pump
inhibitor to decrease gastric acid. This will
decrease likelihood of a stress ulcer in the
stomach or aspiration of gastric acid into the
lung: ranitidine, famotidine, nizatidine,
omeprazole
Administer anticoagulant immobility
contributory to clot formation: heparin
Administer analgesic- used for comfort and to
decrease myocardial oxygen demand:
morphine
Administer steroids to decrease inflammatory
response in the lung tissue: hydrocortisone,
methylprednisolone
Administer exogenous surfactant: beractant
Administer antibiotics for respiratory or
systemic infections.
Nursing Intervention
WBC count: Elevation of WBC with infection,
inflammation. Decrease in WBC in a patient
who is immune compromised or who has a
viral infection.
Monitor hemoglobin (Hgb) and hematocrit
(Hct) for anemias.
Monitor PT, PTT, and INR for coagulation
abnormalities; monitor heparin dosing.
Record intake and output of fluid: monitor for
signs of renal insufficiency or failure.
Decrease in urinary out- put less than 30 ml/h
- monitor BUN and Creatinine.
Monitor for possible fluid overload
Change position at least every 2 hours to
prevent pressure build-up, causing skin
breakdown.
Avoid overexerting the patient during
treatment patient will tire easily and will have
problems with increased oxygen demands.
Explain to the patient:
- The importance of doing coughing and deep-
breathing
- How to identify the signs of respiratory
distress, any sign that symptoms may be
returning.
ATELECTASIS
A portion of the lung does not expand
completely, decreasing the lung's capacity to
exchange gases, which results in decreased
oxygenation of blood.
Obstruction of part of the airway will cause
collapse distal to the area that is blocked.
Obstruction can be from a mucous plug inside
the airway, or a tumor or fluid within the
pleural space may be pressing on the airway
from the outside.
Postoperatively. patients are at risk for
atelectasis due to pain, immobility,
medications for pain or anesthesia, and lack
of deep breathing.
Causes:
Can occur in newborn infants due to lack of
surfactant can occur during and after surgical
procedure due to shallow breathing which
means that there is no enough air reaching
the alveolar region
Airway obstruction
Mucus plug
Tung tumor
Pleural effusion
Tuberculosis
Signs and Symptoms
Dyspnea due to the lack of expansion of part
of the lung
Anxiety due to decrease in oxygenation
Tachypnea in an attempt to increase available
oxygen
Tachycardia as body tries to increase available
oxygen
Diaphoresis as a result of increased work of
respirations
Cyanosis due to decreased oxygen level
Hypoxemia due to lack of gas exchange in the
affected area
Decreased breath sounds due to lack of air
movement in the area of collapse
Accessory muscle use with respiration as the
body tries to get more oxygen
Diagnostic Procedure
Shadows on chest x-ray indicate collapsed
area of the lung. The airless state in this area
of the lung creates a more dense appearance
on the x-ray.
CT scan will show an area of atelectasis.
Treatment
Administer oxygen to meet body's demand.
Administer mucolytics to help loosen or thin
secretions:acetylcystine, inhaled, guaifenesin,
oral
Administer bronchodilators to open airways:
albuterol levalbuterol
Nursing Intervention
Cough and deep-breathing exercise every 2
hours to prevent a further area of atelectasis.
Instruct the patient to use the incentive
spirometer every 2 hours to encourage deep
breathing and monitor progress.
Provide humidified air.
Monitor breath sounds for abnormalities such
as diminished sounds.
Monitor mechanical ventilation if needed. If a
large area of the lung is affected
Explain to the patient:
- How to perform coughing and deep-
breathing exercises
- Chest Physiotherapy
- Position changes
PLEURAL EFFUSION
Abnormal accumulation of fluid within the
pleural space
between the parietal and visceral pleura
covering the lungs.
The fluid may be serous fluid, blood or pus
inhibits full lung expansion.
TRANSUDATIVE
occur when there is an imbalance in the
production and absorption of pleural fluid due
to increase hydrostatic pressure and decrease
oncotic pressure
-Fluid is clear
Causes: congestive heart
Failure, liver cirrhosis, nephrotic synd.
EXUDATIVE
Results from inflammation infection or injury
to the pleura leading to increase capillary
permeability and leakage of proteins cells and
other solutes
-Fluid is cloudy or bloody
Causes: pneumonia, lung cancer, autoimmune
d/o Pulmonary embolism
Hydrostatic pressure the force that blood
exerts on the wall of blood vessel or pushing
force
Oncotic pressure- Fluid moves from an area
of low solute concentration to high solute
concentration
Signs and Symptoms
Chest pain due to presence of inflammation
of the pleura in the area
Dyspnea due to diminished chest expansion in
the area.
Decreased breath sounds on auscultation
over the area due to presence of fluid.
Dullness on percussion over the
affected area due to the presence of fluid.
Fever due to infection with
empyema.
Increased pulse and respirations; decreased
BP due to blood loss with hemothorax.
Low oxygen saturation on pulse oximeter
Diagnostic Procedure
Chest x-ray shows pleural effusion.
Chest CT scan shows pleural effusion.
Chest ultrasound shows pleural effusion.
Thoracentesis (removal of fluid with a needle
from the pleural space) shows type of fluid,
Treatment
Fluid removal is performed either as a one-
time procedure or with a chest tube, to
continuously allow for drainage of the fluid
until the tube is removed.
Supplemental oxygen may be needed to help
meet the body's needs.
Thoracentesis to remove the fluid.
Chest tube to remove larger amounts of
drainage over time.
Administer antibiotics for empyema: Selected
according to results of culture and sensitivity
study
Nursing Intervention
Administer supplemental oxygen therapy to
help meet body's needs.
Monitor for changes in vital signs. Have the
patient perform turning, coughing, deep-
breathing exercises to enhance lung
expansion.
Monitor chest tube drainage for color,
amount, and changes in drainage.
• Assure patency of chest tube to make sure
the tube is draining properly
Explain to the patient:
- Disease process.
- Need for coughing and deep breathing.
EMPYEMA
is an accumulation of thick, purulent fluid
within the pleural space
- has the presence of a large number of WBC,
dead cells, microorganism – leading to a
thick, purulent fluid
Causes:
- Bacterial
- Fungal
- Parasitic
Signs and Symptoms
Fever
night sweats
pleural pain
Cough
dyspnea
Anorexia
weight loss
Diagnostic Findings
Chest auscultation demonstrates decreased
or absent breath sounds over the affected
area, and there is dullness on chest
percussion as well as decreased fremitus.
Chest x ray or chest CT scan.
Thoracentesis is performed, often under
ultrasound guidance
Medical Management
Needle aspiration (thoracentesis) with a thin
percutaneous catheter, if the volume is small
and the fluid not too purulent or thick
Medical Management
Tube thoracostomy (chest drainage using a
large-diameter intercostal tube attached to
waterseal drainage with fibrinolytic agents
instilled through the chest tube in patients
Open chest drainage via thoracotomy,
including potential rib resection, to remove
the thickened pleura, pus, and debris and to
remove the underlying diseased pulmonary
tissue.
Nursing Management:
instruct the patient in lung-expanding
breathing exercises to restore normal
respiratory function.
Provide care specific to the method of
drainage of the pleural fluid ex, needle
aspiration, closed chest drainage, or rib
resection and drainage
Instruct the patient and family on care of the
drainage system and drain site, measurement
and observation of drainage, signs and
symptoms of infection, and how and when to
contact the health care provide
Chest Tube Drainage system
Chest tube drainage and suction are used to
re expand the lung and remove remaining air
or fluid.
Normal breathing pattern: negative pressure
principle
Chest tubes are used to remove air 2nd
intercostal anterior
Chest tubes are used to remove fluid 9th
intercostal space
1 – SUCTION CONTROL CHAMBER
- gentle STEADY OR CONTINUOUS BUBBLING
= there is a good amount of suction being
applied
= if vigorous bubbling – suction is too high
NOT GOOD
2 –WATER SEAL CHAMBER and AIR LEAK
MONITOR
- STEADY RISE AND FALL when breathing or
TIDALING = it means that the system is
WORKING CORRECTLY
continuous bubbling NOT GOOD – there is
leak inside the system
“It shows you lungs has not yet re-expanded”
- Monitor for fluctuation in the water seal
= no fluctuation may indicate blockage
3 – COLLECTION CHAMBER
- helps to drain fluid as well as the blood from
the lung
NOTIFY PHYSICIAN bright red blood over 100
ml/hr (after 1st) replacement Fresh blood
Chest tube management
Check the tube connections periodically
Make sure tube in water seal is emerged 1
inch
Check for fluctuations
Mark original fluid level
Double check tubing for loops that interfere
with movements of the patients
Watch for bubbles or air leaks
Report cyanosis, rapid breathing, shallow
breathing, chest pressure
Encourage deep breathing
Priority is to establish water-seal
Clamp for only 5 minutes
 3. Regularly check the ABGs. ABGs show
LOWER AIRWAY PROBLEM progress or deterioration in the lung’s ability
Pulmonary Edema to
- an accumulation of fluid in the alveoli of the exchange oxygen and CO2.
lungs that causes disturbances in gas 4. Cautiously use diuretics as prescribed.
exchange. 5. Give vasodilators with diuretics as adjuvant
2 Categories therapy to reduces lung congestion and
1. Cardiogenic pulmonary edema- Left preload.
ventricular Failure 6. Administer prophylactic medication as
2. Noncardiogenic pulmonary edema- ordered. High-altitude pulmonary edema is
Pulmonary infection, Inhalation of toxic prevented and treated with nifedipine.
substances, Trauma to the Chest, SEPSIS. 7. Provide inotropes as prescribed. Inotropes
such as dobutamine and dopamine are
Causes: administered to treat pulmonary edema with
Hydrostatic Pressure tissue hypoperfusion.
Oncotic Pressure
Capillary Permeability Pulmonary Hypertension
- blood pressure in the arteries of the lungs
Signs of cardiogenic and noncardiogenic and the right side of the heart becomes
pulmonary edema elevated.
Tachypnea Signs and Symptoms
Abnormal lung sounds such as rales or - Dyspnea during exercise, but may also be
crackles on auscultation present while at rest eventually
Progressive dyspnea - Chest pain that can be described as pressure
like
Signs of CARDIOGENIC pulmonary edema - Edema in the lower extremities
Hypoxemia from fluid overload - Ascites
Cough with frothy pink sputum - Cyanosis
S3 gallop or murmurs on heart auscultation - Chest palpitations and/or tachycardia
Jugular venous pressure - Fatigue
Peripheral edema
Group 1 Pulmonary Arterial Hypertension
Sign of NONCARDIOGENIC pulmonary edema (PAH),
Fever - unknown cause (idiopathic).
Productive cough - It could also result from HIV infection, liver
Acute respiratory distress syndrome cirrhosis, or connective tissue disorders. I
- PAH could also be due to an inherited
Review imaging results. genetic mutation running through the family.
-Cardiogenic pulmonary edema Group 2
- edema - Left-sided Heart Disease which may involve
- pleural effusions the aortic valve, mitral valve, and/or the left
- enlarged heart ventricle.
Noncardiogenic pulmonary edema Group 3
- edema is patchy and peripheral - a disease such as COPD, pulmonary fibrosis,
- with ground-glass opacities and and obstructive sleep apnea
consolidations. Group 4
- Chronic blood clots and clotting disorders
Nursing Interventions Group 5
1. Elevate the head of the bed or place the - may be caused by other disorders such as
patient on their side. For optimal breathing tumors and blood disorders.
and to avoid obstruction from secretions
2. Apply oxygen to maintain oxygen Diagnostic Procedure
saturation. Vital signs
– a loud pulmonic 2nd heart sound upon Diuretics
auscultation, – to reduce excess fluid in the body through
which is usually a murmur or a gallop urination, thereby
- tachycardia decreasing cardiac workload
Blood tests Surgery.
– B-type Natriuretic Peptide (BNP) Atrial septostomy
- Basic Metabolic Panel (BMP) – an open-heart surgery wherein an opening
- Complete Metabolic Panel (CMP) between the two
- Liver Function Tests (LFTs) atria of the heart is created, effectively
Electrocardiogram (ECG) relieving the pressure in
– to check for any irregularity in heartbeat the right ventricle of the heart
are all useful in Treatment
diagnosing pulmonary Transplantation
hypertension – this can be a lung or a heart-and-lung organ
Diagnostic Procedure transplant that
Echocardiogram are done for people with idiopathic PAH.
– utilizes sound waves to create images of the Lifestyle changes.
heart - A low cholesterol, low fat diet to control
Cardiac catheterization (right-sided) and cholesterol and
angiogram triglyceride levels is needed for a patient with
– to directly measure the pressure in the right pulmonary
ventricle and the hypertension.
pulmonary arteries - Weight management, reduced alcohol
Cardiac CT scan / MRI intake, and smoking
Pulmonary function test cessation are also important lifestyle changes.
-a non-invasive test using a spirometer to - Increased physical activity by doing at least
measure how much 150 minutes of
air the lungs can hold moderate aerobic exercises will help promote
Genetic test an active
– if there is a suspected hereditary or genetic lifestyle.
involvement COR PULMONALE
Treatment -the structure and function of the right
Vasodilators ventricle are
– to relax the blood vessels, thereby opening compromised by chronic obstructive
the narrowed blood pulmonary disease (COPD),
vessels and improve blood flow obstruction of the airflow into and out of the
Guanylate cyclase (GSC) stimulators lungs.
– to increase the level of nitric oxide which The heart tries to compensate, resulting in
can relax the right-sided heart
pulmonary arteries, thereby decreasing the failure.
pressure in them
Endothelin receptor antagonists COR PULMONALE
– to stop the endothelin from narrowing the The patient has heart failure
arterial walls - due to a primary lung disorder, which causes
Calcium channel blockers pulmonary hypertension and enlargement of
– to relax the muscles in the arterial walls the right
Digoxin ventricle.
– to help the heart pump more blood and - Patients will have symptoms of both the
treat arrythmias underlying
Treatment pulmonary disorder and the right-sided heart
Anticoagulants (usually warfarin) failure. COPD
– to reduce the formation of blood clots in the S/Sx
pulmonary Cyanosis
arteries Fatigue
-due to hypoxia and heart failure Oxygen therapy at 2 liters/minute (low flow
Wheezing rate)
- due to underlying lung condition such as - to help meet body's needs. The COPD
COPD or emphysema patient cannot
Dyspnea on exertion and when lying down tolerate a high flow of oxygen.
(orthopnea) Administer calcium channel blockers
- due to increased oxygen needs with - to vasodilate
movement and increased = diltiazem, nifedipine, nicardipine,
respiratory effort of the diaphragm when amlodipine
lying down Administer medications to vasodilate the
Productive cough pulmonary artery
- due to underlying respiratory condition . = diazoxide, hydralazine, nitroprusside
S/Sx Administer angiotensin-converting enzyme
Productive cough inhibitor
- due to underlying respiratory condition . = captopril, enalapril
Edema Treatment
- due to right-sided failure Administer anticoagulant
- fluid build-up will be in dependent areas - to reduce risk of clot formation
Weight gain = heparin
- due to fluid retention Administer diuretic
Respiration greater than 20 breaths per - to remove excess fluid
minute (tachypnea) = furosemide, bumetanide
- rate increases to meet body's oxygen needs Administer cardiac glycoside
Increased heart rate above 100 beats per - for symptom relief of heart failure:
minute (tachycardia) = digoxin
- as the body attempts to compensate for Reduce sodium in the diet
hypoxia and carry - to reduce fluid retention.
more oxygen Reduce fluid intake
Diagnostic Procedure - to reduce fluid retention.
Enlarged pulmonary arteries and right Nursing Intervention
ventricle shown on a Limit fluid to 2 liters per day.
chest x-ray. Monitor digoxin level to avoid toxic effect.
Enlarged right ventricle shown on Check pulse before administering cardiac
echocardiography as a glycoside.
result of pulmonary hypertension. - A side effect of the drug is slowing of the
Increased right ventricular and pulmonary heart rate.
artery pressures - Hold medication and contact the physician
in a pulmonary artery catheterization. as needed.
The right ventricle is pumping against greater- Monitor serum potassium levels
than- normal - ACE inhibitors and some diuretics can cause
resistance within the pulmonary artery when potassium retention.
sending blood Monitor respiratory status for rate, effort, use
to the lungs. of accessory muscle,
Diagnostic Procedure skin color, and breath sounds.
Decreased oxygen and increased carbon Explain to the patient:
dioxide in arterial = How to administer oxygen therapy.
blood gas = Medication management.
- due to underlying lung disease.
Pulse oximetry shows decreased oxygen
saturation.
Increased hemoglobin to compensate for
hypoxia.
Treatment
Bedrest or decreased activity.